Background: There is a need for a culturally adapted curriculum within peer support services that addresses mental health and substance abuse issues specific to the American Indian/Alaska Native (AI/AN) population. Method: Nine Tribal Elders from eight tribes were interviewed using semi-structured interviews. Tribal representation spanned the contiguous US. Tribal Elders were selected via a nonprobability convenience sampling using recommendations from tribal members, tribal leaders and tribal officials and were identified for their knowledge of their tribal culture, history, and practices. Data was analyzed using content analysis focusing on subcategories which emerged within the data based on the identified theoretical framework. The subcategories were then grouped into categories. Categories were then grouped into larger themes to frame related categories and organize information in a coherent framework. Results: Four themes were derived from twelve categories identified by participant interviews. The theme of attributes of peer providers encompasses shared background and experience of the role as well as communication and engagement skills of the peer provider. The theme tribal community contains the categories of tribal identity, tribal history and organization, tribal social norms and traditional knowledge and practices. The theme knowledge focuses on confidentiality, barriers, and mental health-related issues whereas the theme practice encompasses engagement as one community, traditional practitioner, and cultural rejuvenation. Conclusion: The goal of the study was to develop a culturally adapted peer support curriculum for AI/AN people in mental health and substance use services. The goal of the curriculum is to use cultural knowledge and practices to provide a curriculum responsive to the unique needs of AI/AN people. The objectives focus on culture as related to peer support services with the outcome based on the results of the study.