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Ethical Issues Raised by Proposals to Treat Addiction Using Deep Brain Stimulation

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Abstract

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more animal research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a “cure” of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction.

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Acknowledgements

We would like to thank Ms Danielle Herbert for her assistance in researching this paper and Ms Sarah Yeates for comments on an earlier draft. This manuscript was prepared with financial assistance from a National Health and Medical Research Council Australia Fellowship (Grant No. 3020774) awarded to Professor Wayne Hall.

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Authors and Affiliations

  1. UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, 4029, Australia

    Adrian Carter

  2. Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, H2W 1R7, Canada

    Emily Bell & Eric Racine

  3. Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, H2W 1R7, Canada

    Eric Racine

  4. Departments of Neurology and Neurosurgery, Medicine, and Biomedical Ethics Unit, McGill University, Montréal, QC, H2W 1R7, Canada

    Eric Racine

  5. UQ Centre for Clinical Research and Queensland Brain Institute, The University of Queensland, Brisbane, QLD, 4072, Australia

    Wayne Hall

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Correspondence to Adrian Carter.

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Carter, A., Bell, E., Racine, E. et al. Ethical Issues Raised by Proposals to Treat Addiction Using Deep Brain Stimulation. Neuroethics 4, 129–142 (2011). https://doi.org/10.1007/s12152-010-9091-3

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