This study examines the diagnoses and treatment received by a cohort (N = 22,678) of late-middle-aged and older substance abuse patients. More than 23% of substance abuse inpatients admitted to Department of Veterans Affairs (VA) Medical Centers in fiscal year 1987 were 55 years of age or older. Most of these patients had multiple health problems. More than 90% had an alcohol-related diagnosis; almost 30% were diagnosed with a psychiatric disorder; and more than 80% had a medical disorder. Compared with their younger counterparts, older substance abuse patients were less likely to receive specialized inpatient or outpatient treatment specifically directed toward their substance abuse or psychiatric problems. In general, older substance abuse patients received services oriented more toward medical management than toward rehabilitative substance abuse or psychiatric care. These findings imply a need to develop treatment programs tailored to the characteristics and substance abuse problems of older patients, and to encourage more use of specialized outpatient aftercare services by these individuals.