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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

Chapter 7 and below, there are important ethical considerations in any such
genetic screening or preventive immunotherapy.
With respect to treatment strategies deriving from neuroscience research,
immunotherapies could also presumably be applied to cases coming to
treatment. Future developments in neuroscience may produce genetic
modifications which would alter susceptibility to use of or dependence on
particular classes of substances, though such developments presently seem
quite far in the future.
Apart from the above, there seem to be two main choices in terms of
biological interventions. Both of these are already on the scene, and the main
pay-off from the neuroscience research is likely to be in improvements in the
particular medication or formulation used. The first choice is the use of
medications or procedures which interfere in one way or another with the
action of the substance in the body, taking away the positive rewards from
using the substance or making its use aversive. Such medications have been
in use for more than half a century. Extensive experience suggests that the
main problem with these interventions is lack of patient compliance, where
those with a history of extensive use of a substance often prove unable to
keep to any commitment they have made to continual use of the antagonist
or aversive substance.
The other choice is the use of substances which are wholly or partially agonists,
replacing the problematic substance or mode of administration with another
which produces at least some of the same biological and experiential effects.
This choice has been most widely explored and used for opioids, with codeine,
methadone, buprenorphine and other substances substituting for heroin or
other opiates. Nicotine replacement therapy, which substitutes for cigarettes, is
now widely used thereby eliminating most of the public health harm.

Ethical issues in the application of the neuroscience findings
In the broadest sense, ethical issues have always been important in the use
of psychoactive substances, and in societal responses to their use. Whether
they should be used at all continues to be a contentious issue. Thus, for
instance, Islam and some branches of other major world religions forbid the
use of alcohol to faithful adherents. Ethical judgements are written into the
major international drug control conventions (see Box 1.1). On the other
hand, arguments against the criminalization of substance use are also
frequently couched in ethical terms (e.g. Husak, 2002).
Within the somewhat narrower frame of ethics in health and human
services, research and interventions, Chapter 7 has considered in some detail
many of the ethical issues which are relevant to neuroscience research and
the application of its findings. Only a few of these are emphasized here, with
particular reference to their potential applications mentioned above.
Perhaps the most urgent ethical considerations arise around the issue
of genetic screening, which is already on the horizon. A person identified

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