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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

community. In the future, increasing social stigmatization of smokers, and
the possibility of discrimination by employers and the health insurance
industry, may raise similar issues for smokers who use nicotine immunization
to stop smoking.
Discrimination may arise if workplace-based drug testing were to screen
for cocaine antibodies before and during employment. A recovering cocaine-
dependent person would be at risk of losing an employment opportunity or
his or her job if cocaine antibodies were detected in a blood sample. If this
information were more widely disseminated to other workers it could have a
devastating effect on the employment prospects and recovery of the
individual (Cohen, 1997).
One way of avoiding these outcomes may be to accept Cohen’s proposal
that a society that wishes to have the benefits of a cocaine immunotherapy
“must institute legal and behavioural changes that preserve privacy and
confidentiality” (Cohen, 1997). This requires a culture that encourages and
supports the recovery of persons with substance dependence. Legislation that
punishes discriminatory behaviour towards recovering persons has been
adopted in the case of HIV-infected persons. The adoption of a similar
approach to people who have been treated for cocaine dependence would
be an important step towards reducing discrimination and protecting privacy.
The risks of loss of privacy and discrimination could also be minimized by
using “passive” rather than “active” immunization to prevent relapse (e.g. by
administering antibodies to cocaine rather than an immunization). This
approach would not produce an enduring change in the person’s immune
system and the antibodies would disappear over a period of weeks. These
advantages would be gained at the expense of a shorter period of protection
(without a booster injection) that may reduce treatment effectiveness. This
may be a trade-off that a patient concerned about privacy would be prepared
to make, but it is a choice that they should be offered (Hall & Carter, 2002).
The preventive “immunization” of children and adolescents against
cocaine dependence is a much more ethically complex issue. Children would
presumably be immunized against cocaine dependence at the request of their
parents. Their parents would consent on behalf of their children who, as
minors, would not be legally able to give informed consent. Parents already
make choices on behalf of their children that will affect their future (e.g.
regarding diet and education). Some have argued, therefore, that
immunization against cocaine dependence would simply be another decision
that some parents would make for their children (Cohen, 1997). On the basis
of this argument, a parent would have the right to immunize their children
against cocaine dependence in much the same way as they have the right to
immunize them against measles or other infectious diseases (Kaebnick, 2000).
Cocaine use may begin in adolescence. Adolescents under the age of majority
have sufficient capacity to be involved in decisions about their future, such as
whether they want to be immunized against cocaine dependence. Even if it is
ethically acceptable for parents to consent on behalf of their children, the assent

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