Ethical Issues in the Treatment of Addiction

  • Benjamin Capps
  • Adrian Carter
  • Yvette van der Eijk
Reference work entry

Abstract

Addiction or dependence to a psychoactive substance – or drug – is a biopsychosocial disorder. Many aspects of addiction can be clinically treated, yet this raises some important ethical issues. The health and social problems resulting from addiction are generally influenced by sociopolitical agendas and prevailing views about addiction, and therefore, we make some brief observations about how these affect the act, manner, or method of treating someone who is addicted.

In this chapter, we focus on some recent developments in the treatment of addiction: pharmacological approaches, and invasive brain therapies. In addition to giving an ethical overview of these, we look more generally at the justification for coerced treatment.

Keywords

Deep Brain Stimulation Relapse Prevention Addiction Treatment Opioid Dependence Drug Court 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. American Psychiatric Association. (1994). DSM-IV: Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. (2012). DSM-V: The future of psychiatric diagnosis. Available at: http://www.dsm5.org/Pages/Default.aspx. Accessed April 2012.
  3. Ashcroft, R., & Franey, C. (2004). Further ethical and social issues in using a cocaine vaccine: Response to Hall and Carter. Journal of Medical Ethics, 30(4), 341–343.CrossRefGoogle Scholar
  4. Ashcroft, R., Campbell, A., & Capps, B. (2007). Ethical aspects of developments in neuroscience and drug addiction. In D. Nutt, T. Robbins, G. Stimson, M. Ince, & A. Jackson (Eds.), Drugs and the future: Brain science addiction and society (pp. 439–465). London: Elsevier.CrossRefGoogle Scholar
  5. Australian National Council on Drugs (ANCD). (2012). Position statement: Naltrexone sustained release preparations (injectible & implants). http://www.ancd.org.au/images/PDF/Positionstatements/naltrexonepositionstatement.pdf. Accessed April 2012.
  6. Bell, J., Hall, W., & Byth, K. (1992). Changes in criminal activity after entering methadone maintenance. British Journal of Addiction, 87, 251–258.CrossRefGoogle Scholar
  7. Caplan, A. (2008). Denying autonomy in order to create it: The paradox of forcing treatment upon addicts. Addiction, 103, 1919–1921.CrossRefGoogle Scholar
  8. Carter, A., & Hall, W. (2012). Addiction neuroethics: The promises and perils of neuroscience research on addiction. London: Cambridge University Press.Google Scholar
  9. Carter, A., & Hall, W. (2011). Proposals to trial deep brain stimulation to treat addiction are premature. Addiction, 106(2), 235–237.CrossRefGoogle Scholar
  10. Courtwright, D. (2001). Forces of habit: Drugs and the making of the modern world. Cambridge, MA: Harvard University Press.Google Scholar
  11. Daniel, M., Martin, A., & Carter, J. (1992). Opiate receptor blockade by naltrexone and mood state after acute physical activity. British Journal of Sports Medicine, 26(2), 111–115.CrossRefGoogle Scholar
  12. Dean, A. J., Saunders, J. B., Jones, R. T., Young, R. M., Connor, J. P., & Lawford, B. R. (2006). Does naltrexone treatment lead to depression? Findings from a randomized controlled trial in subjects with opioid dependence. Journal of Psychiatry & Neuroscience, 31(1), 38–45.Google Scholar
  13. Diefenbach, G. J., Diefenbach, D., Baumeister, A., & West, M. (1999). Portrayal of lobotomy in the popular press: 1935–1960. Journal of the History of the Neurosciences, 8(1), 60–69.CrossRefGoogle Scholar
  14. Engel, G. (1980). The clinical application of the biopsychosocial model. The American Journal of Psychiatry, 137, 535–544.Google Scholar
  15. Gao, G., Wang, X., He, S., Li, W., Wang, Q., Liang, Q., et al. (2003). Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery. Stereotactic and Functional Neurosurgery, 81(1–4), 96–104.CrossRefGoogle Scholar
  16. Gartner, C. E., Hall, W. D., Vos, T., Bertram, M. Y., Wallace, A. L., & Lim, S. S. (2007). Assessment of Swedish snus for tobacco harm reduction: An epidemiological modelling study. Lancet, 369(9578), 2010–2014.CrossRefGoogle Scholar
  17. Hall, W. (1997). The role of legal coercion in the treatment of offenders with alcohol and heroin problems. Australian and New Zealand Journal of Criminology, 30, 103–120.CrossRefGoogle Scholar
  18. Harwood, H., & Myers, T. (2004). New treatments for addiction: Behavioural, ethical, legal, and social questions. Washington, DC: National Academies Press.Google Scholar
  19. Hasin, D. (1994). Treatment/self-help for alcohol-related problems: Relationship to social pressure and alcohol dependence. Journal of Studies on Alcohol, 55, 660–666.Google Scholar
  20. Hubbard, R. (1989). Drug abuse treatment: A national study of effectiveness. London: University of North Carolina Press.Google Scholar
  21. Hyman, S. (2007). The neurobiology of addiction: Implications for voluntary control of behaviour. The American Journal of Bioethics, 7, 8–11.CrossRefGoogle Scholar
  22. Kalant, H. (2010). What neurobiology cannot tell us about addiction. Addiction, 105, 780–789.CrossRefGoogle Scholar
  23. Kass, L. (2003). Beyond therapy: Biotechnology and the pursuit of happiness. Washington, DC: President’s Council on Bioethics.Google Scholar
  24. Kosten, T., & Owens, S. M. (2005). Immunotherapy for the treatment of drug abuse. Pharmacology & Therapeutics, 108(1), 76–85.CrossRefGoogle Scholar
  25. Koob, G., & Le Moal, M. (2006). Neurobiology of addiction. New York: Academic.Google Scholar
  26. Krack, P., Hariz, M., Baunez, C., Guridi, J., & Obeso, J. (2010). Deep brain stimulation: From neurology to psychiatry? Trends in Neurosciences, 33(10), 474–484.CrossRefGoogle Scholar
  27. Krupitsky, E., Zvartau, E., & Woody, G. (2010). Use of naltrexone to treat opioid addiction in a country in which methadone and buprenorphine are not available. Current Psychiatry Reports, 12(5), 448–453.CrossRefGoogle Scholar
  28. Krupitsky, E., & Blokhina, E. A. (2010). Long-acting depot formulations of naltrexone for heroin dependence: A review. Current Opinion in Psychiatry. doi:10.1097/YCO.0b013e3283386578.Google Scholar
  29. Leshner, A. (1997). Addiction is a brain disease, and it matters. Science, 278, 45–47.CrossRefGoogle Scholar
  30. Levy, N. (2007). Neuroethics: Challenges for the 21st century. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  31. Ling, W., Casadonte, P., Bigelow, G., Kampman, K. M., Patkar, A., Bailey, G. L., et al. (2010). Buprenorphine implants for treatment of opioid dependence: A randomized controlled trial. JAMA: The Journal of the American Medical Association, 304(14), 1576–1583.CrossRefGoogle Scholar
  32. Maastricht University Medical Centre (2009). A phase 2B, multi-center, randomized, double-blinded, parallel-arm, study to assess efficacy and safety of 3′-Aminomethylnicotine-P. Aeruginosa r-Exoprotein A conjugate vaccine (NicVAX®) or placebo co-administered with varenicline (Champix®) as an aid in smoking cessation. http://clinicaltrials.gov/ct2/show/NCT00995033. Accessed 6 Oct 2010.
  33. Martell, B., Orson, F., Poling, J., et al. (2009). Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients: A randomized, double-blind, placebo-controlled efficacy trial. Archives of General Psychiatry, 66, 1116–1123.CrossRefGoogle Scholar
  34. Medvedev, S., Anichkov, A., & Poltakov, I. (2003). Physiological mechanisms of the effectiveness of bilateral stereotactic cingulotomy in treatment of strong psychological dependence in drug addiction. Fiziologiia Cheloveka, 29, 117–123.Google Scholar
  35. Moreno, A., Azar, M., Warren, N., Dickerson, T., Koob, G., & Janda, K. (2010). A critical evaluation of a nicotine vaccine within a self-administration behavioral model. Molecular Pharmaceutics, 7(2), 431–441.CrossRefGoogle Scholar
  36. Murphy, M., Checkley, S., Seckl, J., & Lightman, S. (1990). Naloxone inhibits oxytocin release at orgasm in man. The Journal of Clinical Endocrinology and Metabolism, 71(4), 1056–1058.CrossRefGoogle Scholar
  37. Murray, T. (2004). Ethical issues in immunotherapies or depot medications for substance abuse. In H. J. Harwood & T. G. Myers (Eds.), New treatments for addiction: Behavioral, ethical legal and social questions (pp. 188–212). Washington, DC: National Academies Press.Google Scholar
  38. Nutt, D. (2006). Alcohol alternatives: A goal for psychopharmacology? Journal of Psychopharmacology, 20(3), 318–320.CrossRefGoogle Scholar
  39. Nutt, D., & Lingford-Hughes, A. (2004). Infecting the brain to stop addiction? Proceedings of the National Academy of Science of the United States of America, 101(31), 11193–11194.CrossRefGoogle Scholar
  40. Orson, F., Kinsey, B., Singh, R., et al. (2008). Substance abuse vaccines. Annals of the New York Academy of Sciences, 1141(1), 257–269.CrossRefGoogle Scholar
  41. Pedic, F. (1990). Drug use in prisons: Data collection procedures. A review and recommendations. Sydney: National Drug and Alcohol Research Centre.Google Scholar
  42. Schlaepfer, T., & Fins, J. (2010). Deep brain stimulation and the neuroethics of responsible publishing: When one is not enough. JAMA: The Journal of the American Medical Association, 303, 775–776.CrossRefGoogle Scholar
  43. Skog, O. (2003). Addiction: Definitions and mechanisms. In N. Heather & R. E. Vuchinich (Eds.), Choice, behavioural economics and addiction. Oxford: Elsevier.Google Scholar
  44. Stathis, H. (1991). Drug use among offenders: A literature review. Research and Statistics Digit, NSW Department of Corrective Services.Google Scholar
  45. Volkow, N., Wang, G., Fowler, J., et al. (2010). Addiction: Decreased reward sensitivity and increased expectation sensitivity conspire to overwhelm the brain’s control circuit. BioEssays, 32, 748–755.CrossRefGoogle Scholar
  46. Vocci, F., & Chiang, C. N. (2001). Vaccines against nicotine: how effective are they likely to be in preventing smoking? CNS Drugs, 15(7), 505–514.CrossRefGoogle Scholar
  47. Ward, J., Mattick, R., & Hall, W. (1992). Key issues in methadone maintenance treatment. Kensington: New South Wales University Press.Google Scholar
  48. Ward, J., Mattick, R., & Hall, W. (1998). Methadone maintenance treatment and other opioid replacement therapies. Sydney: Harwood Academic Press.Google Scholar
  49. Wild, T., Roberts, A., & Cooper, E. (2002). Compulsory substance abuse treatment: An overview of recent findings and issues. European Addiction Research, 8, 84–93.CrossRefGoogle Scholar
  50. Wu, H.-M., Wang, X.-L., Chang, C.-W., Li, N., Gao, L., Geng, N., et al. (2010). Preliminary findings in ablating the nucleus accumbens using stereotactic surgery for alleviating psychological dependence on alcohol. Neuroscience Letters, 473(2), 77–81.CrossRefGoogle Scholar
  51. Yeomans, M., & Gray, R. (2002). Opioid peptides and the control of human ingestive behaviour. Neuroscience and Biobehavioral Reviews, 26(6), 713–728.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Benjamin Capps
    • 1
  • Adrian Carter
    • 2
  • Yvette van der Eijk
    • 1
  1. 1.Centre for Biomedical EthicsNational University of Singapore Yong Loo Lin School of MedicineSingaporeSingapore
  2. 2.The University of Queensland, UQ Centre for Clinical ResearchRoyal Brisbane and Women’s HospitalHerstonAustralia

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