Wayne Hall, Lucy Carter, Katherine Morley Addiction, neuroscience and ethics [editorial]. Addiction (2003) 98: 867-870 doi: 10.1046/ j.1360-0443.2003.00400.x Blackwell Publishing Ltd, Jul 1, 2003 Copyright © 2003, Published on behalf of the Society for the Study of Addiction If one believes that the brain is, in some as yet unspecified way, the organ of mind and behaviour, then all human behaviour has a neurobiological basis. Neuroscience research over the past several decades has provided more specific reasons for believing that many addictive phenomena have a neurobiological basis. The major psychoactive drugs of dependence have been shown to act on neurotransmitter systems in the brain (Nutt 1997; Koob 2000); common neurochemical mechanisms underlie many of the rewarding effects of these drugs and the phenomena of tolerance and withdrawal symptoms (Hyman & Malenka 2001; Koob 2000), and there is evidence for a genetic vulnerability to addiction (Nestler 2001; Uhl 1999) that is mediated by genes that regulate the metabolism of psychoactive drugs and the brain neurotransmitter systems on which they act (Uhl 1999). Neuroscience research on addiction has the potential to improve treatment of drug dependence (Nutt 1997). It may lead to more effective ways of helping drug- dependent people to withdraw from their drug of dependence and it may increase their chances of remaining abstinent (Koob 2000). We may also have immunological prostheses for relapse prevention—‘drug vaccines’—that help former addicts remain abstinent by preventing their drug of choice from acting on receptors in their brains during the period when they are most vulnerable to relapse (Fox 1997; Hall 2002). Genotyping of people seeking help to deal with addiction may enable patients to be better matched to pharmacological treatments, e.g. by predicting whether smokers were more likely to quit with bupropion or nicotine replacement (Munafo et al . 2001; Walton et al . 2001). Neuroscience perspectives on addiction have more mixed social implications for ‘governing images’ of addiction. According to one influential interpreter of neuroscience research, addiction is a ‘chronic, relapsing brain disease’ (Leshner 1997), a disorder in which chronic drug use flicks a metaphorical switch in the brain after which the person’s drug use is beyond their control (Leshner 1997). This view challenges the common- sense view of addiction as a matter of individual choice that can be influenced by threats of punishment and imprisonment. A neurochemical basis for addiction makes possible a more humane, less punitive response to addiction. It raises the prospect of increased funding for addiction treatment, less resort to imprisonment as the first-line treatment for addiction and less stigmatization of those who are addicted to drugs. It is, for these reasons, a view that appeals to some people who are addicted to drugs and to some of their families. Addiction as a ‘brain disease’ has some of the appeal of the older ‘disease models’ of addiction, with the added authority of the latest science. A ‘disease’ that can be ‘seen’ in the many-hued splendour of a PET scan carries more conviction than one justified by the possibly exculpatory self-reports of addicts who claim that they are unable to control their drug use. The depiction of addiction as a brain disease has benefited addiction research in the competition for funding with neuroscientists working on disorders such as dementia, bipolar disorder and schizophrenia. Increased funding for neuroscience research has meant that some addiction researchers have been the beneficiaries of the view that addiction is a brain disease, a view about which other addiction researchers have been more sceptical, if publicly silent about the reasons for their scepticism. A reviewer of this editorial described the thesis that addiction is a chronic brain disease as a Faustian bargain that secured increased research funding but with costs that are only now becoming apparent. Simplified versions of neuroscience views of addiction depict addicts’ behaviour as being controlled by the state of their brain