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being able to communicate with you and exchange ideas today is really a privilege maybe unfortunately for you what Iamp;#39;m going to try to do today is make you anxious and maybe even a little angry but I hope is it it is for a good cause the reason I want to make you anxious and and I agree is because I want you to make you uncomfortable so that you want to to lead change so hopefully I will make you a little bit anxious but not as anxious that you will get immoralized and you donamp;#39;t want to to make any changes but rather that you get inspired to lead the change forward so Iamp;#39;m going to divide my talk in in two parts one is what do we know and then the second part so not surprisingly what will be what is that we need to know so we already know a format of things we know that treatment is not enough we know a fair amount about risk factors for substance use disorders we know a fair amount also about the course of disorders and we have some knowledge about intervention