Ecstasy (MDMA) is a synthetic man-made drug that is similar to stimulant drugs like amphetamines and hallucinogenic drugs like mescaline. The drug was originally used in the treatment of psychiatric patients, and there are still some clinical trials investigating its utility in this respect. The drug became popular as a club drugs in the 1990s and early 2000s due to its hallucinogenic effects and its reputed ability to make people feel more sociable and empathetic.
Traditionally, ecstasy tablets were made of MDMA, which was artificially produced. Tablets and powdered forms of MDMA sold for illicit use were typically in the range of 30-40 percent pure MDMA, and the rest of the drug typically consisted of bulking agents to “cut” the drug and increase profits for dealers. Over time, the drug has become even less pure. The drug is illegal in most countries, and the ingredients that are required to make synthetic drugs like MDMA are becoming more difficult to obtain. This has resulted in the composition of drugs sold as ecstasy being far less pure than they were in the past.
According to the National Institute on Drug Abuse (NIDA), many forms of ecstasy today do not include the primary ingredient MDMA. A number of other drugs and ingredients are often included, such as methamphetamine, para-methoxyamphetamine (PMA, a synthetic hallucinogen drug), cocaine, synthetic cathinones (bath salts), ketamine, or over-the-counter cough medicines. These mixtures can be dangerous, and when individuals combine what they believed to be ecstasy with other drugs, there may even be a higher risk for harmful effects.
The Effects of Ecstasy
According to NIDA, the effects of ecstasy include the following:
- Euphoria and increased sociability: Many individuals who abuse ecstasy use it for its ability to produce euphoria, mild feelings of wellbeing, increased sociability and friendliness, and stimulant effects as well as its reputed ability to enhance sexuality. However, as tolerance to the drug develops rapidly and the effects of taking higher amounts of the drug are much more negative for most individuals, the perceived positive effects are often short-lived.
- Hyperthermia: Taking ecstasy activates the division of the peripheral nervous system known as the sympathetic nervous system. This system generally speeds up bodily processes when activated. People who use ecstasy in clubs where it is crowded due to poor ventilation or at crowded parties run the risk of becoming overheated. As a result of hyperthermia, individuals also run the risk of becoming dehydrated due to excessive perspiration, developing seizures, and becoming comatose.
- Additional physical issues: Using ecstasy is associated with disruptions in REM sleep, muscle cramping, loss of appetite, blurred vision, nausea, vomiting, grinding of the teeth that can lead to issues with dentition, and significant issues with judgment.
- Cardiovascular issues: Chronic use of ecstasy is associated with a number of cardiovascular effects, including the development of hypertension, tachycardia, and potential heart attack.
- Other organ damage: Chronic ecstasy use is associated with damage to the kidneys and liver.
- Psychological issues: Ecstasy users often experience issues with anxiety, irritability, increased aggression, impulsive behavior, reduced sex drive, and depression as a result of the massive release of neurotransmitters in the brain when one takes the drug and the subsequent depletion of these neurotransmitters when one has stopped taking the drug.
- Central nervous system and cognitive effects: The cycle of massive neurotransmitter release while taking a drug followed by neurotransmitter depletion later can result in an alteration of pathways in the brain. The book Principles of Addiction reports a number of cognitive issues observed in long-term users of ecstasy that include issues with focusing attention, recall for recent information, problem-solving abilities, and depression that are believed to be related to changes in the brain.
- Physical dependence: There is an increased probability that chronic users of ecstasy will develop physical dependence. The research does indicate that individuals who use ecstasy develop tolerance; however, the research is mixed on the severity of any withdrawal symptoms that occur as a result of discontinuation of ecstasy. Some research reports symptoms that are primarily emotional in nature, such as depression, fatigue, distractibility, difficulty with sleeping, and loss of appetite. These symptoms suggest that there is a mild withdrawal syndrome associated with discontinuation of ecstasy; however, the withdrawal syndrome is not believed to be potentially physically dangerous.
- The development of a substance use disorder: Despite the mild controversy regarding the ability of ecstasy to produce serious physical dependence in chronic users, there is no controversy regarding the potential for the drug to result in an individual developing a substance use disorder.
The American Psychiatric Association now defines terms such as addiction and substance abuse under the general heading of substance use disorders. Other organizations, such as the American Society of Addiction Medicine, also use this term. This term embraces all the notions of dysfunctional substance use in a singular heading. According to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5), an individual who has a substance use disorder as a result of using ecstasy would be classified with a hallucinogen use disorder.
Only a trained and licensed mental health clinician can formally diagnose any substance use disorder. The signs of a hallucinogen use disorder as a result of use of ecstasy would include satisfying the diagnostic criteria in the DSM-5 as well as some other signs specific to ecstasy use.
- Those using ecstasy often have sudden rushes of energy and may present as being hyperactive. Most often, these individuals display this behavior at clubs or other social gatherings. When not at such affairs, the individual may be more reserved.
- Those under the influence of ecstasy have dilated pupils and may be sensitive to light. They also may become overly affectionate and talkative. The combination of dilated pupils, uncharacteristic talkativeness, and uncharacteristic sociability in a younger individual could suggest ecstasy use.
- Those on ecstasy become overheated very quickly. Individuals at parties or clubs who sweat profusely and complain of having chills in spite of perspiring may be using ecstasy.
- Because of ecstasy’s stimulant properties, users are often unable to sleep for uncharacteristically long time periods. After the drug has worn off, these individuals may become lethargic, withdrawn, and even depressed. Individuals who display instances of extreme sociability and energy followed by periods of social withdrawal and depression may be using ecstasy.
People with hallucinogen use disorders as a result of ecstasy use are typically younger (in the 16-24 age range). These individuals often require firm guidance and direction during recovery. In general, the treatment approach should consider the following:
- Individuals in this age group often benefit from initial residential treatment in order to isolate them from potential triggers and to assist them in overcoming the issues with depression, apathy, and lethargy that often occur once the drug is discontinued. Residential treatment also allows these individuals to develop strong relationships with others who have similar problems.
- If residential treatment is not an option, then the person should be monitored closely by an addiction medicine physician as well as by their therapists and other treatment providers as an outpatient. An intensive outpatient treatment program should be considered where practical.
- During the initial stages of treatment, a full physical, psychological, and cognitive evaluation should be conducted. Individuals with substance use disorders often have a co-occurring mental health diagnosis that needs to be identified as well as other cognitive issues as a result of chronic ecstasy use.
- Substance use disorder therapy and social support group participation should be initiated at the very beginning stages of the treatment process. Patients should be monitored by a physician and medical management of their issues should be ongoing.
- Therapy and/or social support group participation should continue following the completion of any residential treatment or intensive outpatient treatment. Social support group participation in the form of 12-Step group participation should be considered.
- Family support is essential for clients throughout the recovery process. In some cases, family therapy may be warranted.
- Any other services or interventions that are appropriate for the particular individual’s situation should be applied as soon as possible.
As the primary group that abuses ecstasy is the adolescent and young adult group, it is extremely important that therapy contains some form of psychoeducation that addresses the issues associated with use of drugs like ecstasy.
All substance use disorder treatment programs should be considered as long-term approaches.