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Almost all types of movement disorders can be caused or exacerbated by substance abuse. Abnormal movements are especially common with alcohol, and the number of reported cases related to cocaine, amphetamine, and heroin abuse continues to rise and diversify. These movements can present acutely or insidiously and occur during intoxicated and withdrawal states due to structural or metabolic abnormalities. Most of these disorders are extrapyramidal in nature and are attributed to altered dopaminergic neurotransmission in the basal ganglia or their connections. Neurologic dysfunction is usually reversible but may persist or even progress with repeated exposure. Treatment should be individualized and centered on drug rehabilitation. Substance abuse should be considered as an important trigger of abnormal movements, especially if there is sudden onset or acute exacerbation.