Page 248 - Pagetit

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

based given that the major ethical justification for undertaking research
studies is to contribute to scientific knowledge (Brody, 1998), and this cannot
happen if trial results are not published (Reidenberg, 2001).

Trials of preventive pharmacological interventions
for substance dependence
Psychosocial and educational interventions have been widely used with the
aim of preventing young people from using drugs (Spooner & Hall, 2002).
Universal interventions are aimed at all young people, while indicated,
targeted or selective interventions are aimed at those young people who are
identified as being at higher risk of initiating drug use. The impact of both
universal and selective educational interventions on rates of drug use has
often been modest (National Research Council, 2001).
Psychosocial preventive interventions raise ethical issues. Universal
interventions (those directed at all young people) raise concerns about
unintended adverse consequences, such as encouraging drug
experimentation in young people. Targeted or indicated interventions raise
additional ethical issues because they require the identification of young
people who are at increased risk of using drugs. Their consent and that of
their parents is required for them to participate in preventive interventions.
In the process of obtaining such consent, the parents and their children may
become acquainted with their risk status. Participation in trials of preventive
interventions may also expose the children to social stigmatization and
discrimination, if it becomes known to their teachers, peers and their peers’
parents. For example, parents whose children are judged to be at “low risk”
may actively discourage their children from associating with “high-risk”
children, or they may insist that high-risk children be excluded or removed
from schools.
The same ethical issues of stigmatization and discrimination are also raised
by pharmacological or immunological interventions that aim to prevent
substance dependence. Two such interventions are discussed below: early
pharmacological interventions in persons at risk of substance dependence
that may be inspired by similar efforts to prevent psychoses (McGorry, Yung
& Phillips, 2001); and the preventive use of immunotherapies against drug
effects to reduce risk of substance dependence (Cohen, 1997).

Early intervention studies

Early interventions for substance dependence have been discussed which
would be analogous to studies of schizophrenia that identify persons who are
at increased risk of developing the disorder because they have a family history
of schizophrenia or they have psychological symptoms that may be early or
“prodromal” symptoms of the disorder. The aim of this approach is to prevent
the development of schizophrenia by a combination of good quality

227

Chapter_7 227 19.1.2004, 11:50