Consistent with results of previous needs assessments for urban American Indian and Alaska Native populations, a needs assessment in the Portland, Oregon metropolitan area for the Native American Rehabilitation Association Northwest revealed high levels of co-occurring conditions for American Indian and Alaska Native clients, often combining chronic health problems, substance abuse histories, and mental health diagnoses. Focus group results suggest the need for crisis care as well as specific needs of children and families, veterans, elders, and adults. (Contains 5 tables.)