Cocaine is a major problem in the rural South, but knowledge is limited regarding the impact on African American populations. Purpose: This study of 18-39-year-old black drug users assessed perceptions of contributing factors to drug use and possible interventions. The study design was qualitative-descriptive, utilizing 4 focus groups with 5 rural women and 14 small-city residents. Some respondents perceived that drug use initiation and continuation were due to themes of (1) loss, (2) peer pressure, (3) personal problems and dealing with pain, (4) desire for fun or to "feel good," and (5) drugs and drug-related messages within their environments. Common themes of effective strategies to stop drug use were (1) the necessity of wanting to quit, (2) the importance of help or support from family and friends, and (3) the need for resources, such as a job, car, and housing. Some respondents agreed on 3 human resources: (1) family, (2) ex-users, and (3) churches. Strategies to increase attendance at drug prevention programs included (1) making the program fun/enjoyable, (2) having mixed gender programs, (3) providing food/money, and (4) having the programs in their community. Recurrent themes were the lack of drug prevention intervention programs available to respondents and the failure of traditional programs of the majority culture to adequately meet their needs. Effective drug prevention programs for southern African Americans who use cocaine must be community based, personalized, and culturally relevant.