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

of an adolescent or an older child should be sought, and if they fail to give it,
their decision should rarely be overridden and only if there is a strong reason
for doing so (Brody, 1998). It must be remembered that not everyone who uses
cocaine for the first time goes on to become dependent.

Implications of neuroscience research for models of substance
dependence
There has been a long-standing conflict between moral and medical models
of substance dependence (Gerstein & Harwood, 1990; Leshner, 1997). A moral
model of substance dependence sees it as largely a voluntary behaviour in
which people freely engage. Drug users who offend against the criminal code
are therefore to be prosecuted and imprisoned if found guilty (Szasz, 1985).
A medical model of substance dependence, by contrast, recognizes that, while
many people use certain psychoactive drugs without developing substance
dependence, a small proportion of users develop substance dependence that
requires specific treatment (Leshner, 1997).
Medical models of substance dependence may not be a wholly positive
development if they lead to over-simplified social policies. For example, the
idea that substance dependence is a categorical disease entity lends itself to
a simplification in the case of alcohol, namely, that if people who are
genetically vulnerable to alcohol dependence are identified, then there may
be an assumption that the rest of the population can use alcohol without
developing dependence (Hall & Sannibale, 1996). This view does not take
into account the adverse public health effects of alcohol intoxication. It is
also at odds with the multi-dimensional nature of alcohol and illicit drug use
and symptoms of substance dependence, and with the genetic evidence that
multiple genes are involved in vulnerability to substance dependence (see
Chapter 5). It can also lead users to abdicate responsibility for their behaviour
(Nelkin & Lindee, 1996), and to a preoccupation with individual explanation
of behaviour with a corresponding lack of attention towards remediable social
causes and social policy options for reducing the prevalence of substance
dependence, including drug control policies.
The implications of a neuroscience view of substance dependence for drug
control policy (discussed below) are also not as simple as they may seem.
Exposure to drug use remains a necessary condition for the development of
substance dependence. Thus societal efforts still need to be made (whether
by criminal law or public health measures) to limit access to drugs by young
people (Leshner, 1997). Social disapproval remains a potent means of
discouraging drug use. It is hoped that neuroscience explanations of
substance dependence may temper social stigmatization and ostracism of
people with substance dependence. Demonstrations of the greater cost-
effectiveness of treatment compared with imprisonment may also provide
an economic justification for a more humane, as well as a more effective and
efficient, societal response to substance dependence.

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