Screening for alcohol and substance misuse is necessary to detect the complicated and highly risky behavior of addiction in the elderly population. The guidelines to identify, screen, assess, and treat an elderly person struggling with addiction must address the complex presentations that occur with aging. Co-morbid conditions, such as depression and anxiety, increase the vulnerability of misuse as well as misdiagnosis. Additionally, heavy drinking can worsen health conditions, such as diabetes, high blood pressure, congestive heart failure, liver problems, osteoporosis, impaired motor functioning and fall risks, and neurological/degenerative cognitive disorders. Both alcohol and substance misuse can cause significant and severe interactions with existing medication regimens that include: aspirin, acetaminophen, cold and allergy medicine, cough syrup, sleeping pills, pain medication, and anxiety or depression medicine. Unfortunately, detection of misuse does not occur at an early stage of misuse, but more often at critical and acute stages of medical interventions. Hospitalized adults over the age of 40 with a diagnosis of alcoholism have an estimated cost of $60 billion per year.