This article provides an overview of a sociological study of the views of 338 drug addiction treatment professionals. A comparison is drawn between the bioethical approaches of Russian and foreign experts from 18 countries. It is concluded that the bioethical priorities of Russian and foreign experts differ significantly. Differences involve attitudes toward confidentiality, informed consent, compulsory treatment, opioid agonist therapy, mandatory testing of students for psychoactive substances, the prevention of mental patients from having children, harm reduction programs (needle and syringe exchange), euthanasia, and abortion. It is proposed that the cardinal dissimilarity between models for providing drug treatment in the Russian Federation versus the majority of the countries of the world stems from differing bioethical attitudes among drug addiction treatment experts.

This fact casts doubt on credibility and validity of scientific recommendations. Thus, one may say that Russian addiction medicine is not based on evidence, which is, in our view, erroneous and may impair the quality of care.

Finding ways to objectify the diagnostic process is one of the leading problems of modern psychiatry and substance abuse treatment. The main emphasis in diagnosing mental disorders is on identifying symptoms specific to a particular nosological form, and the evaluation of observed psychopathological phenomena is based on the clinical and descriptive method of examination. The latter circumstance can lead to a subjective diagnosis, since the same symptoms may be interpreted differently by researchers.

The problem of off-label therapy of addictive disorders is analyzed in the article. It has been noted that such a practice became widespread due to the position of narcologists called "therapeutic relativism" according to which establishing a "nosological" diagnosis on ISD or DSM was not basic and significant for making a therapeutic decision. Significant is a determination of a psychopathologic syndrome / phenomenon level and existence of the patient's subjective inquiry. It is estimated that the doctor has the right to prescribe a therapy depending on "inquiry" of the person seeking for a medical attention not only in case of disorders detection, but also in cases of the preclinical states. The discussion history on the limits of addictive norm and pathology has counted more than thirty years when there was an opinion that addictive disorders represented the continuum built as disorders increase and excluded existence of differential criteria between the norm and pathology. The problem of diagnostics and therapy intensified with the introduction of ICD-10 which besides the dependence contained nosologically undetermined heading "harmful (with harmful consequences) use of surfactant" (F1x.1). The article makes a conclusion that off-label therapy in a modern addictology can be considered as justified, but only concerning drugs with the proved safe action profile and in case of unfailing adherence to the informed consent principle.

This article examines the psychiatric and political issues surrounding the case of the controversial Russian performance artist Pyotr Pavlensky, who received a number of court-ordered psychiatric evaluations as part of the legal actions initiated subsequent to his political protest actions. The author presents the results of his own clinical investigation into Pavlensky's case, arguing that previous diagnoses made by psychiatrists were unwarranted and unreasonable. This case draws the attention of experts to a problem: the need for more accurate criteria for the differentiation of behavioral disorders from behavior understood locally as socially-deviant. This issue is especially relevant during the assessment of the mental health of persons engaged in socially transgressive behavior which is explicitly framed as aesthetic and political action.