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

it is a long way from being realized. There are good reasons for caution about
any coerced use of a pharmacological treatment or a drug immunotherapy.
The community has little sympathy for drug dependent offenders who engage
in property-related and other crimes, so particular attention must be paid to
protecting the legal and human rights of drug offenders.

The rationale for treatment under legal coercion

Legally coerced drug treatment is entered into by persons charged with or
convicted of an offence to which their substance dependence has
contributed. It is most often provided as an alternative to imprisonment, and
usually under the threat of imprisonment if the person fails to comply with
treatment (Hall, 1997; Spooner et al., 2001).
One of the major justifications for treatment under coercion is that it is an
effective way of treating offenders’ substance dependence that will reduce
the likelihood of their re-offending (Gerstein & Harwood, 1990; Inciardi
&McBride, 1991). This approach has historically been most often used in
the treatment of offenders who are dependent on heroin (Leukefeld & Tims,
1988) although it has most recently been used with cocaine-dependent
offenders in “drug courts” in the USA (National Research Council, 2001). One
issue is whether there should be a higher standard of proven effectiveness
for coerced rather than for voluntary treatment. Another issue is that if the
treatment is court-mandated, there may be a tendency for the treatment
period to last at least as long as would the jail term. Thus, the form and
duration of the treatment are being set by criteria which relate to the judicial
system, and not necessarily to therapeutic best practice.
The advent of HIV/AIDS has provided an additional argument for treating
rather than imprisoning drug-dependent offenders. Prisoners who inject
drugs are at higher risk of having contracted HIV and hepatitis C virus by
needle-sharing prior to imprisonment (Dolan, 1996). They are at risk of
transmitting these infectious diseases to other inmates by needle-sharing
and penetrative sexual acts while they are in prison (Vlahov & Polk, 1988)
and also to their sexual partners before or after imprisonment. Providing drug
treatment under coercion in the community is one way of reducing HIV
transmission. The correctional and public health arguments for drug
treatment under coercion are reinforced by the economic argument that it is
less costly to treat offenders who are drug dependent in the community than
it is to imprison them (Gerstein & Harwood, 1990).

Forms of legal coercion
Offenders may be coerced into drug treatment in a variety of ways (Gostin,
1991; Spooner et al., 2001). After an offence has been detected the police may
decide not to charge the offender if he or she agrees to enter drug treatment.
This form of coercion is not generally favoured because it is not under judicial

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