Ethical issues in the neuroprediction of addiction risk and treatment response

Brain imaging research in addiction promises to provide neurobiological and functional markers that may improve treatment of alcoholism and other types of drug addiction. More speculatively, it may also enable us to prevent addiction by intervening early with individuals who are identified as being at increased risk. In this chapter, we review the research findings on the use of neuroimaging to identify those at greater risk of developing addiction and to match addicted individuals to the treatments that are most likely to assist them toward abstinence. We then discuss the ethical and public policy issues that may arise from the clinical use of these technologies. We consider issues such as: (i) the commercialization of neuroimaging via direct-to-consumer marketing before the technology has been properly validated; (ii) the misuse of neuroimaging to discriminate against individuals at increased risk of developing addiction; (iii) the possible benefits and risks of ?medicalizing? drug use and addiction, including possible effects on stigmatization of, and discrimination against, drug-dependent persons; and (iv) the possible misuse of neurobiological theories of addiction by those marketing alcohol and tobacco to undermine public health strategies that aim to reduce the population-level harms these substances cause. Finally, we examine arguments that evaluations of the future predictive utility of neuroimaging in the field of addiction will require substantial investments in health services research to evaluate the cost-effectiveness of this approach.