Chapter 28 covers the topic of opioid use disorder. Through a case vignette with topical MCQs for consolidation of learning, readers go through the management of a patient with opioid use disorder from from first presentation to subsequent complications of the condition and its treatment. Topics covered include symptoms and diagnosis of acute intoxication and withdrawal symptoms of opioids and management including that of use in pregnant women.

Chapter 25 covers the topic of alcohol use disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the diagnosis to management of a patient with alcohol use disorder. Topics covered include symptoms and diagnosis of acute intoxication and withdrawal symptoms of alcohol use, investigations, Wernicke’s enceophaloptahy, common co-morbidity, symptoms and treatment of alcohol withdrawal, delirium tremens, pharmacological and non-pharmacological management of alcohol use disorder.

Chapter 27 covers the topic of stimulants use disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the diagnosis of a patient with stimulants use disorder on first presentation. Topics covered include symptoms and diagnosis of acute intoxication and withdrawal symptoms of stimulants use.

Chapter 26 covers the topic of cannabis use disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the diagnosis of a patient with cannabis use disorder on first presentation. Topics covered include symptoms and diagnosis of acute intoxication and withdrawal symptoms of cannabis use and amotivational syndrome.

This chapter explores legislative time limits on the prosecution of crime in civil and common law jurisdictions. It addresses the rationales for barring the prosecution of old crimes and undertakes a comparative analysis of three jurisdictional groupings: Continental Europe (with a focus on Germany and France), the Commonwealth (with a focus on England and Wales) and the United States (with a focus on federal law). The analysis identifies comparable features in limitation doctrine across jurisdictions while revealing how the theory and practice of statutes of limitation differs markedly in different legal systems. In broad terms, Continental systems codify general and categorical time limits on the prosecution of offences; Commonwealth systems tend not to have any statutory time bars on the prosecution of offences other than minor offences; and in the United States, most offences, other than the most serious, are subject to statutory limitation periods. The chapter concludes by drawing together the points of comparison between the three jurisdictional groupings, commenting on their distinctions and similarities.

The addiction syndrome is quite similar across different addictive drug types, reflecting a shared pathway of pathological changes within motivational circuits that increasingly prioritize drug acquisition and use. This neurobiology, and drug addiction symptomatology, overlaps considerably with behavioral addictions (e.g., gambling disorder). However, addiction is distinct from symptoms and mechanisms underpinning intoxication and withdrawal, which are diverse and unique to each drug class. The intoxication phase is followed by some degree of withdrawal, manifesting clinically as opposite to intoxication, reflecting a homeostatic response to it. Withdrawal has a quality, duration, and dangerousness that depends on the individual, the drug type, and drug use history. Heavy/chronic patterns of use in addiction can produce longer, more severe withdrawal phases, but addiction and withdrawal can exist separately. How a drug acts upon different receptors and other downstream brain systems (pharmacodynamics) impacts the strength of its psychoactive (intoxicating) and motivational (addictive effects). Meanwhile, the route and rate of drug intake and its breakdown and elimination (pharmacokinetics) can also impact intoxication, withdrawal, and addiction risk. With addiction, the patient becomes tolerant (insensitive) to the intoxicating profiles of drugs they like, whereas their motivation, craving, and wanting to use the drug sensitizes (grows pathologically).

International criminal law recognizes certain defences, excuses and justifications that may be raised against a charge of genocide. These include mistake of fact, duress and necessity and self-defence. The defences are codified in detailed provisions of the Rome Statute but they are also derived from case law. The Rome Statute declares that an order to commit genocide is ’manifestly unlawful’ and therefore unavaible to an accused person. A defence of ’official capacity’ is explicitly excluded by article IV of the Convention whereby offenders must be punished ’whether they are constitutionally responsible rulers, public officials or private individuals’.

• Prescription medications are highly regulated to make sure they are as safe and effective as possible.

• The last decade has seen an emerging black market for prescription medications particularly from unscrupulous online pharmacies,

• Some of the products sold illegally by these pharmacies are poor quality counterfeits

• Tobacco is the largest killer of all the psychoactive drugs, but smoking rates are now falling.

• Electronic cigarettes are safer than tobacco smoking because they only contain nicotine and none of the other harmful chemicals found in tobacco.

• The aggressive marketing of electronic cigarettes to young people has rapidly driven up their use causing concern that they will result in a new generation addicted to nicotine.

• If you don’t smoke, don’t vape!

• Young people are drinking less, but tend to binge drink when they do drink

• Reduce the many risks of alcohol intoxication but pacing drinking, avoiding drinking, understanding alcohol ‘units’ and knowing how to put a friend in the recovery position.

• There is emerging research suggesting that some illegal psychoactive drugs, such as cannabis and some hallucinogens, may have therapeutic value, but further research is needed to understand their potential benefits.

Violence is common and is a public health issue. Forensic psychiatrists offer treatment for the small amount of violence that is due to mental disorder. It is essential to distinguish between meaningful explanations and causes. Violence is not a unitary concept. Evidence for the specific causal associations between mental illness and violence is reviewed. Anger, anxiety, moral and amoral actions are reviewed including intoxication and withdrawal, deception, antisocial personality and psychopathy, and a range of mental illnesses and developmental disorders. Social and developmental factors are also important. Memes, media and social contagion influence the forms of violence. Court reports and treatments are considered critically in relation to violence.

Substance use disorders commonly co-occur with mood disorders (major depression, bipolar disorder) and may be due to the direct effects of illicit substances, such as intoxication and withdrawal, or due to effects stemming from chronic use, including substance-induced mood disorders. Self-medication of mood disorders with legal or illicit substances is highly prevalent. Careful assessment of patients is necessary to determine whether a co-occurring disorder is due to substance use or a separate diagnosis that requires independent treatment. Many depressive symptoms may resolve with treatment of the substance use disorder. Independent mood disorders can be treated with behavioral therapy and standard pharmacological therapy. Some mood disorder medications are also effective for substance use disorders. Some substances that have historically been used recreationally are being studied as possible treatments for mood disorders.

Does cannabis use play a causal role in subsequent violence? The available research suggests an association between cannabis use and risk of being a perpetrator of violence. Indeed, cannabis users are at increased risk of carrying out severe violence, including aggravated assault, sexual aggression, fighting, and robbery. There is also evidence on the association between cannabis use and subsequent victimization (e.g., intimate partner violence). Individuals with severe mental disorders also show an incremented risk of violence, considering their higher rate of cannabis use compared to the general population. Possible mechanisms underlying this association involve (1) the neurobiological effect of the substance after acute use, but also during abstinence and withdrawal, and (2) social factors, such as the violent/criminal lifestyles of cannabis users. However, it is important to acknowledge the limitations of the current literature. Most available studies are cross-sectional and retrospective, so it remains difficult to disentangle the direction of the association. Despite that, cannabis use may be a useful preventive intervention target, particularly among at-risk groups such as psychiatric patients.

The decision of the Supreme Court of Massachusetts concerned the difficult problem of defining the quantum of intoxication abrogates a person’s ability to consent to sex. The jury convicted a police officer, who was summoned to assist a highly intoxicated person, of rape of that person. However, the high court overturned the conviction, holding that the “wholly insensible” test was too vague to support a legal conviction. Notably, the court offered no alternative to the rejected test, essentially leaving the state without any rule about the degree of intoxication or other incapacitation abrogates consent.

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Chapter 1 examines the problem of campus sexual assault in the United States. It critically discusses major recent studies that measure the incidence and prevalence of campus rape and sexual assault including the 2007 National Institute of Justice Study, the 2014 Bureau of Justice Statistics Study, the 2015 AAU Campus Climate Survey, the 2016 Campus Climate Validation Study, and the most recent 2019 Association of American Universities Study. The chapter then explains why, for a long time, the criminal justice system could not respond to what was happening on campus because it wasn’t a crime. It closes by discussing attempts at reform and explains why those have been largely unsuccessful at addressing campus rape.