Avoiding potential misuses of addiction brain science

The scientific journal Addiction has an editorial on the potential unintended consequences of addiction brain science. Here are some of the current and potential problems that they identified:

Simplistic interpretations of this model of addiction have been used to justify heroic treatment interventions in the brain’s function, such as ultra-rapid opiate detoxification and, recently, neurosurgery for heroin dependence.

If addicts suffer from a brain disease, then it may also be argued that they need to be coerced legally into treatment because they are incapable of acting in their own best interests. Universal childhood vaccination against drugs could come to be seen as a morally justified ‘public health’ measure to prevent an epidemic of ‘chronic brain disease’.

…if genetic and neuroscience research is seen as justifying the view that ‘alcoholism’ is a categorical disease entity, then one can expect the alcohol industry to argue that social policies should identify the minority of people who are genetically vulnerable to alcohol dependence so that the rest of the population can use alcohol with impunity.

It will also be important to avoid folk genetic understandings of addiction undermining social policies that are effective in reducing drug use, drug-related harm and addiction. Research in behaviour genetics, as well as epidemiology and sociology show that drug use and addiction are affected by social and environmental factors.

…[researchers] need to make clear that addiction is not a Mendelian disorder, i.e. it is not the case that if you have ‘the gene’ you will become addicted and if you do not then you will not. Instead, addiction is most likely to be a polygenic disorder that results from interactions between the environment and the effects of a large number of genes…

If taken too literally, the ‘brain disease’ model of addiction may also undermine the capacity of neuroscientists to conduct the type of research on which the model is based. Bioethicists in the United States have argued, for example, that addicts lack the capacity to give free and informed consent to participate in: (1) experimental neurobiological studies of addiction [e.g. using positron emission tomography (PET) scans] that involve giving drugs of dependence to addicts; and (2) clinical trials of injectable heroin as a treatment for opioid dependence.

I share the concerns of the bioethicists mentioned in the article. Experiments involving giving drugs to addicts seem more than a little unseemly and the bar for approving such studies should be very high. There ought to be expectations that the study will provide significant advances in understanding and treating addiction, and the subjects should continuously be given every possible opportunity to recover. (e.g. – Active linkage to high quality treatment even if it disqualifies them as a subject.)