Substance use disorders are among the most prevalent and emergent public health problems in India. The treatment of individuals with these disorders is associated with many ethical dilemmas. Due to the pervasiveness of substance use disorders, the majority of mental health professionals working in the area of addiction medicine face several ethical dilemmas. When discussing substance use disorders, it must be borne in mind that there are important differences between India and the western countries in terms of the social and cultural aspects, as well as the legislative framework and healthcare delivery system. In this paper, we discuss the common ethical dilemmas that practitioners of addiction medicine face when dealing with patients with substance use disorders. We use the principlist approach defined by the four ethics principles – autonomy, beneficence, nonmaleficence and justice – to deliberate upon these dilemmas and how they may be resolved. Further, we emphasise the need to sensitise practitioners to the importance of giving due consideration to the ethical aspects in their clinical work.