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

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.

Keywords: Addiction Psychiatry; Medication-Assisted Treatment; Substance Use Disorder.

FIGURE 1.. Pathways by which treatment can shift the balance away from substance use^a

^aCraving, intoxication, withdrawal, and stress play a prominent role in driving habitual drug use in substance use disorder—addressing these factors with treatment (pharmacology and/or psychotherapy) can shift the balance toward recovery. Treatments that leverage neuroplasticity (ketamine, psilocybin, and transcranial magnetic stimulation) could also restore the balance between the striatum and the prefrontal cortex, increasing the ability to enact change. (Figure created in BioRender.com.)