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LCSW
Clinical Social Worker/Therapist

We live in an age of drugs. It is hard to imagine, but until a few hundred years ago the only psychoactive drug commonly available in the Western world was alcohol. Nicotine, in the form of tobacco, was introduced to Europe in 1559 and was considered a medicinal wonder drug for a few centuries. The first coffee houses in Europe came about 100 years later. But the modern use of drugs and their manufacture did not develop until the end of the 19th century and the beginning of the 20th century. That means that the development of the pharmaceutical industry happened at the same time as the development of psychotherapy.

A History of Drugs in Psychotherapy

Of course there are drugs that have been developed in order to “cure” mental and emotional disorders. Most of them have not proven very efficient at curing, even when they provide some relief from symptoms.

But there have also been many attempts to use drugs as aids in the course psychotherapy over the past hundred years. Freud, following the fashion of his times, experimented with cocaine, not only for himself, but also to assist in his newly developed “talking cure.” He abandoned it, but the idea of using drugs to help psychotherapy persisted and still persists.

One class of drugs that sparked particular interest is the hallucinogens. This includes drugs such as LSD, and MDMA (ecstasy). There was a period, from about 1950 till the mid 1960’s when there was a lot of interest and research into using such drugs to enhance psychotherapy.1 With the growth of the use of these substances as recreational drugs, and abuse and negative side effects, they became illegal and the potential for enhancing psychotherapy became too difficult to investigate. MDMA was not one of the focuses even though it had been investigated as early as the 1950’s. Interest in MDMA as a psychiatric drug began in the 1970’s.2 In fact, by 1985 there were more than 1000 documented MDMA assisted psychotherapy sessions.3 But research was thwarted by its popularity and abuse as a recreational drug and being illegalized in 1985.

Recreational vs. Therapeutic Use

MDMA was illegalized when it became popular and became known as “ecstasy”. It was (and is) commonly used in conjunction with other hallucinogens. It became popular in the “rave” scene, connected to psychedelic music. It is thought that it has a calming effect so it can prevent over-excitement and “bad trips” from LSD alone. This has not been substantiated. As a party drug it is still very popular but is becoming more dangerous due to the fact that many dealers and manufacturers are adding all sorts of chemicals and other additives that can make the pills lethal.4

However, it would be a mistake to equate irresponsible and illegal use of a substance with controlled responsible use. To be sure there was serious debate that led to the decision to make MDMA a strictly controlled substance, one that officially has no medicinal use.5 Because governments have equated the dangers of irresponsible use with responsible research, research in this country has fallen behind. Fortunately, there has been research in other countries and the research here has begun to pick up.

So, what do we know about the use of MDMA as an enhancer of psychotherapy? Much more than was known back in 1985 when it was made illegal. At that time therapy was different and our understanding of biology was very different. Although the research was prevented in the United States it continued in Europe, particularly in Switzerland, but also in Canada, Israel, Jordan and Australia.6 Originally MDMA was thought to be helpful for anxiety disorders. Currently, the focus of most of the research has been for Post Traumatic Stress Disorder (PTSD).

MDMA for PTSD Therapy

  1. When being used as an adjunct to traditional psychotherapy, a low dosage of the drug is administered about an hour before an actual therapy session.
  2. While the drug is taking effect the patient relaxes, might listen to relaxing music, and in some instances, will be comforted by hand-holding or other supportive touch.
  3. As the drug takes effect the patient is encouraged to share the experience and engage in a therapy session.
  4. After the session is over, the therapist will then supervise an additional stage called “integration.” This will take place over the next day or two. The integration stage is to help the patient incorporate the insights gained during the session into a reality based perception and his or her everyday life. This stage is considered critical5 and can include anything from family sessions to shamanistic rituals, depending on the needs of the patient.

Taking MDMA as a medicinal drug carries with it all the regular risks of any other serious drug. There are side effects that one needs to be aware of such as dry mouth, jaw clenching, elevated blood pressure, irritability, impaired judgment, and inability to concentrate, amongst many other potential side effects. Without extensive studies the frequency is not well documented. However, there are numerous studies that document a lack of significant long term negative effects. At least enough to justify the studies on human subjects. Additionally, there is strong evidence that this type of protocol actually helps the psychotherapy.7

Why Does It Seem to Help?

How does MDMA work? What does it do to a person, when properly administered, to actually help a person utilize the therapy session?

One possible answer is that it does three things to the patient.

  1. First, it increases the level of oxytocin. Oxytocin is the hormone that makes us feel connected to other people. When we feel that we are in the presence of love and care our bodies produce oxytocin. This may strengthen the alliance between the patient and the therapist.
  2. Second, it seems to increase the intellectual functioning of the brain while decreasing activity of the emotional areas of the brain. This can allow the patient to feel less fear while recalling and talking about the trauma.
  3. Third, MDMA seems to encourage the body to ramp up the processes that we use to recover from stress.8

Not Yet Available for General Therapeutic Use

MDMA is not ready for general use by the average clinician. It is only used in research settings, which means one needs to volunteer to take part in experimental use of the drug. Even experienced psychiatrists do not use it. If it ever does become available it would have to be used by both a psychiatrist (MD) and a clinician. While it does seem to have promise for the future, we are not there yet. If you have suffered greatly and have an opportunity to participate in a study, it might be something to consider, but it is not for everybody.

References
  • 1. Grinspoon, L., & Bakalar, J. B. (1986). Can drugs be used to enhance the psychotherapeutic process?. American Journal of Psychotherapy, 40(3), 393-404.
  • 2. Benzenhöfer, U., & Passie, T. (2010). Rediscovering MDMA (ecstasy): The role of the American chemist Alexander T. Shulgin. Addiction, 105(8), 1355-1361. doi:10.1111/j.1360-0443.2010.02948.x
  • 3. Herzberg, G. (2012). The phenomenology and sequelae of MDMA-assisted psychotherapy. California Institute of Integral Studies). ProQuest Dissertations and Theses, , 160. Retrieved from http://search.proquest.com/docview/1240572852?accountid=14872. (1240572852).
  • 4. Gill, R. (2012, Apr 22). Ecstasy availability. Global News Transcripts. Retrieved from http://search.proquest.com/docview/1009109501?accountid=14872; Narain, J., Tozer, J., & Parveen, N. (2013, Jan 23). FIVE young people killed by batch of super-strong ecstasy pills [edition 2]. Daily Mail.
  • 5. Herzberg, G. (2012). The phenomenology and sequelae of MDMA-assisted psychotherapy. California Institute of Integral Studies). ProQuest Dissertations and Theses, , 160.
  • 6. Kirkey, S. (2002, Sep 23). 'Penicillin for the soul'?: A california psychiatrist wants to know more about the positive effects of a drug called MDMA. unfortunately, its other name is ecstasy, and many want this popular party drug labelled bad for good. National Post.
  • 7. Oehen, P., Traber, R., Widmer, V., and Schnyder, U. (2013). A randomized, controlled pilot study of MDMA (±3,4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD) J Psychopharmacol 27: 40-52, first published on October 31, 2012 doi:10.1177/0269881112464827
  • 8. Johansen, P., and Krebs, T. S. (2009).How could MDMA (ecstasy) help anxiety disorders? A neurobiological rationale J Psychopharmacol 23: 389-391, first published on March 9, 2009 doi:10.1177/0269881109102787
About the author Ari Hahn:
I am a professional helper since 1976 and an LCSW since 1991. I have specialized in survivors of trauma. Presently I also have an on-line therapy and coaching practice where I also specialize in helping families and loved ones of ex-abused people. I also am a professor at TCI College in NYC.
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Page last updated Aug 31, 2013

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