Not only is the number of older people in our society is increasing, but their use of substances is rising. All substances should be considered (i.e. alcohol, tobacco, polypharmacy, illicit drugs, over-the-counter medication, substances obtained over the internet, and misuse of prescription drugs). Associated mental health and physical health difficulties need to be viewed in light of the combination of substances and interactions with clinical conditions. The service delivery system is unprepared partly due to an invisible epidemic fuelled by numerous factors including ageism, denial, stereotypes, and non-specific symptoms. A thorough ongoing routine assessment of substance use is the keystone of a treatment management plan. Older people willing to be engaged in a multidisciplinary team treatment do have capacity to change, and outcomes are at least was positive as their young adult counterpart. There are gaps about treatment prevalence, the facilitators and barriers to treatment, including comorbid conditions.