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7. ETHICAL ISSUES IN NEUROSCIENCE RESEARCH ON SUBSTANCE DEPENDENCE TREATMENT AND PREVENTION

with participants in experimental studies, they may also be exposed to risks
of the drug treatment, such as side-effects and toxicity (Brody, 1998; Gorelick
et al., 1999).

Trials of pharmacotherapies to prevent substance dependence
Preventive trials involve controlled evaluations of pharmacological
treatments that aim to prevent the development of substance dependence.
This might be achieved by using a drug to treat a condition that increases a
person’s risks of developing substance dependence (e.g. attention deficit
hyperactivity disorder (ADHD), see Chapter 4). It could conceivably involve
the administration of a drug immunotherapy (e.g. against nicotine or cocaine)
to young people who are at risk of substance dependence in order to reduce
their chances of developing substance dependence.
Trials of preventive pharmacotherapies are more a prospect on the
horizon than a major undertaking at present; however, two research
developments suggest that such trials may soon be advocated. One is the
development of immunotherapies against cocaine and nicotine (see
Chapter 4). The initial motive for developing these immunotherapies has
been to reduce relapse to substance use in persons who have been treated
for substance dependence (Fox, 1997). However, these immunotherapies
could be administered to children and adolescents with the intention of
reducing their likelihood of becoming dependent. The second development
is that of “early interventions”, which so far have involved persons at high
risk of developing schizophrenia, but it is likely that the same could be
proposed for substance dependence. These involve a combination of
psychosocial and pharmacological interventions. Because this work has
been controversial in the field of psychiatry, neuroscience researchers on
substance dependence would benefit from discussions of issues that may
arise in trials of preventive pharmacological treatments for substance
dependence.

Approach to ethical analysis

Over the past 30 years or so, an influential set of moral principles has emerged
in Anglo-American analyses of the ethics of biomedical research (Brody, 1998;
Jonsen, 1998). These are the principles of autonomy, non-maleficence,
beneficence, and justice (Beauchamp & Childress, 2001). They have also been
included in influential international statements of ethical principles for
medical research, such as the Helsinki Declaration (see Box 7.1) and the
declarations of United Nations organizations (Brody, 1998). These principles
can be regarded as a moral baseline for the ethical analysis of neuroscience
research on substance dependence; with the proviso that they may need to
be supplemented to deal with newly-emerging issues.

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