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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

The challenge for the neuroscience community in the field of substance
dependence is to explain substance dependence in biological terms without
depicting people with substance dependence as automatons under the
control of receptors in their brains (Valenstein, 1998). This means viewing
substance dependence as the result, in part, of choices that are made by
individuals, not always independently. In the case of young people, many of
them operate with a short-term view, a sense of personal invulnerability, and
with scepticism towards their elders’ warnings about the risks of substance
use. Adolescents are particularly vulnerable to marketing pressures, especially
with regard to tobacco and alcohol use. It will also mean viewing substance
dependence as a matter of degree, with dependent drug users retaining the
capacity to choose to become abstinent and to seek help to do so. It will also
mean acknowledging that pharmacological treatment is only the beginning
of the process of recovery and reintegration of the drug dependent person
into the community. Moreover it will require attention to a broader range of
social policies in seeking to prevent drug use by young people (Spooner &
Hall, 2002).

Implications of neuroscience research for the treatment
of substance dependence
Access to treatment

If pharmacological treatments derived from neuroscience research prove to
be effective, the issue of ensuring equal access to treatment for all those who
may need it is an ethical issue that needs to be addressed. If a substantial
proportion of substance-dependent persons are unable to access treatment
because they cannot afford it, public funding may be needed (Gerstein
&Harwood, 1990). Public provision of such treatment will require economic
justification, especially in the case of persons who are dependent on illicit
drugs, many of whom will be indigent and unable to pay for their treatment.
Advocates for publicly subsidized drug treatment will need to make clear the
comparative economic and social costs of treating drug dependent people,
as against the current policy in many countries of dealing with substance
dependence solely through the criminal justice system (Gerstein & Harwood,
1990; National Research Council, 2001).

Legally coerced treatment

The potential use of a pharmacological treatment for substance dependence
or a drug immunotherapy under legal coercion needs to be considered
(Cohen, 1997). It is often the first possible use raised when the concept of a
drug immunotherapy is mentioned; community concern about this way of
using drug immunotherapies may also adversely affect attitudes towards
other therapeutic uses. The issue accordingly needs to be discussed, even if

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