In her early years, Eva would probably have been called a "teetotaler." Except for an infrequent sip of wine on special occasions, she never drank alcoholic beverages. But after her children moved away and her husband and many of her close friends died, Eva turned to the bottle for escape and companionship. Now in her late 70s, Eva is an alcoholic. Harry has had problems with substance abuse since his late teens. Although drinking binges were often followed by periods of sobriety, he inevitably returned to his addictive ways. At 75, he is on several prescription medications, some of which should not be taken with alcohol. His children, long ago burned out from trying to persuade him to get help, have come to believe that you really can't "teach an old dog new tricks." These two composite situations illustrate what has been called one of the fastest growing health problems in this country—substance abuse among the elderly. More people are living longer and more of them are abusing drugs and alcohol in their later years. Recent census data estimates that nearly 35 million people in the United States are 65 years or older. Substance abuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double. As demographics change, attitudes about and use of alcohol and drugs change as well. "In January 2006, the leading edge of the baby-boom generation (those born during the population swell of 1946-1964) will turn 60," said Frederic Blow, professor in the Department of Psychiatry at the University of Michigan and a Huss Research Chair on Older Adults and Alcohol/Drug Problems at Hazelden's Butler Center for Research. "These individuals have had more exposure to alcohol and illegal drugs, and there is more acceptance among them about using substances to 'cure' things. We expect to see an increase in drug and alcohol use; and more use means more problems." Blow said there has also been an attitude shift regarding addiction and treatment, and that gives him hope that older substance abusers will get the help they need. "There is less shame and guilt associated with substance abuse now and more acceptance of treatment as a way to make things better," he said. According to Blow and other experts, when people age, their sensitivity to alcohol increases as their tolerance decreases. Also, the percent of their body weight composed of water decreases, and alcohol—which is water-soluble—affects them more quickly and to a greater degree. Alcohol takes longer to metabolize in older persons, accumulating in their bodies and leading to intoxication if consumption is not controlled. Because of their physical make-up, older women are more vulnerable to the negative effects of alcohol. As a whole, more older men have substance abuse problems than do older women, but women are more likely than men to start drinking heavily later in life. Substance abuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health. The fact that women are more likely to be widowed or divorced, to have experienced depression, and to have been prescribed psychoactive medications that increase the negative effects of alcohol help explain these gender differences. Unfortunately, health care providers often overlook substance abuse among older adults because they don't know what to look for or they mistakenly assume that older adults cannot be successfully treated. Loved ones, too, may excuse an older relative's substance abuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them or get "written out of the will," said Blow. Yet Blow said there is "good evidence" that older adults do as well as young people when it comes to treating substance abuse and that they may even do somewhat better. "Older adults can recognize all kinds of benefit from treatment," stressed Blow. "There are often direct health benefits, improved cognition, more independent living, more and better social connectedness, and new hobbies. The benefits are enormous."