Ecstasy (4-methylenedioxy-methamphetamine, or MDMA) is a drug that is considered to be a psychedelic or hallucinogenic drug, but it also has properties of both stimulant drugs like amphetamines and hallucinogenic drugs like mescaline. The drug was originally used in psychiatry for treatment of individuals with severe disorders, and it is currently under investigation for its utility in the treatment of trauma- and stress-related disorders, such as post-traumatic stress disorder.

The drug also became popular among young adults and adolescents for its euphoric effects and its ability to increase the sociability of individuals who take it. Individuals who take ecstasy report that it makes them more sociable, more empathetic, and friendlier when they are under the influence of the drug.

Other Effects of Ecstasy

 

According to the National Institute of Drug Abuse and the book Principles of Addiction: Comprehensive Addictive Behaviors and Disorders, ecstasy use can lead to various issues, such as:

  • Psychological effects: Individuals may experience anxiety, depression, irritability, aggressiveness, impulsiveness, reduced interest in sex, and reductions in mental abilities for up to a week after using ecstasy.
  • Adverse health effects: Ecstasy users may also experience issues with sleep, anorexia, muscle cramping, profuse sweating, dehydration, blurred vision, nausea, and teeth grinding due to tension. Chronic use may lead to issues with cardiovascular functioning, including high blood pressure, irregular heartbeat, and heart failure. Chronic use of ecstasy can also result in issues with the liver and kidneys.
  • Hyperthermia: Because ecstasy use automatically results in sympathetic nervous system activation that results in hyperthermia (increased body temperature), there is been a concern that most individuals who use the drug do so in restricted, crowded, enclosed areas, such as dance clubs, that are hot and stuffy to begin with. The combination of use of the drug and the surrounding environment has been known to lead to overheating, dehydration, fainting, seizures, and even the potential to become comatose in these situations.
  • Central nervous system effects: When a person uses ecstasy, there is a large-scale release of neurotransmitters in the brain. After a person stops taking ecstasy, there is a rebound effect where there is a severe depletion of these neurotransmitters. This can result in the alteration of many different brain pathways and permanent alteration of certain aspects of neurochemistry, such that the availability of certain neurotransmitters becomes significantly decreased when one is not taking the drug. These results can lead to serious issues with attention, memory, problem-solving, mood (the potential for the development of chronic depression), and other cognitive and emotional issues.
  • Abuse: Due to ecstasy’s euphoria-producing effects, its ability to make individuals feel more sociable, and the fact that it is often used in conjunction with other drugs, it is a drug with a high potential for abuse. Research indicates that tolerance to ecstasy does occur (the need to use more ecstasy to get the same effects that once occurred at lower doses). However, the research does not support the notion that chronic ecstasy use results in the syndrome of physical dependence (both tolerance and withdrawal). Withdrawal symptoms reported in the research literature are most often issues associated with emotional letdown, such as fatigue, difficulty concentrating, loss of appetite, and depression. Thus, the potential for chronic ecstasy use to result in the development of serious physical dependence seems questionable, even though there does appear to be a mild discontinuation syndrome associated with the drug that is primarily psychological or emotional in nature.

Abuse Issues

 

The age group that appears most vulnerable to abusing ecstasy includes those 16-24 years old. There are various signs of ecstasy abuse that one can look for if use is suspected:

  • People who abuse ecstasy will often have a sudden rush of energy and may even appear to be hyperactive. These instances occur most often in social gatherings, such as at parties, dance clubs, bars, etc. This newfound energy results in them being able to dance at clubs and parties for uncharacteristically long periods of time.
  • An individual using MDMA may become overheated rather easily, sweat profusely, and may even complain of being chilled despite this.
  • Ecstasy use results in dilated pupils and sometimes sensitivity to bright lights and loud sounds.
  • Individuals who abuse ecstasy may become uncharacteristically sociable, friendly, affectionate, and talkative in social situations.
  • Individuals using ecstasy often have difficulty sleeping and remain awake for long periods of time.
  • Individuals who abuse MDMA often display a reversal of the extreme energy and sociability after the drug has worn off. In the morning, individuals suddenly become quiet, withdrawn, and even seemed depressed. Like individuals who abuse stimulants like cocaine and methamphetamine, users of ecstasy often refer to this situation as “the crash.” In the case of ecstasy, the crash appears to affect a number of cognitive functions as well as emotional variables. Patterns of extreme sociability, energy, and activity demonstrated in social situations are later followed by periods of withdrawal, apathy, and depression. These patterns are considered to be important indicators that the individual may be abusing ecstasy.

Treatment for Ecstasy Abuse

 

Individuals who have developed a substance use disorder as a result of their use of ecstasy are typically younger individuals who will require significant guidance in the recovery process. Keeping this in mind, the general approach to treating substance use disorders applies to ecstasy users.

  • Younger individuals often benefit from an initial residential treatment program even though the need for withdrawal management in individuals abusing ecstasy may be minimal. However, like with cocaine abuse, once an individual stops using ecstasy, they may experience a crash that results in a number of potentially serious psychological effects. These individuals can be closely observed in an inpatient program.
  • Individuals recovering from ecstasy abuse will need to be fully assessed in the initial stages of the treatment program and may need medically assisted treatments, such as medications for psychological disorders, physical conditions, and perhaps even cognitive issues.
  • During the inpatient treatment process, individuals need to participate in therapy to begin to identify and address the issues that led to their substance abuse.
  • Following residential treatment, therapy should continue.
  • Social support is a key factor in recovery, and this is no less true for younger individuals. Family therapy, group therapy, and participation in social support groups, including 12-Step groups, are extremely important. Long-term participation in treatment is essential.

Because ecstasy is a drug often used by younger people and in the context of social situations, one solid form of treatment is exposing younger individuals to psychoeducation regarding the use of MDMA before it becomes a problem for them. The development of prevention programs in schools and universities to educate individuals regarding the short-term and long-term dangers of use of this and other drugs is a solid form of intervention. The development of advocacy groups led by individuals in recovery or even peer-led advocacy groups could be an effective intervention.