According to the ICD-11 (World Health Organization, 2019), substance use disorders include disorders that result from a single occasion or repeated use of substances (both legal and illegal) that have psychoactive properties; all drugs that are taken in excess have in common direct activation of the brain reward system, which is involved in the reinforcement of behaviours and the production of memories. They produce such an intense activation of the reward system that normal activities may be neglected. Instead of achieving reward system activation through adaptive behaviours, drugs of abuse directly activate the reward pathways. The pharmacological mechanisms by which each class of drugs produces reward are different, but the drugs typically activate the system and produce feelings of pleasure, often referred to as a ‘high’ (American Psychiatric Association, 2013). This chapter will cover all substance use in people with intellectual disability, whether it is a problem, and alternative treatments.

Substance use among lawyers is a common way to self-medicate stress, anxiety, and depression and to fuel overwork. To facilitate an understanding of how substances of abuse work in the brain, it is helpful to grasp the basics of neurotransmission. Information travels through the brain via chains of neurons. This information is an electrical impulse while in the brain cell, but to travel across the gap between neurons, the information uses chemicals called neurotransmitters. The site of action for self-medicating substances is at that gap, which is called a synapse. Different substances cause various changes in the brain by influencing the synapses of those lawyers who use them. These drugs are divided by substances that stimulate and can fuel overwork (caffeine, nicotine, amphetamine, cocaine) and sedatives that can calm stress and anxiety (alcohol, cannabis, opioids). Some lawyers use prescribed antidepressant medications. All of them impact the brain at the gap between brain cells, the synapse, where communication involves neurotransmitters and their receptors.

substances other than alcohol (see Chapter 8). The purpose is to introduce the reader to the wide variety of substances that are abused by explaining why people may use them, why the use can be harmful and broadly how this is managed. Liaison psychiatry is the bridge between inpatient care and community care and this complex relationship is demonstrated herein when discussing the management of these cases that require the input of a variety of clinicians. The substances detailed are further subdivided to cover background information, acute intoxication, toxicity, withdrawal states and other management advice. ‘Top tips’ are included where appropriate, which are practical considerations to make based on day-to-day experience working in the field.

This opinion held that a viable fetus was a “child” under the state’s criminal child endangerment statute. The defendant was accused of using illegal drugs during her pregnancy and the South Carolina Supreme Court held that her alleged drug use could serve as the basis for a child endangerment charge. This opinion is cited as severely eroding the reproductive rights and bodily autonomy of women.

Latin Americans can feel insecure for many different and overlapping reasons. U.S. and Latin American leaders don’t always agree on what these are, what causes them, and what should be done about them. Given all the previous chapters, this shouldn’t surprise us. In 2021, the Office of the Director of National Intelligence pointed to threats stemming from economic crisis (exacerbated by Covid-19), crime, narcotics trafficking, corruption, and Venezuela. It also noted the threatening presence of China and Russia. Latin American leaders show widely varying degrees of agreement about these. This chapter highlights U.S. policy dealing with insecurity and Latin American divergence from it. The dynamics of the economy, as well as extrahemispheric actors, are already addressed in other chapters. That leaves a focus on crime, drug trafficking, and corruption, but also considered is climate change, which the Organization of American States keeps front and center.

Cerebrovascular disorders, contribute to the morbidity and disability associated with illicit drug use, which may be the most common predisposing condition for stroke among patients under 35 years of age. We present the case of young man with multiple illicit drug addiction and no other vascular risk factors, who presented with acute ischemic stroke and complex cardiovascular etiopathogenic mechanism. We summarize stroke mechanisms by illicit drug and stroke type and suggestion for the management of these challenging cases

Drugs and addiction are relevant to the present study: (1) by analogy with drug-taking, the term ‘addiction’ can be applied to serial killing even where drugs are not involved and (2) drugs play an important role in the lives of some serial lust killers. The discussion first turns to two killers where the term ‘addiction’ has been applied but where it appears that drugs were not used. It then looks at two examples of drug-associated killing. Serial lust killer Michael Ross described feeling assailed by intrusive thoughts urging the rape and murder of women. He published an account of his experience in an academic journal concerned with addiction. Joel Rifkin was adopted and seriously bullied by his peers. He described his sexual behaviour as addictive and gave evidence of ambivalence in his killings. Anthony Sowell appears to have been influenced in his sexual addiction by extensive use of crack cocaine.

This chapter begins with an analysis of the Colombian state’s efforts to transform the Caguán frontier region of Caquetá into a site of land colonization, settlement, and agrarian development in the 1960s. It demonstrates that these state-directed agrarian development initiatives lacked the political and economic support of Colombian elites, which resulted in the transformation of the region into a site of large-scale cattle ranching under the despotic rule of Colombia’s cattle rancher association, Fedegán. It then shows how the movement of the FARC guerrillas into the region, followed by their involvement in taxing and regulating the region’s emerging coca economy, helped generated a counter-hegemonic coca-producing labor regime that was effective in protecting local migrants from the displacement and marginalization they had experienced under the auspices of Fedegán. It ends with a discussion of the similarities and differences between the FARC’s counter-hegemonic regulatory interventions in the coca regime with Fedecafé’s hegemonic interventions in the coffee regime.

This chapter begins by analyzing how the adoption of neoliberal agrarian policies in the 1990s intensified land struggles in the region by generating new waves of displaced migrants who became incorporated into the coca economy of the FARC while also transforming the cattle industry from a domestic meat and hide supplier into an exporter of dairy products for the world market.It shows how FARC control of the region remained strong until the late 1990s and early 2000s, when the region became a geographic focal point of the state’s new neoliberal development strategies. I then demonstrate how and why previous efforts to dislodge the guerrilla threat through US-backed Cold War containment strategies failed, but that the balance of power shifted to the Colombian military in the late 1990s and early 2000s, following a massive influx of US military aid that was appropriated under the aegis of the US War on Drugs and War on Terror.I conclude this chapter with a discussion of the future economic prospects of the region’s cocalero farmers and workers in the absence of FARC protection or a developmental alternative to capitalist accumulation through dispossession.

This introduces the topic of multilateral drug control, its contemporary relevance and the areas under examination within the book. It highlights the key themes grouped by three overarching focuses: historical, contemporary-legal and international relations theory. It examines the major debates under way in UN drug control and their direct relation to the historical-legal regulatory discussion encapsulated within the book. It outline existing historiography on international drug control and examines more recent developments. It points to continuing gaps in historiography, international relations, legal and policy literature which this book will fill. In particular it highlights the extensive literature on international legal fragmentation and its relevance for drug control debates. It offers an overview of regime theory and international relations approaches, suggesting a new and emerging framework based on evaluating drug control as a ‘regime complex’ in a similar lineage to climate change and intellectual property regimes, which will be covered in a more breadth in the Conclusion.

This chapter examines the legal legal of the Single Convention and its successor treaties. The passage of the Single Convention represented a high-water mark in the international regulatory system. While it contained little in terms of innovation, it streamlined the complex array of drug treaties, while moving the terrain of control forward marginally. It essentially solidified an economic regulatory framework for a global licit commodity market in certain essential medicines. To enforce this market it mandated certain action around controlling and prohibiting non-medical production and manufacturing. Key questions around dealing with ‘addiction’ and suppressing non-medical consumption were left largely unanswered. The US may have lost the battle around the Single Convention and control of the system in the 1960s but they would enter the 1970s ready to refight many of these battles, beginning with the declaration of the ‘war of drugs’ and an aggressive new round of bilateral drug diplomacy. Ultimately the ‘war on drugs’ was not an inevitable outgrowth of these documents, but instead represented a specific set of interpretations, bureaucratic and normative trajectories and member state implementations.

This chapter argues that whereas much of the past century was geared towards a legal and institutional homogenisation of international drug control, the coming decades appear underpinned by recourse to ‘policy pluralism’ as a mechanism to enable policy evolution. It is precisely these endogenous processes of pluralism, devolution and increasing diversity of global drug policies that provide the most promising avenues for various actors to influence policies at local, national, regional and international levels. It further argues that the international drug control system is undergoing a long-term process of fragmentation and evolution towards what international relations scholars in other spheres would term a ‘regime complex’. It concludes by suggesting that these endogenous regime changes likely provide the greatest opportunity to draw exogenous actors and regimes into the system’s orbit and thereby modernise and adapt drug policies to new global realities.