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Drug-Induced Impulse Control Disorders: A Prospectus for Neuroethical Analysis

Abstract

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson’s Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine the evidence that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis.

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Notes

  1. 1.

    Research suggests that ICDs are most strongly associated with dopamine agonist use, whereas DDS and punding are found primarily with levodopa use. This is an unresolved issue in the literature: there are a small percentage of PD patients treated only with levodopa who develop ICDs [28], while some treated with DAs develop addiction-like use of their medication, including a DA withdrawal syndrome [29]. Such a debate is beyond the scope of this analysis. However, readers should keep in mind that the majority of cases of ICDs in medicated PD patients involve DA use. For simplicity, we use DRT to refer to any dopaminergic treatment of PD.

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Acknowledgements

This research was funded by an Australian National Health and Medical Research Council Australia Fellowship (Grant ID: 569 738). We would also like to thank Associate Professor Jayne Lucke, Ms Sarah Yeates and the anonymous referees for comments on an earlier draft of this paper that substantially improved it.

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Carter, A., Ambermoon, P. & Hall, W.D. Drug-Induced Impulse Control Disorders: A Prospectus for Neuroethical Analysis. Neuroethics 4, 91–102 (2011). https://doi.org/10.1007/s12152-010-9071-7

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Keywords

  • Addiction
  • Neuroethics
  • Dopamine agonists
  • Parkinson’s Disease
  • Impulse control disorders
  • Moral responsibility