Substance use disorders (SUD) include substance abuse and dependence as well as acute intoxication, withdrawal, and various psychiatric disorders. In the course of the SUD, severe comorbid disorders and somatic consequences can occur. The treatment of withdrawal symptoms focuses on the relief of immediate symptoms and the prevention of complications. The treatment of SUDs should achieve long-term abstinence with relapse prevention or harm reduction using maintenance treatment strategies. Beside psychosocial interventions, the pharmacotherapy has become an important factor for the treatment of SUDs and withdrawal syndromes. This review reports evidence-based pharmacologic treatment strategies of the most frequent SUDs according to current guidelines for SUDs. In the pharmacological treatment of alcohol dependence long-lasting benzodiazepines or clomethiazole for alcohol withdrawal, and acamprosate or naltrexone for relapse prevention are preferable. There exists no effective relapse prevention for cannabis dependence. During cocaine withdrawal tricyclic antidepressants demonstrated the highest efficacy. For cocaine dependence no medication can be recommended, so far. However, mood stabilizers such as topiramate and tiagabine or disulfirame were found to be efficacious in preliminary studies. There is consistent evidence for methylphenidate in treating cocaine dependence co-occurring with attention-deficit/hyperactivity disorder. For opioid dependence, methadone or buphrenorphine treatment is the pharmacotherapy of first choice. Nicotine replacement therapy, Bupropion and Vareniclin are efficacious in smoking cessation.