Substance use disorders (SUDs) are a significant cause of morbidity and mortality in the United States. In spite of the significant public health impacts of SUDs, medications approved by the US Food and Drug Administration (FDA) are underutilized for the treatment of SUDs. This chapter reviews the history of FDA-approved medications for alcohol, nicotine, and opioid use disorders and provides some background on barriers to use of these medications to treat patients with SUDs. Suggestions are provided to guide clinicians on a path forward to reduce these barriers and increase the use of FDA-approved medications for the treatment of SUDs.