This article identifies factors that participants in a study based in an Australian regional centre believed to be critical to understanding and responding to crystal methamphetamine (ice) use among Aboriginal people.The study entailed a participatory methodology involving a university and an Aboriginal community controlled organisation. Semi-structured interviews conducted with ice users (n = 14), family members (n = 6) and workers (n = 6) were analysed thematically.Interviewees believed that historical trauma, contemporary disadvantage and racism cohere to produce a market for ice and other drugs within Aboriginal communities. Intense shame prevented some ice users and their families from seeking help, while fear about ice use was exacerbated when suppliers of ice threatened violence. Disconnection from family and community further intensified a sense of isolation and despair. By contrast, family reintegration provided ice users in the study with the strongest motivation for change.Although drawing only on a small sample of participants, the study suggests that Aboriginal people's experiences of ice use may have some distinct characteristics, meaning that tailored responses are required. Interventions should address the shame and ameliorate the fear that surround problematic ice use for families and users, provide help to those who feel trapped because of drug debts and relationships with dealers, and support families to maintain contact with ice users where this is manageable. Supports for users to remain connected to family and community are also critical. The effectiveness of family wellbeing interventions as adjuncts to treatment could be evaluated. [MacLean S, Hengsen R, Stephens R Critical considerations in responding to crystal methamphetamine use in Australian Aboriginal communities Drug Alcohol Rev 2017;36:502-508].