This report follows an extensive survey of primary care physicians (N=400) about the problem of substance abuse in women over the age of 59. Research has shown that an individual who reaches the age of 21 without smoking, using drugs, or abusing alcohol is virtually never at risk to abuse these substances. The only exception occurs with mature women, especially those who suffer the loss of a child or spouse, have financial difficulties, or experience loneliness. Only one percent of the physicians in this survey ever even considered a substance abuse diagnosis when presented with the typical early symptoms of alcohol and prescription drug abuse in these women. As gatekeepers of their care, physicians need to assume a key role in detecting early signs of trouble. There is strong evidence that brief physician interventions can improve medication compliance, improve smoking cessation rates, and reduce risky drinking. Medical schools and Continuing Education Programs need to provide physicians with the information about recognizing early signs of substance abuse. The problem can be directly addressed by training physicians who then in turn train their patients about the dangers and risks of alcohol and substance abuse. Suggestions are presented for policymakers and future research. (Contains 6 appendixes, 10 tables, and 538 references.) (JDM)