Wayne Hall: Reaping The Benefits and Avoiding Misuse of Addiction Neurobiology (Buchman)

waynehallThere was no doubt in my mind that Professor Wayne Hall was the ideal person to give the plenary talk at our Neuroethics of Addiction conference. He boasts an impressive track record as the former director of the Office of Public Policy and Ethics at the Institute for Molecular Bioscience and Director of the National Drug and Alcohol Research Centre at the University of New South Wales. Currently, Prof. Hall advises the World Health Organization on issues ranging from the health effects of cannabis use, to the effectiveness of opioid substitution treatment, vaccines against drug addiction and the ethical and social implications of addiction neuroscience research, to name but a few. He has published extensively in the area of addiction, neuroscience and ethics (and is lead author on an eloquent editorial by the same name), and draws upon an interdisciplinary toolbox of public health, sociology, neuroscience and bioethics in his thinking.

Professor Hall’s lecture focused on two areas. Broadly, he presented an overview of some ethical and social implications of: 1) recent neuroscience research on addiction, and 2) a “brain disease” concept of addiction, and the effect this concept may have on addiction treatment, prevention and drug policy, neuro-enhancement, and privacy. Although the title of his presentation suggested a balanced appraisal, Professor Hall weighed in for the most part on the potential “negatives” of neuroscience research in addiction. The majority of the talk was recognizable to those familiar with Prof. Hall’s neuroethics work, particularly the important research he has conducted with his student Adrian Carter.

One area that I found particularly interesting was the discussion of the potential implications of understanding people who have an addiction to be biologically vulnerable. Here, Hall focused on the debate over the commonsense perspective of addiction as an immoral choice, versus the medical brain disease view, which posits that addiction is a condition akin to other medical illnesses such as schizophrenia or cancer – the latter promoted by many high-profile scientists such as the National Institute on Drug Abuse’s director Nora Volkow and Alan Leshner of the American Association for the Advancement of Science. This aspect of Prof Hall’s presentation was a perfect follow-up to the first speaker of the day, neuroscientist Dr. Anthony Phillips, who presented with the controversial title, Addiction is a Brain Disease. Hall argued that these brain disease endorsements and categorical views of addiction may actually present more drawbacks than benefits. For example, if individuals living with an addiction are brain-diseased, it may be argued that they lack the capacity to provide free and informed consent to research and treatment (see: Carter and Hall, 2008). Second, a focus on a disease model may instigate misguided efforts towards heroic and “spurious biological remedies” to “cure” addiction, and thus a premature enthusiasm for treatments such as naltrexone which may be used to justify coerced treatment, or as Art Caplan has suggested, to “deny autonomy in order to create it” (for a recent debate in the journal Addiction on this topic see Caplan 2008; Hall, Capps, and Carter, 2008; and Buchman and Russell, 2009). Although Prof Hall did not refer to this directly, some of his arguments in many ways reflect earlier exploration and concern around the social and ethical implications of psychiatric genetics, in particular how a genetic model of mental illness may increase stigma (see for example some of Jo Phelan’s work).

Although Professor Hall mainly focused on the potential negative ethical and social implications during his presentation, he did spend some time emphasizing the potential positives of addiction neuroscience research. These included the possibilities of new treatments,  preventative measures such as genetic screenings and drug vaccines, maintenance therapies that have a lower overdose risk, and that advances in pharmacogenetics may lead to more precise treatment matching. Further, despite the drawbacks, Hall stated that a disease model may lead to a less punative response to addiction and may increase funding for research. Ultimately, the takehome message of the lecture was that addiction neuroscience is an incredibly exciting field and his concerns do “not justify a moratorium.” Hall does, however, encourage moderation of the therapeutic and preventative claims made by research, and suggests that neuroscience researchers ought to reflect upon the potential implications of their work.