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Module 1: What are Substance Use Disorders?

Presented by

Sanchit Maruti, MD, MS
University of Vermont Medical Center

Dr. Sanchit Maruti MD, MS is an Attending and Assistant Professor in Psychiatry at the University of Vermont College Of Medicine. He also holds a joint clinical appointment as an Attending in Psychiatry at the Massachusetts General Hospital. He completed his medical school and residency training at the University of Vermont College of Medicine and his fellowship in addiction psychiatry at the Harvard combined program. Prior to his medical training he worked for 7 years in Biotech and health care consulting in the areas of genetic epidemiology, program management and strategy. He serves as the Area 1 Vermont representative for AAAP.

This module provides an overview of how to diagnose a substance use disorder, with a discussion of the neurobiology of addiction.

At the end of this module, participants should be able to:

  • Describe major features of substance use disorders and explain how a substance use disorder is identified.
  • Identify factors that predispose an individual to becoming addicted.
  • Explain the roles of positive and negative reinforcement in substance use disorders.
  • Compare recovery from addictions to other chronic medical conditions.


  1. How clinicians define substances use disorders, various levels of the spectrum, and the differences between physical dependence and a substance use disorder.
    1. What to Do If You Have a Problem with Drugs: For Adults
    2. How Drugs Can Kill
    3. Genes and Addiction
    4. Mental Illness: The Challenge of Dual Diagnosis
    5. Environmental Risk Factors
    6. Easy to Read Drug Facts
    7. Prescription Painkiller Sales and Deaths
  2. The neurobiology of addiction
    1. The Reward Pathway Reinforces Behavior
    2. Social Environment Impacts the Reward Pathway
    3. Drugs, Brains, and Behavior: The Science of Addiction
  3. References
    1. Fishbain DA, Cole B, Lewis J, et al (2008). What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Medicine 9: 444-459.
    2. Koop GF (2013). Negative reinforcement in drug addiction: the darkness within. Current Opinion in Neurobiology 23: 559-563.
    3. Martinez D, Saccone PA, Fei L, et al (2012). Deficits in dopamine D2 receptors and presynaptic dopamine in heroin dependence: commonalities and differences with other types of addiction. Biological Psychiatry 71: 192-198.
    4. O’Brien CP and McLellan AT (1996). Myths about the treatment of addiction. Lancet 347: 237-240.
    5. Urbanoski KA and Kelly JF. Understanding genetic risk for substance use and addiction: a guide for non-geneticists. Clinical Psychology Review 32:60-70.
    6. Volkow ND, Fowler JS, and Wang G-J (1999). Imaging studies of the role of dopamine in cocaine reinforcement and addiction in humans. Journal of Psychopharmacology 13: 337-345.
    7. Wise RA and Koob GF (2014). The development and maintenance of drug addiction. Neuropsychopharmacology 39: 254-262.

Funding Language

This project was supported by Grant No. G1299ONDCP02A awarded by the Office of National Drug Control Policy, Executive Office of the President. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the Executive office of the President.