The Neurocircuitry of Substance Use Disorder, Treatment, and Change: A Resource for Clinical Psychiatrists

Substance use disorder is common among psychiatric patients and often goes untreated, negatively affecting health. This review provides a neuroscience-based framework for psychiatrists to address SUD. It describes how pharmacotherapy can target craving, intoxication, and withdrawal to interrupt the substance use cycle. The neuroscience of stress is reviewed, including medications that act on neurotransmitter systems involved in alarm and fear. Treatments that promote neuroplasticity, such as ketamine, psilocybin, and transcranial magnetic stimulation, are discussed. The review concludes with resources and practice guidelines for physicians.

Study at a glance

Abstract

Substance use disorder (SUD) is common in psychiatric patients and has a negative impact on health and well-being. However, SUD often goes untreated, and there is a need for psychiatrists, of all specialties, to address this pervasive clinical problem. In this review, the authors' goal is to provide a resource that describes treatments for SUD, using neuroscience as a framework. They discuss the effect of pharmacotherapy on craving, intoxication, and withdrawal and its ability to interrupt the cycle of substance use in SUD. The neuroscience of stress is reviewed, including medications targeting neurotransmitter systems activated by alarm and fear. Neuroplasticity and promising treatments that use this mechanism, including ketamine, psilocybin, and transcranial magnetic stimulation (TMS), are discussed. The authors conclude by listing resources and practice guidelines for physicians interested in learning more about treatments for SUD.