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Article Excerpt
Young adults' 3,4-methylenedyoxymethamphetamine (MDMA) use is a national public health concern. Although research on the epidemiology of MDMA use has increased, inquiry into intervention and treatment is needed. The authors examine results from an epidemiological investigation from a clinical perspective and provide suggestions for clinicians working with MDMA users.
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Research shows that 3,4-methylenedyoxymethamphetamine (MDMA), commonly known as ecstasy, is currently one of the more popular recreational drugs in the Western world (Corapcioglu & Ogel, 2004; Martins, Mazzotti, & Chilcoat, 2005). A synthetic analog to amphetamine with hallucinogenic features similar to those of mescaline, MDMA is often described as an entactogen (defined as to produce a touching within) for its ability to heighten but not distort sensory perceptions (Gahlinger, 2004). Merck Pharmaceuticals developed MDMA in 1914 as an appetite suppressant. However, results from initial animal drug testing were inconclusive, and MDMA originally was not tested on humans (Connor, 2004). In the 1960s and 1970s, MDMA was used to heighten sensory experience, both recreationally and psychotherapeutically. In 1965, psychiatrists began prescribing MDMA to enhance introspective states, communication, and intimacy (Martinez-Price, Krebs-Thomson, & Geyer, 2002). However, in response to subsequent reports of neurotoxicity in 1985, the Food and Drug Administration classified MDMA as a Schedule 1 controlled substance (i.e., no approved medical use, high abuse potential, and lack of accepted safety for use in medical purposes), and its use was made illegal (Freese, Miotto, & Reback, 2002).
MDMA has complex neuropharmacological effects through stimulating acute release of serotonin (Croft, Klugman, Baldeweg, & Gruzelier, 2001; Maartje et al., 2004), dopamine (Colado, O'Shea, & Green, 2004), noradrenaline (Back-Madruga et al., 2003), acetylcholine (Montoya, Sorrentino, Lukas, & Price, 2002), and histamine (Martinez-Price et al., 2002). Typical effects of MDMA use include a relaxed, euphoric state; teeth grinding (bruxism); jaw rigidity (trismus); emotional openness; increased empathy, extroversion, and physical energy; and a decrease in inhibitions (Pape & Rossow, 2004). Acute neuropsychiatric effects include moderate derealization, depersonalization, thought blocking, impaired decision making, and slight elevation in anxiety (Schifano, 2000). The physiological influences of MDMA use include hyperthermia, increased heart rate, and elevated blood pressure (Croft et al., 2001).
At higher or repeated doses, MDMA has been found to be neurotoxic to serotonin systems in the brain of primate and other animal species, resulting in a user's vulnerability to depression (Dafters, Hoshi, & Talbot, 2004; McGregor et al., 2003), anxiety (Dughiero, Schifano, & Forza, 2001; Parrott et al., 2002), impulsivity (Curran, Rees, Hoare, & Bond, 2004; Moeller et al., 2002; Morgan, 1998), and other mood impairment (Maartje et al., 2004; McCardle, Luebbers, Carter, Croft, & Stough, 2004). Chronic MDMA users report short-term and long-term memory deficits (McCardle et al., 2004) and greater risk of immunosuppression (Connor, 2004) and Parkinson's disease (Kuniyoshi & Jankovic, 2003). Research also suggests that physical and psychological morbidity (e.g., depression, anxiety, and heightened mood swings) from this drug are increasing, especially among adolescents and young adults (Broening, Morford, Inma-Wood, Fukumura, & Vorhees, 2001; Rowe, Liddle, Greenbaum, & Henderson, 2004).
The 2002 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMSHA], 2003) found reported lifetime use of MDMA among individuals between the ages of 18 and 25 years to be 15.1%, past year use to be 5.8%, and last month use to be 1.1%. Furthermore, individuals 18 to 25 years old composed nearly two thirds of all ecstasy users (SAMSHA, 2003). Similar results among individuals between the ages of 14 and 25 years were found in the 2002 National Institute on Drug Abuse's (NIDA; 2003) Monitoring the Future survey (13.5% lifetime, 5.6% past year, and 1.2% past month). High percentages of MDMA use among undergraduate students were found in several university-specific surveys (McCabe, Boyd, Hughes, & d'Arcy, 2003; Waiters, Foy, & Castro, 2002). In a sample of 1,264 undergraduate students at a private, southern university, Cuomo and Dyment (1994) found that 24.0% of participants reported having used ecstasy in the previous 4 years. These results indicate a high prevalence of MDMA use among young adults, thereby highlighting the need for further examination of this at-risk age group.
Although research on the epidemiology of MDMA use among young adults is increasing (NIDA, 2003; Yacoubian, Boyle, Harding, & Loftus, 2003), there continues to be scant inquiry into intervention and treatment. Confounding issues that have hindered these efforts to study MDMA have included prevalence of alcohol and illicit drug use, especially cannabis (Daumann et al., 2004); infrequent identification of MDMA as a primary drug of choice by both the user and the researcher (Boeri, Sterk, & Elifson, 2004; Jansen, 1999); and perceived low risk associated with MDMA use (Falk, Carlson, Wang, & Siegal, 2004). Nevertheless, the potential side effects of MDMA are particularly deleterious to adolescent and young adult users because of cerebral and hormonal vulnerabilities during the maturation process (Maartje et al., 2004; Schifano, 2000). In particular, early depletion of serotonin may perturb the developmental processes of the cerebral cortex, thereby interfering with lifelong modulation of affect (Montoya et al., 2002). These concerns make it especially important for all helping professionals to understand the unique risks and usage patterns of MDMA and the intervention strategies for working with young adult MDMA users.
In this article, we examine data from an epidemiological survey project from an assessment perspective and provide suggestions for mental health professionals working with MDMA users. The primary research questions and associated hypotheses addressed in this article include the following:
Research Question 1: What is the relationship between alcohol and illicit substance use, on the one hand, and differing diagnostic criteria of young adult MDMA users, on the other?
* Gay, lesbian, and bisexual young adult users of MDMA are more likely to be dependent users of MDMA than are heterosexual young adult users of MDMA.
* Young adult male users are more likely to be dependent MDMA users than are young adult female users.
* Dependent users of MDMA will report higher levels of marijuana, methamphetamine, and cocaine use than will recreational or abusing users of MDMA.
Research Question 2: Does the perception of risk associated with MDMA use differ by a user's diagnostic classification?
* Dependent MDMA users are more likely to report greater risks associated with the drug's use than are recreational or abusing users.
Research Question 3: Are dependent users of MDMA more likely to view chemical dependency treatment more negatively than are recreational or abusing MDMA users?
* Dependent users of MDMA are more likely than are recreational and abusing MDMA users to believe substance abuse treatment is too demanding.
* Dependent users of MDMA are more likely than are recreational and abusing MDMA users to view chemical dependency treatment as not working.
Method
Study Procedure
We used community identification methods to develop targeted sampling strategies in a population of young adult ecstasy users in a major...
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