Ethical Issues in Substance-Use Prevention Research

Abstract

Substance use and dependency among individuals living in the United States has been recognized as a public health crisis. Substance-use prevention scientists are at the forefront of identifying current and continually evolving individual and social factors contributing to the misuse of prescription and illegal drugs and for designing and empirically validating preventive and treatment approaches that can inform public health policy. Along with the benefits of a substance-use science agenda are the ethical challenges associated with conducting socially sensitive research involving participants whose daily lives are vulnerable to psychological, social, legal, and economic harms. Given these vulnerabilities, investigators often encounter roadblocks to the conduct of scientifically valid and socially valuable research as a result of IRB requirements that may be the result of overestimation of participant risk and lack of information on the adequacy of risk protections developed specifically for this population. IRB concerns often include questioning whether monetary compensation will condone or increase illicit substance use, if street recruitment will draw police attention to illegal behaviors, whether cravings or withdrawals are indications of incapacity to consent, and if questions regarding factors associated with substance use such as sexual risk behaviors, depression, and interpersonal violence will in themselves cause emotional distress or internalized stigma. This chapter discusses these challenges through examination of four domains essential for the responsible conduct of addiction science: balancing of research risks and benefits, informed consent, confidentiality and disclosure policies, and fair and noncoercive compensation. We conclude with a discussion of the importance of community perspectives and the applicability of the goodness-of-fit ethics model for enhancing participant protections in substance-use prevention research.