Pharmacological Treatment of Substance Use Disorders

Substance use disorders (SUDs) represent a significant public health challenge, with morbidity and mortality from overdoses and other use-related causes increasing substantially during the COVID-19 pandemic. Thus, a working knowledge of treatment of substance use disorders is prudent for any psychiatrist. The United States Food and Drug Administration (FDA) has approved medications for the treatment of opioid, alcohol, and tobacco use disorders; however, evidence-based pharmacotherapy exists for many of the major classes of substances. This chapter will detail mechanistic approaches to the treatment of SUDs, evidence for the use of pharmacotherapy for the treatment of SUDs including efficacy and safety, and important clinical caveats including optimal management of SUDs and co-occurring psychiatric disorders. Important nuances regarding the treatment of withdrawal, relapse prevention, harm reduction, and how different medications may be appropriate for a given purpose will be described. Additionally, avenues for medication development will be discussed, suggesting ways in which pharmacotherapy for SUDs can be improved.