MDMA became a popular rave or club drug with younger people due to its reputation as a drug that can enhance sociability, empathy, and feelings of euphoria as well as its hallucinogenic properties. These effects have been substantiated by a number of research studies, including a 2014 article in the journal Psychopharmacology. MDMA’s abuse reached its peak in the late 1990s and early 2000s.The National Institute on Drug Abuse (NIDA) reports that initially the powder and tablet forms of MDMA were 30-40 percent MDMA, and the rest of the substance consisted of cutting agents, such as lactose, to increase profits for dealers. NIDA reports that substances being sold as MDMA currently are probably even less pure, and a number of other drugs are now often substituted for the MDMA in the drug, such as bath salts (synthetic cathinones), methamphetamine (crystal meth), cocaine, ketamine, the synthetic hallucinogenic para-methoxyamphetamine, and over-the-counter medications.
Today, use of the drug has significantly decreased since its peak use in the 1990s and early 2000s; however, it is still a significant and dangerous drug of abuse in either its diluted or purer forms.
Molly’s mechanism of action is primarily focused on three neurotransmitters:
- Serotonin: Molly increases the effects and actions of serotonin in the brain, resulting in a number of effects, including euphoria, empathy, and sociability. It may also affect sexual arousal, sleep cycles, and appetite.
- Dopamine: Molly causes increases in dopamine, leading to feelings of pleasure/euphoria and increased energy.
- Norepinephrine: Molly increases norepinephrine, leading to stimulant effects as heart rate and blood pressure increase. This also can lead to dangerous side effects.
The Basics of MDMA
- Traditionally, the forms of MDMA labeled as Molly and ecstasy differ. Molly is most often available in capsules, and ecstasy is most often available as a tablet.
- Molly is often considered to be the more potent form of MDMA, although this is largely a myth since it often contains other drugs instead of MDMA.
Empirical research studies analyzing various street forms of MDMA have discovered a number of other substances in the drug (in either Molly or ecstasy), including caffeine, amphetamines, cocaine, and PCP.
The potency or concentration of MDMA sold on the street is quite variable from source to source.
- Chronic use of MDMA may alter various neurobiological pathways.
MDMA use results in amplified energy, feelings of emotional closeness, and sensory alterations.
- After Molly has left a person’s system, a “crash” is common. This crash involves feelings of depression and emotional withdrawal due to neurotransmitter depletion.
Other Effects of Taking Molly
NIDA reports on some of the other short-term and long-term effects of MDMA use. These include:
- Physical effects: A number of varied physical effects are associated with taking Molly, including blurred vision, nausea, vomiting, muscle cramping, appetite loss, hyperactivity, and teeth grinding that can lead to problems with severe wear and tear on the teeth.
- Increased body temperature: One of the immediate effects of taking MDMA is its effects on the sympathetic nervous system, which acts to speed up various bodily functions. People who use the drug become at risk for overheating (hyperthermia) and dehydration due to excessive sweating, especially when they are using the drug in crowded environments. This can also lead to the development of seizures and other potentially serious issues.
- Effects to the cardiovascular system: Long-term use of ecstasy has been associated with a number of cardiovascular issues that include the development of an irregular heartbeat, high blood pressure, and increased potential to have a stroke or heart attack.
- Liver and kidney damage: Long-term use of MDMA is associated with damage to the liver and kidneys.
- Mood swings: MDMA use results in massive neurotransmitter release in the brain that is later offset by a depletion of neurotransmitters when the individual has stopped using the drug. This results in a cycle of mood swings that include euphoria and sociability while under the influence of MDMA and severe depression, hopelessness, and apathy after one has stopped taking the drug. Other psychological issues that occur with long-term use of the drug include issues with anxiety, poor judgment, impulsive behavior, reduced sex drive, and increased aggressive behaviors.
- Long-term changes in the brain: Research has identified a number of potential long-term changes to the brain associated with chronic use of MDMA. These include issues with areas of the brain that are involved in attention, memory, and problem-solving.
- Physical dependence on MDMA: Chronic use of MDMA may be associated with the development of physical dependence (the development of both tolerance and withdrawal syndromes); however, the research is mixed regarding this. There is no formal recognized withdrawal syndrome associated with chronic use of MDMA, although it is generally recognized that tolerance to MDMA does develop. In the sources where withdrawal from MDMA is described, the withdrawal syndrome consists primarily of psychological symptoms, such as fatigue, depression, difficulty concentrating, issues with sleep, and other similar symptoms.
- Substance use disorders: Chronic use of Molly can result in the development of a substance use disorder.
Addiction to MollyThe American Psychiatric Association (APA) and other professional organizations still use the terms addiction and abuse in their discussions of addictive behaviors; however, in terms of the formal diagnosis of addictive behaviors to drugs, the term substance use disorder has replaced these terms. This is because research studies and the experiences of clinicians agree that the terms substance abuse and addiction do not described mutually exclusive conditions. Instead, addictive behaviors occur on a continuum from use to abuse to the development of a formal psychological disorder.
The development of a substance use disorder as a result of MDMA abuse would be labeled a hallucinogen use disorder under the current diagnostic scheme. According to APA, the signs of a hallucinogen use disorder include:
- A pattern of maladaptive use of Molly that leads to significant distress in the individual and/or significant issues with everyday functioning
- Frequent strong urges to use Molly in various situations, such as stressful situations, situations where the individual is happy, situations where the individual is socializing, etc.
- Using the drug in situations where it is dangerous to do so
- Giving up important activities as a result of MDMA use
- Failing to fulfill important obligations as a result of Molly use
- The development of significant tolerance to Molly
- Demonstrating issues controlling use of MDMA that include the following:
- Even though the person has formally stated they wish to stop or cut down on their use of MDMA, they cannot do so.
- The person spends significant amounts of time trying to get MDMA, using it, or recovering from its use.
- The person continues to use MDMA even though its use results in significant issues with their job, personal relationships, school, and/or other important areas.
- Even though the person recognizes that their use of MDMA is resulting in psychological and/or physical problems, they continue to use the drug.
Some sources suggest that chronic use of MDMA may result in a mild level of physical dependence, demonstrating withdrawal from MDMA is not a diagnostic criterion for a hallucinogen use disorder because most hallucinogenic drugs do not result in the development of physical dependence. A formal diagnosis of a hallucinogen use disorder can only be made by a licensed mental health clinician.
The use of Molly results in a number of other nonclinical signs and symptoms that may be indicative that the individual is developing an issue with abuse of the drug. Some of these include:
- A cycle of increased energy, sociability, talkativeness, etc., followed by periods of withdrawal, depression, etc.
- Periods of increased sociability and increased energy accompanied by extreme talkativeness and dilated pupils
- Periods of increased energy and becoming overheated very quickly in crowds
- Periods of hyperactivity and insomnia followed by periods of increased need for sleep and low energy
Treating MDMA Abuse
The group at the greatest risk to abuse MDMA includes those 16-24 years old. Treating adolescents and young adults with substance use disorders is a delicate matter, and it is suggested that treatment providers for these individuals have special training in dealing with the issues that occur in this group.The treatment approach generally consists of various components, outlined below.
- The person may initially be placed in an inpatient treatment program or similar program that can isolate them from potential bad influences and help them focus on the early stages of their recovery. This can also be quite useful to help the person overcome the early “crash” that often occurs in individuals who have chronically abused Molly. Individuals in an inpatient treatment program should have access to a physician-assisted withdrawal management program that is monitored by an addiction medicine physician or addiction psychiatrist in addition to therapists and caseworkers. In some cases, an intensive outpatient treatment program can be used in place of an initial residential program.
- The main component of any recovery program is substance use disorder therapy. This can be delivered in a number of ways as long as the approach adheres to empirically validated principles of substance use disorder treatment and is also tailored to meet the specific needs of the person in recovery. Therapy should begin right when the individual enters recovery and continue after any withdrawal management treatment. Options include:
- Individual therapy
- Group therapy (The group should consist of other members with substance use disorders who are relatively close in age with the client.)
- Family therapy (This is specialized group therapy where family members participate.)
- Support group participation, such as participation in 12-Step groups or other social support groups, can be extremely beneficial. Support groups are not formal therapy even though individuals may believe that their participation in these groups is “therapeutic.” Social support group participation is compatible with all forms of substance use disorder therapy and enhances the effects of therapy.
- Many individuals with substance use disorders also have other co-occurring mental health disorders that can include issues with other forms of substance abuse, clinical depression, conduct disorders, personality disorders, anxiety disorders, etc. In the initial stages of treatment, it is assumed that the client should undergo a thorough assessment to identify any co-occurring psychological issues or physical conditions. These co-occurring conditions should also be treated along with the individual’s substance use disorder.
- Individuals all have special needs. Other interventions suitable for the particular case should be instituted whenever possible. These can include tutoring for school; vocational training; finding the individual suitable living quarters; formal therapy, such as speech therapy, occupational therapy, vocational rehab; etc.
- Participation in therapy should continue long enough for the individual to achieve the full benefits of treatment. Participation in support groups should continue indefinitely. One of the strongest indicators for positive treatment outcomes for substance use disorder treatment is the length of time one remains in treatment. Individuals remaining in treatment for longer periods of time tend to have better outcomes and fewer relapses.