Judge McGinnis will describe how changes commonly found in the brain of people struggling with substance misuse and trauma may lead to unexpected behaviors. This will help justice stakeholders better understand why sometimes justice-involved people respond in frustrating ways to services and court requirements. The judge will explain the mechanisms of different substances of abuse and medicine for opioid use disorder. The audience will learn from a judge’s perspective how MOUD enhances outcomes and saves lives. The presentation will help multidisciplinary team members understand why many participants may repeatedly return to use; use other substances while on MOUD; and respond to treatment and case management with frustrating behaviors.