Addiction medicine ethics: relapse, no lapse and the struggle to treat addicts like everyone else.

Two case studies are presented as a focus for discussion of ethics in addiction medicine. The first is that of the alcohol-dependent patient who receives a liver transplant. The second is that of a heroin-dependent patient who continues to inject himself while in a general medical ward. I make some comments about the obligations of doctors to treat those who cause harm to themselves as they would treat those who are 'not responsible'.

The ethical dimensions of everyday alcohol and other drug work: An empirical ethics investigation.

INTRODUCTION: The complex and contentious nature of alcohol and other drug (AOD) clinical work affords the likelihood of significant ethical dimensions. However, little attention has been paid to clinicians' perspectives of ethics in their practice within AOD settings. This potentially neglects an important aspect of AOD clinical work. METHODS: We used an insider empirical ethics methodology, where the first author (DS) concurrently worked as an AOD clinician in the research setting. Participants were 30 experienced AOD clinicians, working within a large specialist AOD service in Victoria, Australia. We used three qualitative data collection methods: moral conversation, involving semi-structured interviews; moral participation, involving the first author reflecting on his own ethical practices; and participant-observation, involving observation of clinical meetings. We used Applied Thematic Analysis to analyse the data. RESULTS: Although participants rarely used explicitly ethical language to describe their work, they described four ethical goals: helping clients to access AOD care and treatment; facilitating change in clients' lives; challenging stigma; and keeping people safe. We argue that these clinical goals should also be conceptualised as ethical goals. DISCUSSION AND CONCLUSIONS: Ethics is an integral component of everyday AOD work. Our findings had some overlap with established ethical principles. Participants demonstrated expertise in engaging with ethical dimensions, without using ethical language. Given the limited attention paid to ethics in AOD clinical settings, increasing the focus on ethics in everyday clinical practice is an important contribution to future AOD clinical work. Its absence negates important aspects of care for clients.

Funder interference in addiction research: An international survey of authors.

OBJECTIVE: Scientific research is essential to the development of effective addiction treatment and drug policy. Actions that compromise the integrity of addiction science need to be understood. The aim of this study is to investigate funder (e.g. industry, government or charity) interference in addiction science internationally. METHOD: Corresponding authors of all 941 papers published in an international specialist journal July 2004 to June 2009 were invited to complete a web questionnaire. A sensitivity analysis with extreme assumptions about non-respondents was undertaken. RESULTS: The questionnaire was completed by 322 authors (response fraction 34%), 36% (n=117) of whom had encountered at least one episode (median=3, Interquartile range=4) of funder interference in their research: 56% in Australasia, 33% in Europe, and 30% in North America. Censorship of research outputs was the most common form of interference. The wording or writing of reports and articles, as well as where, when and how findings were released were the areas in which influence was most often reported. CONCLUSIONS: Funder interference in addiction science appears to be common internationally. Strategies to increase transparency in the addiction science literature, including mandatory author declarations concerning the role of the funder, are necessary.