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8. CONCLUSION AND IMPLICATIONS FOR HEALTH POLICY

As with our knowledge of mechanisms of dependence, much remains to
be learned about the genetics of dependence. We are far from genetically
identifying which individuals will become dependent or will experiment with
drugs. Genetic vulnerability tells little about the individual probability of
psychoactive substance use and its related problems.
There is a need for governments to support, to whatever extent possible,
neuroscience research, to develop a cadre of expertise, and to facilitate linking
neuroscience with social science. Governments in developed countries
should provide support for international collaborations and aid to developing
countries to build local capacity.

Potential advances in policy, prevention and treatment from
the neuroscience findings
Neuroscience findings in recent years have transformed our understanding
of the actions of psychoactive substances. This knowledge should be used
not only for the prevention and treatment of disorders and problems arising
from acute and long-term use of these substances, but also for updating how
they are controlled both under international drug conventions and in national
and local laws and policies.
In the light of the neuroscience findings, there is increasing understanding
that substance use disorders are like many other disorders in having
biological, psychological and social determinants. However, a major
difference in the case of substance dependence is the extreme stigma with
which the disorder is regarded in many societies. A WHO study of attitudes
to 18 disabilities in 14 countries found that “drug addiction” ranked at or near
the top in terms of social disapproval or stigma, and that “alcoholism” ranked
closely behind in most of the societies (Room et al., 2001). Reintegrating back
into society persons treated for problems with psychoactive substance use
will require developing and disseminating effective approaches to reducing
this stigma.
With respect to prevention strategies, the main potential application of
neuroscience findings so far would be from the genetic studies. Genetic
screening, based on the research findings, can potentially identify
subgroups of the population with a greater susceptibility to dependence or
harm from a particular psychoactive substance. At present, such
identification is in terms of probabilities rather than certainties. Actions
which could be taken on the basis of a positive screen might include
notification of the affected person (or of the person’s parents or guardian,
in the case of a child), and preventive interventions such as therapeutic
education, or those targeted at reducing vulnerability to substance use and
dependence. Possible preventive measures resulting from other
neuroscientific research include preventive immunotherapies, e.g. against
cocaine or nicotine, performed either on the general population or on those
identified genetically or otherwise as being at high risk. As discussed in

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