This chapter explores the complex interaction between executive functions, especially decision-making, and substance use such as alcohol and other drugs. It analyzes how the prefrontal cortex, in conjunction with the basal ganglia, coordinates the selection of adaptive behaviors through specific neural pathways, directly influencing the ability to assess risks and rewards. Studies highlight that dysfunctions in this system are associated with risky choices, exacerbated by the use of substances that alter cognitive and motivational processing. In conclusion, decision-making in the context of substance use is crucial for understanding the mechanisms underlying the transition from controlled use to harmful use. A better understanding of this process is essential for developing effective assessment and intervention strategies for individuals with alcohol and other substance use disorders, aiming to improve clinical outcomes and reduce the negative impact on public health.