Substance use is increasing with the baby boomer generation, particularly alcohol, and alcohol use disorders (AUD). These are linked to depression, anxiety, dementia and a higher death rate in older adults. While older adults are twice as likely to engage in integrated primary care models for at-risk drinking than referral services, these programs are rarely available. Illicit drug use among baby boomers aged 50-59 doubled from 2002-2007, with 90% reporting a lifelong history of use. Further, from 2002 to 2014, the rate of older adult opioid misuse doubled. Given age-related changes in metabolism, any amount of alcohol or drugs may effect older adults adversely. Unfortunately, many providers are often uncomfortable addressing substance use among their older patients, which can lead to overlooking the underlying cause of physical health and cognitive problems.