Substance use disorders are described in the light of a physiopathological framework, in which great importance is recognized to the subjective meaning given to the substance of use, and in which socio-cultural factors as well exert influences. A treatment approach derived from this model is proposed in a critical way, focused on key factors such as agency, control and awareness; a viable declination of these factors in an ericksonian perspective is offered. In order to exemplify the theoretical concepts, a clinical case is presented.