Imaging Biomarkers in SUD explores what brain imaging really adds to the care of substance use disorders—what is robust, what is promising, and where caution is warranted. This page translates neuroscience into clinical prudence. We summarize consistent MRI/PET findings in reward, control, and salience networks; clarify when imaging may stratify risk or predict response; and map those insights to levers you already use—CBT/MI, contingency management, sleep/circadian repair, exercise, and medications that reduce craving or improve control. If you’re comparing approaches at a SUD imaging conference, you’ll find practical guidance on endpoints that matter (function, retention, safety), consent and privacy language for clinical/research settings, and ways to combine imaging with digital phenotyping and registries so results travel beyond the scanner. The throughline: imaging should inform care, not replace it.

Translation requires humility and equity. We outline when no-scan strategies are the right choice—using behavioral proxies like sustained attention tasks, craving diaries, and sleep metrics to track the same circuits—so services without access aren’t left behind. Where neuromodulation (TMS/ECT) is considered, we connect symptom profiles to plausible targets and emphasize sleep timing to support plasticity. We discuss avoiding therapeutic misconception, handling incidental findings, and ensuring diverse participation in research so markers generalize. Finally, we show how to communicate results in plain language to patients and teams—“what this means for your plan”—and how to iterate with learning health systems that pair imaging, phenotypes, and outcomes over time. Use imaging like any tool in medicine: for the right question, at the right time, with the right expectations.