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Ecstasy Addiction: Recognize the Signs (A Guide)

The drug ecstasy is a popular name for the chemical 3,4-Methylenedioxymethamphetamine, or MDMA. Ecstasy is typically considered a “club drug” since it is mainly consumed in social settings such as raves, concerts, nightclubs, and similar locations or events. Although ecstasy is a Schedule I drug according to the Drug Enforcement Administration (DEA), the chemical originally was developed as a prescription drug until it became widely abused. Its medical uses were outweighed by the potential for harmful effects of use such as addiction. 

Ecstasy Abuse Started With Pharmacology 

MDMA was developed as a potential pharmaceutical chemical in 1912 by a German pharmaceutical company. It was intended as an appetite suppressant because the foundation is an amphetamine. However, in the late 1970s, therapists hoped to use the substance to improve marriage counseling and psychotherapy for some forms of trauma. Although in small doses, ecstasy can cause emotional detachment, and in larger doses, it can be highly intoxicating in a psychedelic way, which leads to cravings and compulsive behaviors associated with addiction. 

Ecstasy became illegal in the U.S. in 1988 when it was moved to Schedule I. Through the late 1980s and into the 1990s, the drug was increasingly found at parties and larger social events, especially raves and dance parties. As the drug was sold only illicitly, the substance’s purity decreased. Today, many adulterants, including ketamine, synthetic cathinones such as bath salts, fentanyl, and other amphetamines, are mixed into ecstasy.

When MDMA is in the form of ecstasy, it is typically sold in pill form, but it also can be found as a powder, liquid, or gel tab. It is most often eaten, but ecstasy may sometimes be snorted or smoked. Injection of ecstasy is rare.

When swallowed, ecstasy’s effects typically begin within 20 to 40 minutes, with peak effects occurring between 60 to 90 minutes after that. Many of the drug’s effects can last for up to six hours, which can cause the individual to experience a “comedown,” which is a condition similar to a hangover that can last up to two days.

Although ecstasy is not as widely abused now as it was in the 1990s, many people still struggle with the drug, including adolescents. The Monitoring the Future Survey (MTF) for 2017 found that 1.5 percent of eighth-graders, 2.8 percent of 10th-graders, and 4.9 percent of 12th-graders had ever tried ecstasy; 0.4 percent of eighth-graders, 0.5 percent of 10th-graders, and 0.9 percent of 12th-graders abused the drug at least once in the prior month. 

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Short-Term Effects Cause Harm

Ecstasy releases a flood of dopamine and serotonin in the brain. These neurotransmitters are associated with higher physical energy, elevated mood, and pleasurable changes to sensory experiences. These neurotransmitters can cause negative side effects while there is a surge of them in the brain and as they begin to wear off. Some of those side effects are:

  • Heightened senses
  • Euphoria
  • Losing touch with reality
  • Empathy
  • Anxiety or panic attacks
  • Muscle tension
  • Involuntary jaw clenching
  • Grinding of teeth
  • Nausea and vomiting
  • Elevated body temperature, leading to hyperthermia
  • Extreme sweating
  • Dehydration
  • Heat exhaustion
  • High blood pressure
  • Rapid heartbeat
  • Fast breathing rate
  • Fainting
  • Chills and clamminess
  • Blurry or double vision

Dehydration, rapid heartbeat, and hyperthermia can all lead to severe health problems like kidney failure, which may require hospitalization. Most ecstasy-related deaths that have been reported involve heat stroke and dehydration. The drug increases internal temperature and is associated with social situations in which someone is dancing or sweating a lot, and may be ignoring how much water they need. Although ecstasy is involved in this kind of acute health problem, it is not an overdose.

However, ecstasy can cause an overdose, and there are certain symptoms to watch for. Among them are:

  • Hypertension
  • Chest pain and heart attack
  • Panic attacks
  • Loss of consciousness
  • Seizures

After the first dose of MDMA is consumed and the body metabolizes it, the chemicals created as by-products interfere with metabolizing additional doses. Therefore, ecstasy can pile up in the body and reach lethal doses very quickly.

Taking ecstasy with caffeine, amphetamines, synthetic cathinones, marijuana, and alcohol also increases the risk of acute health issues.
If someone shows any of the above symptoms, call 911 immediately. Whether they’re suffering from heat stroke associated with drug abuse or specifically suffering from an ecstasy overdose, they need medical attention immediately.
In the hours when ecstasy wears off and neurochemistry changes, a person’s perception of their surroundings may change, so they may have slower reaction times, difficulty judging distances, and trouble with controlling their body. This can lead to problems like falling or having a car accident, which can result in significant injury or even death.

The Ecstasy Comedown

A comedown from drugs is a little bit like having a hangover from drinking too much alcohol. The term was developed as a reaction to the mood and physical effects caused by ecstasy after a night of partying, which can take two or three days to recover from. The condition is also sometimes euphemistically called the “midweek flu,” as that is when comedown symptoms from a night of partying on ecstasy can feel the most intense. Comedown symptoms include:

  • Depression
  • Anxiety
  • Paranoia
  • Fatigue
  • Dizziness

It is rare that comedowns lead to binges, but some people may take more ecstasy to alleviate the discomfort of this condition. More often, people party over the weekend and suffer the ecstasy comedown throughout the week.
People who experience more intense comedown symptoms may be more likely to struggle with ecstasy withdrawal symptoms. An experience of comedown symptoms, in one study, was found to increase the potential of withdrawal symptoms between 1 percent and 11 percent among those who experienced intense comedown symptoms, and 75 percent for those who had “regular” comedown symptoms.

Long-Term Ecstasy Abuse Causes Brain Damage

Repeated ecstasy abuse can lead to chronic health problems. 

  • Confusion about surroundings
  • Memory loss
  • Trouble learning
  • Depression
  • Cravings for ecstasy
  • Anxiety disorder
  • Paranoia
  • Sleep disturbances, including chronic insomnia
  • Impulsivity problems

When compared to cocaine or meth binges, ecstasy binges are rare, but they do occur. Consistent abuse of ecstasy for several days can drastically deplete neurotransmitters in the brain, making it harder for the brain to stabilize. In addition, ecstasy can cause damage to the cardiovascular system, leading to chronic arrhythmias and other damage to the heart muscle.

Some studies also have found that long-term ecstasy abuse can cause brain damage. A small study using MRIs of 10 participants’ brains measured the volume of the hippocampus, which is a part of the brain believed to be responsible for long-term memory. In the participants who abused ecstasy, hippocampal regions were 10.5 percent smaller than in the group who had not tried ecstasy. Gray matter was reduced as well, by 4.6 percent on average.

The National Institute on Drug Abuse (NIDA) also reports that neurotoxic symptoms may be associated with long-term ecstasy abuse. These include:

  • Reduced serotonin
  • Less available serotonin metabolites
  • Reduced number of serotonin transporters
  • Degeneration of serotonin terminals

If the brain is physically less able to produce serotonin, then depression or anxiety can result. Other mental illnesses such as bipolar disorder or schizophrenia also can be triggered by the sudden, intense change in neurochemistry associated with ecstasy abuse, if the person is at risk of developing these conditions.

Withdrawal Requires Medical Supervision

Withdrawal symptoms from ecstasy can be uncomfortable. People who experience ecstasy withdrawal may experience:

  • Insomnia
  • Confusion and disorientation
  • Irritability, anxiety, and restlessness
  • Depression
  • Impulsiveness and aggression
  • Trouble focusing on tasks
  • Memory problems
  • Reduced appetite

The body may not develop a dependence on ecstasy, but the brain loses the ability to produce enough dopamine and serotonin for a few hours or days. This can lead to cravings for the drug to rebalance brain chemistry.

Withdrawal symptoms from abusing ecstasy consistently are affected by individual factors, such as age, gender, body weight, how much of the drug was abused, how long the drug was abused, hormone levels, history of drug abuse, genetics, family history, and environmental stress. Detoxing from ecstasy should only take up to 10 days, but for some people, post-acute withdrawal syndrome (PAWS) can develop because moderating brain chemistry takes much longer than overcoming stomach cramps or nausea. It is important to get medical supervision during detox to avoid PAWS.

Is Addiction Possible?

Research has not conclusively determined that ecstasy or MDMA is addictive. The drug causes an intense surge in neurotransmitters that also are associated with the brain’s reward system, and some studies in animals have found that test subjects will repeatedly self-administer ecstasy, which is an indicator of cravings and addiction. However, animals in studies have abused MDMA at lower rates than other stimulants like cocaine, so the addiction potential of the drug may be lower.

Since ecstasy is mainly abused in social situations, and very rarely abused alone or in small groups, it is hard to know from human behaviors if the drug can cause addiction. Some people show signs of compulsions associated with addiction, leading to consistently taking the drug and taking larger doses as the body develops a tolerance to it; however, even among people who regularly take the drug, many people are able to simply stop taking it when they are removed from the setting.

Even so, many people develop an addiction to ecstasy and need help quitting the drug. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are 11 criteria used to diagnose an addiction or substance use disorder. They can be applied to ecstasy use.

  1. Taking more ecstasy than intended or taking it for longer during an event than intended
  2. Wanting to quit or repeatedly trying to quit using the drug but relapsing
  3. A lot of time is devoted to obtaining ecstasy, using it, and recovering from its effects
  4. Intense cravings to use the drug or be in situations, like clubs or raves, where the drug is commonly used 
  5. An inability to meet obligations at work or school, or with friends and family, due to ecstasy use
  6. Harm to personal relationships because of the drug use 
  7. Giving up hobbies or activities to abuse ecstasy instead 
  8. Abuse of ecstasy that results in dangerous situations, like driving while under the influence
  9. Physical or psychological problems because of ecstasy, but abuse of the drug continues 
  10. Physical tolerance to the drug develops
  11. Withdrawal symptoms occur when the drug cannot be taken

Experiencing at least two of these symptoms in one year (12 months) can lead to a diagnosis of addiction or substance use disorder. A mild addiction is two or three of these symptoms; moderate addiction is four or five symptoms; and severe addiction is six or more symptoms in a year. If a loved one displays these symptoms, you should encourage them to find evidence-based detox and rehabilitation to overcome ecstasy addiction, which can otherwise lead to chronic illness, loss of mental capacity, or death. 

Treatment to Overcome Ecstasy Abuse

As with other addictions, the best course of treatment for ecstasy abuse is evidence-based: medically supervised detox followed by behavioral therapy in a rehabilitation program. There are no drugs to taper someone off dependence on ecstasy, so the main focus of detox is to manage physical symptoms during the week it takes for the body to process the drug. Behavioral therapy is useful to most people who need treatment to overcome ecstasy abuse.

Sources

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Drug Fact Sheet: Ecstasy or MDMA. Drug Enforcement Administration. from https://www.dea.gov/druginfo/drug_data_sheets/Ecstacy.pdf

MDMA (Ecstasy/Molly): Statistics and Trends. National Institute on Drug Abuse. from https://www.drugabuse.gov/drugs-abuse/mdma-ecstasymolly

MDMA (Ecstasy/Molly). (June 2018). National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly

MDMA (Ecstasy) Abuse: What Are the Effects of MDMA? (September 2017). National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-are-effects-mdma

What Is a Comedown? (2017). DrugWise. from http://www.drugwise.org.uk/comedown/

The Effect of the Ecstasy “Come-Down” on the Diagnosis of Ecstasy Dependence. (June 1, 2014). Drug and Alcohol Dependence, ScienceDirect. from https://www.sciencedirect.com/science/article/pii/S0376871614007522

The Neurobiology of Ecstasy (MDMA). (January 2007). National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-ecstasy/section-iii/2-long-term-effects-ecstasy-neurotoxic

MDMA: What You Need to Know About Molly. (June 29, 2017). Medical News Today. from https://www.medicalnewstoday.com/articles/297064.php

MDMA (Ecstasy, Molly) Drug Withdrawal Symptoms: What You May Experience. (March 9, 2014). Mental Health Daily. from https://mentalhealthdaily.com/2014/03/19/mdma-ecstasy-molly-drug-withdrawal-symptoms-what-you-may-experience/

MDMA (Ecstasy) Abuse: Is MDMA Addictive? (September 2017). National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/mdma-addictive

DSM-5 and Its Use by Chemical Dependency Professionals. (September 27, 2014). NAADAC 2014 Annual Conference and 40th Anniversary Celebration. from http://www.naadac.org/assets/1959/greg_bauer_-_dsm-5_and_its_use_by_chemical_dependency_professionals_09272014_naadac.pdf

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