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As an addiction specialist, it is refreshing to see physicians from other specialties directing attention to substance related disorders. These disorders are very commonly missed or are misunderstood by physicians who have not had extensive training or experience in their assessment. As he suggests, these disorders, especially alcohol dependence, can have consequences that are most severe when their existence is not known or suspected during the course of medical treatment. Dr. Crippen's discussion of neuronal hyperexcitability and delirium tremens is concise and clear, so it will be a pleasure to read future installments from him on alcohol related emergencies. St. Francis has always had a leadership role of in the assessment and treatment of substance related disorders so it is most appropriate that the SFJM is devoting space to these important illnesses.