The DTI's Foresight programme exists to produce challenging visions of the future to ensure that we develop effective strategies. The Brain Science, Addiction and Drugs project aimed to provide information on how scientific and technological advancement may impact on our understanding of addiction and the use of psychoactive substances over the next 20 years.
Based on currently available scientific evidence, it looked at scenarios for possible future change. To do this it asked one key question: how can we manage the use of psychoactive substances in the future to best advantage for the individual, the community and society?
Psychoactive substances have always been an integral part of society. For millennia people have been using them in religious rituals and for centuries we have been using birch bark (which contains the active ingredient in aspirin) as a medicine.
A quick look down the aisles of a supermarket confirms how embedded in our culture and expectations these developments have become. But over the past ten years there have been significant advances which have moved us to a new under-standing of how our brains work, and how chemicals affect the brain's performance and our behaviour.
These advances are likely to be applied in three key areas to provide a better understanding of:
- mental health and the development of new treatments for it
- the effects of recreational drugs on different people and how to treat addiction
- cognition enhancers - substances that can enhance the performance of our brain in specific ways
The future for mental health
There is a large unmet need for medicines for mental health which is set to increase as the population ages. Treatments for mental health are therefore likely to develop in a wide range of areas, with new therapies emerging for diseases such as Alzheimer's, Parkinson's and schizophrenia, as well as stress, depression and anxiety.
But given the difficulty of developing drugs that act on the brain's communications systems, other avenues are being pursued such as the use of stem cells to enhance parts of the brain that are underdeveloped or damaged, and the direct electrical stimulation of certain regions of the brain - already an effective treatment for Parkinson's disease - and which Professor Nutt and others at Bristol will soon be trialling for severe depression.
Depression is a growing problem for society. A number of treatments work by raising the levels of serotonin in the patient's brain and it now appears that serotonin may protect the brain by allowing it to repair itself through growing more nerve cell connections or even new brain cells - neurogenesis.
This may open the way for new forms of drugs to treat moods. Behavioural and cognitive therapies are also increasing in importance with the growing recognition that we need to treat the individual's psychology and not just their physiology. In the future, we may see a growing use of mental exercises and this is likely to affect our education programme. There may be games for children that develop their brains to have greater capacity in later life.
Future treatments for addiction
It is undisputed that substance misuse can lead to significant harm to individuals, families and communities. It is estimated that the current total economic and social costs in the UK are in the order of £13 billion a year. The largest part of this relates to the estimated social costs associated with the victims of crime. The potential harm to health is also significant, with around 350,000 problem drug users in the UK.
Significant advances have been made in our under-standing of the changes that occur in the brain when some-one becomes addicted. For instance, vaccines are being trialled that might eliminate the 'reward' gained from taking drugs. This could pave the way to non-addictive recreational drugs. Drugs are also being developed which help people to forget experiences, so it might become possible to 'forget' an addiction.
But this highlights the social issues of such advances, such as the importance of holding on to some memories so we do not make the same mistake twice. David Nutt has been involved in developing a drug that can block the memory-impairing actions of alcohol, while other scientists believe that they could produce a substance with similar effects to alcohol but with fewer harmful effects.
Future use of cognition enhancers
There is likely to be a blurring between drugs taken by someone who is ill and those that require 'mental cosmetics'. New psychoactive substances are being developed which improve performance of the healthy brain and it is likely they may be used more widely by healthy people to optimise their mental performance.
Modafinil, for example, makes the user think through issues more carefully before making decisions, while Ritalin is being used by a small number of students in an attempt to improve exam results and by business people to improve their performance in the boardroom.
In a world that is increasingly stressful and competitive, the individual's use of such substances may move from the fringe to the norm, with cognition enhancers being used as routinely as coffee is today. But given that we do not allow sports people to take performance-enhancing drugs, is it fair to allow others to take cognition enhancers before an exam?
What strategic choices do we face?
Though the effects of these changes are uncertain and some may be far in the future, we need to take action now if we are to manage the risks. We are faced with a number of difficult and sensitive choices but there are no simple decisions as each option includes advantages and disadvantages.
In some areas it is not an either/or, it is more a question of finding the right balance between competing goals. The 'horizon scanning' approach taken by this report articulates Foresight's objective of providing Government and others with challenging visions of possible futures. It does not offer predictions, but it does raise issues and possibilities that policy makers and others might wish to consider.
We gratefully acknowledge access to the Office of Science and Technology's Foresight Report, Drug Futures 2025, July 2005, on which much of this article is based.
Professor David Nutt/Bristol Neuroscience