Data indicate that alcohol and substance abuse problems are common in the elderly but are largely ignored by clinicians. As the United States and the world experience dramatic and unprecedented increases in the number of individuals over the age of 65, health care providers will be responsible for the complex issues facing this population and their families. This paper presentation will provide information on (1) alcohol and substance abuse issues unique to elderly persons, (2) screening and detection of alcohol problems among the elderly, (3) obstacles to identification and intervention of alcohol and substance abuse problems, and (4) suggestions for working with elderly persons who have an alcohol or substance abuse problem.  All clinicians working with elderly adults should have a comprehensive working knowledge of the physical, emotional, and social problems associated with alcohol use, abuse, substance dependence in relation to older adults and the aging process. This must include familiarity with current knowledge concerning medication misuse and alcohol/medication interactions. It is important that clinicians must be able to discern symptoms of physical, cognitive, mental health, or social problems from symptoms of alcohol use disorders, and to recognize how these disorders and symptoms may interact. Many signs and symptoms among the elder adult are complex, subtle, and easily confused with the normal aging process: proper differential diagnosis is essential to creating relevant and effective treatment plans.