Objectives: To identify effective treatment services for older, substance-using adults, an examination of the evidence associated with interventions for this group is presented. Methods: Using explicit, validated criteria to identify effective interventions, 22 publications were included in a review and were subject to a critical appraisal of study methodology. Results: The review identified four types of substance use treatment service settings for older adults, with mixed efficacy. These settings included: (1) primary care settings or health clinics, (2) combined individual and group-based settings, (3) individual-based treatment settings, and (4) multiple treatment/multisite settings. Conclusion: Analyses of these publications revealed primary care settings or health clinic settings offered the most evidence of effective interventions, with noticeable gaps in research on interventions within other settings. Implications for social work practice and research are discussed.