person uses a substance and experiencesuephoria, perhaps decrease pain sensitivity, sedation or feeling energized depending on the substance and often lowered inhibition. those are by-products of intoxication. if we look at the next slide, the opposite effect is tolerance. so when a person comes up they come down and the flip side of euphoria is perhaps hang over and consequence. behaving in ways we didn't intend or contrary to our values or obligations. in fact withdraw. the absence of that with this teeter todder back and forth repeatedly what begins to happen is the person experiences reduced pleasure over time, and the amount of dysphoric or an hedonic consequence is greater and duration longer. eventually a person is using substances not to experience euphoria but just to feel normal. substance use disorder is disrupt decision making and we can see substance use disorder emerge across the 3 domains you see in this-call a stair step table. beginning with binge and intoxication. over time drug use individuals begin to learn the effect. begin to anticipate the effect. absence of that