MDMA for treating alcoholism is now being examined for its effectiveness in combating this disease. In discussing the mechanisms of action of MDMA it is importantto stress that there remains a lack of scientific consensus around it’s pharmacology.
MDMA as most people know is the substance known as “ecstasy” in street lingo. Studies in the U.K. have been underway for more than a decade and the findings, although early in their process (relaively speaking) show some promising signs. The known pharmacology of MDMA, which has been elegantly described in the past as “messy”, means that attempts to subsequently relate it’s pharmacology to predict-able psychological effectsea nd, furthermore, how these effects might impact on MDMA-assisted psychotherapy is even more complex, says an article on DrEssa.com.
The capacity for MDMA to increase feelings of empathy and compassion for the self and others may contribute to improved self-awareness and subsequently reduce the denial of alcohol misuse. In summary, MDMA has the potential to enhance and intensify the psychotherapeutic processes in the treatment of alcohol use disorder. It may also address symptoms of other conditions that are frequently comorbid with substance use disorders, particularlythose symptoms associated with a history of psychological trauma, and is well-tolerated. As such, there is a possibilty that using MDMA for treating alcoholism might be viable at some point.
Origins of the Treamtent Studies
A team in Russia in the 1990s, driven by the theory behind the1950s and 1960s studies, investigated the potential role for Ketamine-assisted psychotherapy for both alcohol and opiate use disorders. Placebo-controlled studies on more than 1000 patients showed Ketamine psychotherapy produced total abstinence for more than one year in 66% of the alcoholic patients compared to 24% of the control group (Krupitsky and Grinenko, 1997). A revisiting of Ketamine therapy for treating alcohol use disorder is currently underway in Exeter, UK. Psychedelic psychotherapy as a treatment for substance usedisorders was reviewed in 2012 in a paper by Michael Bogenschutz and Pommy, in 2012. Bogenschutz subsequently carried out a single-group proof-of-concept study on 10 volunteers with alcohol usedisorder. Participants received two doses of psilocybin in combination with 12 weeks of outpatient psychosocial treatment ncluding Motivational Enhancement Therapy. Results showed abstinence increased significantly following psilocybin administration and the gains were maintained at follow-up to 36 weeks (refer to Bogenschutz et al., 2015). Another recent psychedelic-assisted research study for treating other substance use disorders was a small psilocybin-assisted psychotherapy pilot study for nicotine use disorder, which produced abstinence rates from cigarette smoking that far exceeded those of current available nicotine cessation treatments (Johnsonet al., 2014). The psychedelic compound ayahuasca has also been explored as a treatment for several different substance use disorders (Loizaga-Velder and Verres, 2014), with one Canadian study showing significant results for ayahuasca improving abstinence from cocaine use disorder (Thomas et al., 2013). To date there have been no published studies proposing MDMA Therapy as a treatment for any substance use disorders.
Will MDMA work for addictions?
Whilst the classical psychedelics (including LSD and psilocybin)have a rich history in thefield of substance use disorders, MDMAhas never been explored. Furthermore, the popular press is abun-dant with tens of thousands of anecdotal reports of how LSD and magic mushrooms, taken recreationally or in semi-therapeutic underground conditions, have helped drinkers to overcome theiralcohol use disorder. However, there is a notable scarcity of anecdotal stories stating how ecstasy cured my alcoholism. This is important because convincing the general public that using MDMA for treating alcoholism will have to pass the litmus test of acceptance by the general population.
How MDMA therapy works
In discussing the mechanisms of action of MDMA it is importantto stress that there remains a lack of scientific consensus around it’spharmacology. The known pharmacology of MDMA, which has been elegantly described in the past as“messy”(Ray, 2016), meansthat attempts to subsequently relate it’s pharmacology to predict-able psychological effectseand, furthermore, how these effectsmight impact on MDMA-assisted psychotherapy – is even more complex. Nevertheless, an attempt to reflect on this challenge ispostulated below. MDMA is a ring-substituted phenethylamine that exerts is effects through promoting raised levels of serotonin, dopamine andnoradrenaline.
Is MDMA therapy safe?
MDMA therapy is not without its challenges. Some users ofclinical MDMA experience an increase in anxiety associated withderealisation-type experiences (Mithoefer et al., 2010). Acuteneurocognitive effects include a transient reduction in verbal andvisual memory, which tend to resolve after the acute subjective psychological effects of the drug have worn off (Kuypers andRamaekers, 2007). MDMA possesses only mild abuse potential. Inthe limited studies in which MDMA has been administered clini-cally in a therapeutic setting to healthy volunteers without anyprevious experience with ecstasy, subjects did not express a wish touse it outside of the clinical setting. and in the recent MDMA-PTSD studies carried out, illicit use ofecstasy after having used it clinically is very rarely observed(Mithoefer et al., 2013).Acute MDMA produces increased blood pressure and heart rateand an increase in body temperature (Harris et al., 2002; Mas et al.,1999). Jaw tightness, bruxism, reduced appetite, poor concentra-tion and impaired balance are also common (Mithoefer et al., 2010;Oehen et al., 2013). When the recreational drug ecstasy is taken outside of the clinical setting, more serious adverse effects havebeen observed, including hyperthermia, liver disease and hypona-traemia (Rogers et al., 2009). But these are all features that can beeasily controlled for in a clinical setting in which vulnerable pa-tients can be screened, participants’ vital signs are monitored throughout the MDMA session and follow-up sessions providepost-session support. There remains much work to be done to convince a doubting medical profession and cautious governments that a compoundthat is experienced recreationally by hundreds of thousnads of people every weekend may also, in its clinical form, have benefits for pa-tients suffering with substance use disorders (Sessa, 2017b). Regulatory approvals associated with MDMA’s status as a scheduleone drug continue to hamper research; adding unnecessary coststhat put research beyond thefinancial capabilities of many academic institutions and hold back progress. We have a long way to go before we can seriously look at MDM for treating alcoholism and possibly someday, opiate addiction.