Substance abuse disorder: JS is a 27-year-old male patient who you are seeing for the first time. His past medical history is significant for his history of heroin and prescription opioid abuse. His substance use disorder started four years ago with prescription pain pills that were originally prescribed for injuries sustained in an automobile accident. For three years after the accident, he was able to readily obtain prescription opioids, but that changed when his prescribing physician was arrested for running a pill mill. JS then turned to the streets to maintain his supply of opioids. As the prescription medications became harder to come by, he turned to heroin. Two months ago he overdosed on heroin. He was admitted to a treatment facility for detoxification and treatment. During treatment he was started on Vivitrol.