Addiction Neuroethics

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ISBN: 9781107003248 | 1107003245
Cover: Hardcover
Copyright: 1/30/2012

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Addiction is a significant health and social problem and one of the largest preventable causes of disease globally. Neuroscience promises to revolutionise our ability to treat addiction, lead to recognition of addiction as a 'real' disorder in need of medical treatment and thereby reduce stigma and discrimination. However, neuroscience raises numerous social and ethical challenges: · If addicted individuals are suffering from a brain disease that drives them to drug use, should we mandate treatment? · Does addiction impair an individual's ability to consent to research or treatment? · How will neuroscience affect social policies towards drug use? Addiction Neuroethics addresses these challenges by examining ethical implications of emerging neurobiological treatments, including: novel psychopharmacology, neurosurgery, drug vaccines to prevent relapse, and genetic screening to identify individuals who are vulnerable to addiction. Essential reading for academics, clinicians, researchers and policy-makers in the fields of addiction, mental health and public policy.

Preface	p. xv
Acknowledgements	p. xix
List of abbreviations	p. xxi
Introduction	p. 1
Introduction	p. 1
Neuroethics: the promises and perils of neuroscience research	p. 4
Addiction enters the neuroscientific era	p. 7
Aims and overview	p. 10
The Science of Addiction
What is addiction?	p. 19
Introduction	p. 19
The phenomenology of addiction	p. 20
Folk understanding of addiction	p. 21
Clinical understanding of addictive behaviour	p. 21
The social and economic costs of drug use and addiction	p. 23
Prevalence of drug use and addiction in Australia	p. 23
Drug use related harm	p. 24
Burden of disease due to alcohol and drug use	p. 25
Social response to drug abuse and addiction	p. 26
Governing models of addiction	p. 28
Moral vs. medical models of addiction	p. 28
Neurobiological models of addiction	p. 31
Potential consequences of neurobiological explanations of addiction	p. 32
Conclusion	p. 34
The neurobiology of addiction	p. 35
Introduction	p. 35
The neuroanatomy of addiction	p. 36
Reward and reinforcement: the 'dopamine hypothesis'	p. 38
The endogenous opioid system	p. 45
Memory, learning and habits	p. 46
Compulsion, craving and inhibitory control	p. 47
Executive control and cognitive impairment	p. 47
Representing bodily urges	p. 50
Stress and drug use	p. 50
Molecular and cellular changes in addiction	p. 51
Synaptic plasticity in addiction	p. 52
Epigenetic changes in addiction	p. 53
Vulnerability to addiction: genetic and neuropsychological factors	p. 55
Genetic susceptibility to addiction	p. 55
Vulnerabilities to addiction: a confluence of the genetic and the social	p. 57
Conclusion	p. 59
Neurobiological treatment of addiction	p. 61
Introduction	p. 61
Pharmacological treatments that block drug binding	p. 62
Agonists	p. 62
Antagonists	p. 66
Partial agonists	p. 67
Duration of pharmacological treatment of addiction	p. 68
Pharmacological treatments of withdrawal	p. 69
Pharmacological treatments of craving and relapse	p. 70
Dopaminergic mesolimbic reward pathway	p. 70
Pharmacological interventions in systems related to the reward pathway	p. 72
Opioids	p. 72
The amino acid neurotransmitters: glutamate and GABA	p. 73
Cannabinoids	p. 74
Corticotropin-releasing factor and the stress response	p. 74
Memory manipulators and cognitive enhancers	p. 75
Pharmacogenetic treatment of addiction	p. 75
Novel approaches to drug treatment	p. 76
Immunotherapies	p. 76
Long-acting or sustained-release medications	p. 77
Neurosurgery and deep brain stimulation	p. 78
Transcranial magnetic stimulation	p. 79
Applications of neuroimaging and neurocognitive screening in addiction treatment	p. 79
Psychosocial treatment of addiction	p. 81
Conclusion	p. 81
The Ethical and Philosophical Implications of Neuroscientific Knowledge of Addiction
Autonomy, addiction and the public good	p. 85
Introduction	p. 85
Approaches to ethical analysis	p. 87
Introduction to ethics	p. 87
Principlism	p. 90
Human rights	p. 94
A pragmatic approach to neuroethics	p. 95
Ethical principles in the treatment of addiction	p. 97
Autonomy and addiction	p. 99
Addiction and the public good	p. 101
The minimum conditions for the ethical treatment of addiction	p. 102
Conclusion	p. 103
Autonomy and the capacity to consent to addiction treatment	p. 105
Introduction	p. 105
The role of informed consent in addiction treatment	p. 106
Can 'addicts' say 'no' to drugs?	p. 108
Sceptical views of impaired autonomy in addicted individuals	p. 113
Capacity to consent to abstinence-oriented treatment	p. 114
Implications for obtaining informed consent to enter addiction treatment	p. 115
Guidelines when admitting individuals into addiction treatment	p. 117
Conclusion	p. 119
The rights of individuals treated for addiction	p. 121
Introduction	p. 121
Addiction, drug policy and human rights	p. 122
Basic human rights for addicted individuals	p. 123
The right to access to effective treatment of addiction	p. 124
The case for medical treatment of addiction	p. 124
Effective treatment of addiction	p. 125
The right to access harm reduction measures	p. 126
The right to effective medical treatment	p. 127
The use of unevaluated and risky treatments of addiction	p. 128
Respecting human rights when treating under legal coercion	p. 129
Human rights in the treatment of addicted prisoners	p. 130
Human rights in the treatment of addicted pregnant women	p. 131
Future challenges for human rights practitioners	p. 132
Conclusions	p. 133
Coerced treatment of addiction	p. 134
Introduction	p. 134
Approaches to coerced treatment	p. 135
The case for legally coerced treatment	p. 136
When is coerced treatment ethical?	p. 138
Ethical issues in providing coerced addiction treatment	p. 142
Is compulsory addiction treatment ethically acceptable?	p. 142
Conclusion	p. 144
Ethics of addiction research	p. 146
Introduction	p. 146
Informed consent to participate in addiction research	p. 148
Paying addicted subjects	p. 150
Privacy, confidentiality and anonymity	p. 152
Administering addictive drugs in research studies	p. 153
Why do neuroscientists give drugs to 'addicts!,?	p. 154
The risks of giving 'addicts' drugs in research settings	p. 156
Research participation by treated vs. untreated 'addicts'	p. 157
Recruiting subjects and obtaining consent	p. 158
Conclusion	p. 160
The Ethical and Public Policy Implications of Novel Technologies for the Treatment of Addiction
New developments in the treatment of addiction	p. 165
Introduction	p. 165
Novel pharmacological treatments of addiction	p. 167
Ethical and policy issues in pharmacological R&D in addiction	p. 168
Anti-craving drugs	p. 169
Novel relapse prevention treatments	p. 170
Drug vaccines as a prophylaxis against relapse	p. 170
Sustained-release treatments: depot medications and drug implants	p. 173
The Australian naltrexone implant experience	p. 176
Coerced use of depot naltrexone to 'restore autonomy'?	p. 176
Conclusion	p. 179
The search for a neurological 'cure' of addiction?	p. 180
Introduction	p. 180
A brief history of addiction 'cures'	p. 181
Quacks and nostrums: 1830-1900	p. 181
Early medical treatments of drug withdrawal: 1900-1970	p. 183
The modern era: neurobiologically inspired addiction 'cures'	p. 185
Ibogaine therapy	p. 186
Ultra-rapid opioid detoxification	p. 187
Neurosurgical'treatment'of addiction	p. 187
Deep brain stimulation for intractable addiction?	p. 190
Avoiding future therapeutic enthusiasms	p. 195
Preventive medicine and personalised treatment of addiction	p. 197
Introduction	p. 197
Bioprediction of addiction liability	p. 197
Predictive genetic testing of addiction liability	p. 198
Using genetic information to increase abstinence from drug use	p. 200
Genetic discrimination and third party uses of genetic information	p. 202
Premature commercialisation of genetic testing	p. 204
Preventive interventions: 'vaccinating' against addiction	p. 206
Predictive uses of neuroimaging technologies	p. 207
Personalised treatment of addiction	p. 208
Pharmacogenetic treatment of addiction	p. 209
Neuroimaging and cognitive tests in the clinic	p. 211
Conclusion	p. 213
Feeling better than well	p. 214
Introduction	p. 214
Memory modifiers, cognitive enhancers and mood modulators	p. 214
What's wrong with neuroenhancement?	p. 216
Concerns about safety and efficacy	p. 217
Coerced neuroenhancement:a psychopharmacological 'arms race'	p. 218
Equity of access to neuroenhancement technologies	p. 219
Naturalistic objections to enhancement: morality and personhood	p. 220
Lessons from recreational drug use and drug policy	p. 221
The future of drug regulation	p. 223
Conclusion	p. 225
The Future of Addiction Research and Policy
The social and policy implications of addiction neurobiology	p. 229
Introduction	p. 229
Implications for public health policies towards drug addiction	p. 229
Medicalisation of addiction	p. 230
Neuroscience, addiction treatment and public health policy	p. 232
Competing population health strategies	p. 233
Subversive uses of neuroscience research on addiction	p. 234
Drug policy and double standards	p. 237
The prospects of novel pharmacological harm reduction: engineering 'safer' recreational drugs?	p. 240
Conclusions	p. 242
Concluding remarks and summary	p. 244
Introduction	p. 244
Summary and conclusion	p. 244
Key findings	p. 247
Specific implications for the treatment of addiction	p. 250
Neuroscience and the media: the role and responsibility of neuroscientists	p. 254
The tasks ahead for ethicists and policy makers	p. 256
Future directions for addiction neuroethics	p. 258
Private and public understanding of addiction neuroscience	p. 259
Capacity to consent in a research or treatment setting	p. 260
Epidemiological modelling of addiction policy	p. 261
Using incentives to reduce drug use and achieve better health outcomes	p. 262
Conclusion	p. 262
Glossary	p. 264
Bibliography	p. 275
Index	p. 331
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Addiction Neuroethics

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