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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

benefits are an improved understanding of substance dependence that may
benefit future patients by improving treatment outcome.
Informed-consent procedures for provocation studies on substance
dependence need to make clear to potential participants the absence of any
therapeutic gain, and the risks of participation. Participants who were seeking
treatment should be actively referred to a treatment service (Gorelick et al.,
1999). Steps also need to be taken to ensure that the capacity to give voluntary
consent is not impaired because participants are intoxicated or experiencing
withdrawal symptoms. This may require screening for symptoms of
intoxication and withdrawal at the time of recruitment (Adler, 1995).
Drug administration in these studies is considerably less risky than drug
use that occurs outside the laboratory setting. Significantly lower doses of
pharmaceutically pure drugs are used in laboratory studies, in the absence
of concurrent drug use which occurs in the community. In addition, the drug
is administered under medical supervision with protocols in place to deal
with any adverse events (Adler, 1995). The risks of drug administration can
be further reduced by screening out persons who have experienced adverse
effects from drugs such as the psychostimulants. The use of stimuli associated
with substance use is much less invasive and poses fewer risks than exposure
to drugs. The radioactively-labelled substances used in some forms of
neuroimaging pose very little risk to participants, and the newer imaging
methods, such as fMRI, do not involve exposure to radiation or radioactive
substances (Gilman, 1998).

Ethical issues in epidemiological research on substance
dependence

The major ethical issues in epidemiological research are: ensuring that
participants give free and informed consent, and protecting their privacy and
the confidentiality of any information that is collected. There are also
considerations unique to epidemiological studies. Since no experimental
procedures are involved, the major risks that research participants face arise
from the possible mis-use of any information that they provide. These risks
may potentially include social ostracism and stigmatization, if their drug use
becomes known to family, friends or neighbours; and criminal prosecution,
if any information that they provide about illegal drug use or other criminal
behaviour becomes known to the police in a way that can be linked to the
individual.
Justice and the criteria for good epidemiological research both require that
a representative sample of the population at risk is recruited into studies of
patterns of substance use and dependence in the population. There may be
issues raised by poorer retention in longitudinal studies of the indigent and
homeless, who may be at higher risk of developing substance dependence.
Justice may also be an issue if there is a preponderance of studies of persons
entering publicly-funded treatment for substance dependence, and a lack of

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