The spectrum of substance use disorders (SUDs) is characterized by increasing degrees of craving, compulsive use, loss of control, and continued use despite harm (see Fast Fact# 68). Addiction is understood to be a disease with complex genetic, neurobiological, psychosocial, and behavioral determinants. If not effectively managed an SUD can:(1) complicate the diagnosis and treatment of psychological (eg, depression) and physical (eg, pain) symptoms;(2) compromise adherence with the palliative treatment plan;(3) impair a stressed social support network;(4) weaken trust in patientphysician/nurse relationships; and (5) promote ‘‘chemical coping’’strategies during periods of stress and decision making.

The prevalence of SUDs in palliative care is unknown, but likely reflects that of the general population, in which alcoholism and abuse of prescription and non-prescription drugs are common. Bruera reported a prevalence of alcoholism of 27% in patients admitted to a tertiary care palliative medicine unit. Far from being a source of pleasure, SUDs are more commonly a source of suffering for affected individuals and their loved ones. Addressing SUD may allow for:(1) preservation/restoration of damaged social supports;(2) restoration of self-respect and dignity;(3) accomplishment of end-of-life work through recovery; and (4) improvement in quality of life for patients and families.