Is Ecstasy (MDMA) Addictive?

A young woman has ecstasy on her tongue in a night club

According to one of the major works on the drug ecstasy, (MDMA), the 1989 book Ecstasy: The Clinical, Pharmacological, and Neurotoxicological Effects of the Drug MDMA, ecstasy is a drug that has mixed effects and generally classified as a dissociative hallucinogenic drug. The effects of the drug depend on the dose taken. It can produce stimulant- or amphetamine-type effects as well as hallucinogenic effects similar to the hallucinogenic drug mescaline.

The drug was initially used in the treatment of certain types of psychological disorders (e.g., PTSD) due to its calming effects on an individual’s social behaviors; however, due to a number of potential issues with the drug, it was discontinued for this purpose, even though studies still continue to investigate its medicinal utility. The drug became a popular “rave” or club drug in the late 1980s to early 2000s; however, its use has declined significantly.

The United States Drug Enforcement Administration (DEA) currently classifies all forms of MDMA as Schedule I controlled substances, indicating that these substances are not legally available except with special permissions from the government, and the drug is considered to be a drug with an extremely high potential for abuse and the development of physical dependence.

The Addictive Potential of MDMA (Ecstasy)

The notion of whether or not a particular substance is “addictive” depends on the subjective interpretation of the word. Typically, when individuals are discussing whether or not some substance is addictive, they are referring to the notion of physical dependence.

When a person develops physical dependence on a substance, they must have developed some level of tolerance and some level of withdrawal.

  • Tolerance: This refers to a very common syndrome that often develops when an individual uses any particular drug for a lengthy period of time. The individual will find that they need more of the drug to get the effects that were once obtained at lower doses.

  • Withdrawal: Withdrawal symptoms also develop to a number of different drugs. Individuals who regularly use a drug or medication will inevitably experience a change in bodily functions. One of these changes is a regulation of the normal balance that the system maintains regarding levels of hormones, neurotransmitters, and other chemical substances. An individual’s system will adjust itself to account for the presence of the substance in the system if they use it regularly. Once the individual’s system has adjusted itself, if they are not able to keep levels of the particular drug at a specific amount, the physical system becomes unbalanced. As a result, they experience a number of negative effects that can range from emotional effects to serious physical changes.

Physical dependence is not necessary for an individual to have a substance use disorder. Although many individuals believe that the development of physical dependence is a sure sign of being “addicted” to a drug, this is simply not the case. Individuals are diagnosed with substance use disorders on a regular basis, even with severe substance use disorders, without the presence of physical dependence.

Secondly, a number of individuals develop physical dependence on drugs that they need to take for medicinal purposes, such as those with chronic arthritis who need to take powerful narcotic pain medications in order to control their pain. As long as individuals continue to take the medication according to the prescribed purposes of the drug and are using it for medicinal purposes, they would not be diagnosed with a substance use disorder. The notion of a substance use disorder requires that an individual uses the drug for non-medicinal reasons, and this use results in negative consequences, including issues with functioning, significant distress, and problems with controlling use of the substance.

Several sources, such as the National Institute on Drug Abuse (NIDA), report that chronic use of MDMA may lead to the development of physical dependence. However, a number of other professional sources and research studies suggest that while tolerance for ecstasy does most likely develop, chronic use of the drug does not result in a significant withdrawal syndrome. Without a significant withdrawal syndrome that is formally recognized, it is questionable whether or not an individual can develop physical dependence on ecstasy.

Any withdrawal symptoms that occur from chronic use of ecstasy are most likely primarily psychological in nature. This is because chronic use results in a massive release of the neurotransmitters dopamine, serotonin, and norepinephrine in the brain, and when the individual stops using the drug, the levels of these neurotransmitters are drastically depleted. This results in feelings of severe depression, apathy, malaise, hopelessness, and even suicidal behaviors. Some clinical and research sources suggest that these emotional and psychological symptoms are not consistent with a syndrome of physical dependence; however, this designation in no way is meant to minimize the potential issues associated with individuals who experience an “ecstasy crash” once they stop taking the drug.

Thus, the research suggests that there is no formal withdrawal syndrome recognized with discontinuation of ecstasy; however, discontinuation of the drug is often associated with a number of very distressing psychological and emotional symptoms that often drive individuals to seek out the drug to reduce the emotional stress. Whether or not these symptoms qualify as a formal withdrawal syndrome, and whether or not chronic use of ecstasy results in a formal syndrome of physical dependence, does not have any bearing on the need for individuals to seek professional help if they have abused MDMA on a regular basis for significant period of time.

The Development of Addiction as a Result of Ecstasy Abuse

The other important consideration regarding whether ecstasy is addictive concerns the development of a formal substance use disorder as a result of ecstasy abuse. Individuals who abuse any drug and develop significant issues with functioning and controlling use of the drug are at risk to be diagnosed with a substance use disorder. Substance use disorders reflect severe mental health disorders that impact an individual’s ability to objectively evaluate their own behavior, result in distress for them, and lead to significant impairments in their ability to function within reasonable limits.

Individuals who chronically use ecstasy and develop these issues would be diagnosed with a substance use disorder. According to the American Psychiatric Association (APA) and the number of other professional organizations, such as the American Society for Addiction Medicine (ASAM), an individual who has developed a severe abuse problem with ecstasy would qualify for a diagnosis of a hallucinogen use disorder. A diagnosis of a substance use disorder reflects a dysfunctional and harmful pattern of substance use that is a more realistic reflection of what the term addiction is supposed to represent.

Briefly, the symptoms of a hallucinogen use disorder as a result of the chronic use of ecstasy would include the following:

  • Issues with controlling use of ecstasy: Signs that an individual is having difficulty controlling their use of the drug occur over a number of different situations and include:
    1. Stating that one wants to stop or cut down on use but not being able to do so
    2. Often using more of the drug or using it for longer than originally intended
    3. Continuing to use the drug even though it is resulting in issues with personal relationships, work, school, finances, etc., and/or continuing to use the drug even though one recognizes that it is causing physical harm or emotional damage
    4. Spending significant amounts of time using the drug, trying to get it, or recovering from its use
    5. Giving up important activities or interests in favor of using ecstasy
  • Neglecting important personal responsibilities as a result of ecstasy use
  • Frequently experiencing strong cravings to use the drug
  • Significant distress or functional impairment as a result of using ecstasy
  • The development of significant tolerance associated with ecstasy use

Because it is unclear if withdrawal symptoms occur as a result of chronic ecstasy abuse, a withdrawal syndrome is not specified as a specific diagnostic criteria for a hallucinogen use disorder. However, tolerance is recognized it is a formal diagnostic symptom of ecstasy abuse. Moreover, anyone who develops tolerance to a Schedule I controlled substance is obviously illegally using the substance on a regular basis, and this would raise suspicions that the individual has developed a substance use disorder.

As chronic use of ecstasy produces specific physical and emotional effects, certain behaviors that occur in individuals who use the drug may also suggest that the individual needs to be evaluated for a substance use disorder. According to NIDA, APA, and ASAM, some of these behaviors include:

  • Alternating periods of hyperactivity/extreme sociability with periods of lethargy and depression: Because ecstasy use results in heightened sociability and energy levels, and once the individual’s system has eliminated the drug, they become lethargic and depressed, chronic users of the drug often display periods of extreme sociability, talkativeness, energy, etc., in social situations where they use the drug followed by periods of depression, irritability, lethargy, and isolation.

  • Overheating easily in social situations: Ecstasy has stimulant effects that result in the arousal of an individual’s sympathetic nervous system. This results in users sweating profusely and often becoming overheated when they are in crowded conditions, such as parties or clubs. Individuals who are normally rather sedate but become extremely active, sweat profusely, and/or become dehydrated at parties or clubs may be abusing ecstasy.

  • Displaying periodic cognitive/psychiatric symptoms: People who abuse ecstasy often display periodic issues with confusion and memory loss, and may even experience hallucinations. Because of the repeated massive release of neurotransmitters followed by neurotransmitter depletion, some of these issues may become permanent.

Conclusions

Ultimately, yes, ecstasy can be addictive. While it is questionable whether individuals who abuse ecstasy develop physical dependence on the drug, repeated use of ecstasy can lead to a substance use disorder.

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