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The gut and brain communicate bidirectionally through the gut–brain axis, immune signaling, hormonal pathways, and the vagus nerve. Disruption in gut function is common in individuals with substance use disorders due to:

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• Chronic stress and nervous system dysregulation

• Medication effects (antibiotics, PPIs, psychotropics)

• Irregular eating patterns and nutrient depletion

• Inflammation and microbiome disruption

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These factors can contribute to symptoms often attributed solely to psychological causes, including anxiety, depression, cravings, fatigue, and emotional dysregulation.

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