Ecstasy is a recreational drug used primary by those between the ages of 12 and 17. Older individuals also report use, but without the prevalence of the younger users. In the scientific and substance use community, ecstasy is often referred to by its chemical composition, which is 3,4-methylenedioxymethamphetamine (MDMA). It is a stimulant and a hallucinogenic. Ecstasy is known by multiple street names, such as Molly, E, X, ETC, and many others.
Ecstasy (at the time known simply as MDMA, its chemical composition) was manufactured by Merck pharmaceuticals in the early 1900s. During the 1970s and 1980s, some psychiatrists began to use ecstasy with their clients because of its helpful effects, even though it had never been approved by the Food and Drug Administration (FDA). Because it lowers inhibitions and gives the user a sense of connectedness to others, therapists felt that these effects helped the therapeutic relationship and led to more substantive work in therapy. Ecstasy came on the scene as a recreational drug shortly thereafter. It became popular among adolescents and younger adults at dance clubs or long dance parties called raves.
More recently, in 2014, Imperial College London published its findings relating to therapeutic uses of ecstasy. Its early findings suggest that ecstasy (MDMA) may be helpful in treating anxiety and post-traumatic stress disorder, commonly referred to as PTSD. Their study is the first of its kind to use fMRI (function magnetic resonance imaging) to examine the resting brains of ecstasy users. One must weigh, however, those uses with the degree of harm caused by this potentially addictive drug.
What Is Ecstasy?
Ecstasy is designated as a Schedule I drug by the US Drug Enforcement Agency (DEA). meaning that it is likely to be abused, there is no accepted medical use for the drug in this country, and there is no safe use even under medical supervision. The general consensus is that ecstasy use is dangerous, but one study examined potential for harm as compared to other drugs. In the Lancet, a group of British researchers ranked 20 illicit drugs, with a value of one being the highest. Ecstasy ranked near the bottom, coming in at number 16.
The substance is usually taken orally but may be snorted for a quicker onset. Although rare, it may be injected or smoked. It usually comes in a multitude of colors with designs on the tablets. The average dose is 50-milligram or 150-milligram tablets, with effects that last approximately 4-6 hours. Some individuals will take another pill when the effects of the initial dose begin to wear off.
Ecstasy influences the levels of three important neurotransmitters in the brain: dopamine, which causes euphoria and increased energy; norepinephrine, which regulates blood pressure and heart rate; and serotonin, which affects mood, appetite, sleep, and other functions. Serotonin is the neurotransmitter that most governs an ecstasy user’s behavior when they are experiencing a high. Ecstasy inhibits serotonin after it is released and, in the short-term, prevents its reuptake (reabsorption). This process increases the level of serotonin in the brain, which causes increased pleasure.
Once it is taken, there is about a 30-45-minute lapse before it takes effect, depending on the dosage. The user begins to feel euphoric due to the stimulant and psychedelic properties of the ecstasy. In addition, they are flooded with feelings of social and emotional connectedness to others, empathy, an increase in motor activity, and an increase in tactile stimulation. Ecstasy is often taken in dance clubs or other places where there are lights, colors, and noise, as it amplifies the experience because of the changes in sensory perception. It significantly alters the user’s faculties and judgment, which can be very dangerous if an ecstasy user, for example, attempts to drive a car or jump from something, such as a stage.
In addition to those inherent dangers, ecstasy is often made with other harmful drugs, which are unknown to the user. These are called adulterations. The Center for Substance Abuse Research found that substances like methamphetamine, ketamine, cocaine, bath salts, dextromethorphan (a non-prescription cough suppressant), ephedrine, and caffeine are mixed in with “standard” ecstasy. When a user takes a standard dose of significantly adulterated ecstasy, it may be lethal.
Who Uses Ecstasy? A Snapshot
According to the National Drug Intelligence Center (NDIC), most ecstasy users start as teenagers or young adults. Ecstasy is relatively inexpensive compared to other drugs, running approximately $20-30 per pill. This cost makes the drug relatively accessible.
The National Institute on Drug Abuse (NIDA) has found that the demographic of the typical ecstasy user has seen many changes, expanding from Caucasian youth to more ethnic groups, including use by African Americans in their 20s and 30s. New York suggests that there is increased prominence in non-Caucasian communities. In its National Drug Threat Assessment, the US Drug Enforcement Agency reports that ecstasy is trafficked into the country via many routes in Washington, Michigan, New York, and Vermont.
NDIC also found that more than 10 percent of high school seniors have tried ecstasy at least once, and more than 2 percent had used the drug in the past month. The National Institute on Drug Abuse (NIDA) offers key statistics that support an increase in ecstasy use. In the 2015 Monitoring the Future Study,both 10th graders and 12th graders reported ecstasy use that was statistically significant from the year before. Of 10th graders, 3.8 percent had used the drug over the course of their lifetime; 5.9 percent of 12th graders reported that they had previously used ecstasy. The age 18 and older group did not have statistically significant results from 2014. This study reinforces the cause for alarm regarding growing ecstasy use as early as middle school.
Ecstasy doesn’t appear to cause severe physical dependence like other substances of abuse, like alcohol and benzodiazepines. In animal studies, ecstasy has been shown to have some physical dependence potential, but its primary hold is believed to be via psychological dependence.
The signs of growing addiction to ecstasy are not that different from physical dependence on many other drugs. Some include:
- Preoccupation with the drug
- Increased tolerance
- Decline in other areas of life (e.g., work, school, relationships, finances, etc.) due to ecstasy use
- Continued use despite demonstrated negative consequences
- Spending an abundance of time on things related to ecstasy use
Withdrawal from Ecstasy
Ecstasy doesn’t result in significant physical dependence; however, there are withdrawal symptoms that may occur as ecstasy is continually metabolized and depleted from the body. Users may experience the following withdrawal symptoms:
- Cravings for more ecstasy
- Lack of appetite
- Problems with sleep
- Sadness to the degree of clinical depression
- Irritability and aggression
- Attention and memory difficulties
- Delusions (in severe cases)
These symptoms can last up to a week or more, and they are especially prominent if the user has used ecstasy with another substance, such as alcohol or marijuana.
In 2013, the Drug Abuse Warning Network, part of the Substance Abuse and Mental Health Administration (SAMHSA), reported that the estimated amount of emergency room visits related to ecstasy use increased by 128 percent from 2005 to 2011. For each year, there was an increase in the number of visits that were attributable to ecstasy and alcohol in the under-21 population.
While the drug may seem harmless to users, it is possible to overdose on ecstasy. There are much more serious complications for users who continue taking additional pills before they are metabolized by the body. For instance, it’s common for a user to takes a pill and then take another four hours later. Oftentimes, users may repeat this binge use repeatedly. If they do so, the drug builds to high levels in their system and can be fatal. This is called “piggybacking.”
Ecstasy overdose can be fatal or result in serious, long-term injury. Any of the following symptoms constitutes a medical emergency:
- Hyperthermia (significant increase in body temperature)
- Organ failure due to higher body temperature
- High blood pressure
- Abnormal heartbeat (tachycardia)
- Loss of consciousness
Hyperthermia is the most lethal of these symptoms and can happen easily in a scenario where the user becomes dehydrated, such as dancing in a very hot club without taking in sufficient fluids or by consuming alcohol with ecstasy. This triggers body temperature to continue to rise to near fatal levels. Organs may shut down and blood pressure can soar. If overdose is suspected, call 911 immediately.
Treatment for Ecstasy Abuse and Addiction
Inpatient programs often offer medical detox, a process where the user may withdraw from substances of abuse under medical supervision and address any complications that arise during this process. Often, this involves the administration of approved medications to keep the individual more comfortable as they experience withdrawal. With regard to ecstasy, studies do not identify a need for medical detox. There are no medical treatments approved for ecstasy withdrawal. In some instances, however, medications may be used to address specific symptoms of withdrawal, such as antidepressants to aid in mood stabilization.
A comprehensive treatment program is needed to address the reasons that led to substance abuse in the first place. Without addressing these issues, relapse following withdrawal is likely. Working on a plan for relapse prevention becomes the central focus of treatment.
Therapists and medical professionals assist clients in developing treatment goals and help to facilitate their success. In additional to individual therapy, clients will spend time in group therapy and support groups, such as those in the 12-Step style, where they will meet others who identify with their struggles. This helps clients to begin to build a support system that will carry them into ongoing recovery.
Per NIDA, behavioral therapies can be vital in the treatment of addiction, helping clients to adjust behaviors and thoughts related to substance abuse. Cognitive Behavioral Therapy (CBT) is a commonly used approach. In CBT, a therapist works with the client to identify persistent negative thoughts and employ a number of techniques to help the individual change the thought patterns that have driven negative behaviors. The tools learned in CBT and other behavioral therapies can help the client build new coping skills that don’t involve ecstasy or other substances.
Clients come to addiction treatment shouldering a heavy burden, but they don’t have to manage that burden on their own. In the secure and supportive environment provided, they can examine their reasons for ecstasy use and work to manage triggers by gaining insight into their previous choices and behaviors. Ultimately, the treatment process is built on the concept of empowerment, which can lead to sustained change. With effective treatment, clients can acquire the skills needed for recovery and thus are better prepared to make the transition to a new life in recovery.