If you place a thing in the center of your life
that lacks the power to nourish
It will eventually poison everything you are and destroy you.
-"Liontamer" by Faithless
What is addiction?
one extreme of the normal range of human behavior. It comes in a
thousand degrees of severity
and can apply to almost anything. Loosely defined, it's a compulsion
that keeps drawing you back to something. In the range of
reasonably healthy addictive behaviors is the absolute commitment
of many young boys to get home from school so they can log more
on a video game. Less healthy sorts of compulsive behavior involve
food (some people just can't say no to chocolate) or sex (extreme
promiscuity, sense of self-worth through sexuality.) Sometimes it
involves chemicals like caffeine, cocaine, etc.
What all these things
have in common is that the person is strongly motivated to repeat
a certain behavior (whether it's playing a game, eating a cake, or
taking a drug.) Sometimes these compulsive behaviors have a component
of physical addiction (the user will suffer physical/mental problems
if the drug is withdrawn, such as can occur with heroin, prescription
drugs like Paxil, and even caffeine.) However, it has become clear
over the years that the more powerful aspect of addiction is psychological:
There is something about the behavior that is rewarding. The adolescent
video game junkie gets a rush of adrenaline and sense of accomplishment
as well as entertainment. The "comfort food" addict gets
a release of serotonin to calm anxiety and depression. The coffee
drinker gets an increase in alertness and motivation to help face
their day. The heroin user gets to emotionally shut out the world
and feel liberated from all earthly cares and traumas. What all of
these manifestations of addictive behavior share is that the user
wants what the behavior gives them. The gamer really wants
to play that game: The game does not enslave them against their will.
The heroin addict really wants the release and escape of the drug:
They are not simply compelled by some sinister chemical.
That's not to say that
addicts aren't paying a high price for what drugs give them. The
addict can escape the physical and emotional pain of their life,
but pays a high price financially, risks overdoses, diseases if
they inject the drug, arrest, and becoming an outcast in an anti-drug
society. Yet they
continue to do it. If you put them in a lock-down 'de-tox' program,
get them past the agony of opiate withdrawal and let them go, most
will go back to heroin in short order. The physical addiction was
powerful, but the psychological dependence, their reliance on it
to provide something they emotionally needed, probably wasn't affected
by the de-tox process. Taking bananas away from monkeys for a month
doesn't make them stop wanting bananas.
So what is it about MDMA that might appeal to a user
so strongly that they would be willing to put up with the negative
aspects of frequent use?
release. MDMA is an antidepressant and anti-neurotic drug of almost
unparalleled power. If you are under severe emotional strain, MDMA
can provide an escape. How compelling returning to the MDMA state
will be to a given person largely depends on how rotten their lives
otherwise are (a common theme to drug dependency.) To a reasonably
healthy, happy person the MDMA state is often a great gift; a transcendent
experience to be remembered fondly as they go on with their normal
lives. To somebody suffering from depression or other emotional
MDMA can easily become an escape; a way to run away from reality.
What's so wrong about that? People have a right to
try to be happy.
Perhaps, but the MDMA state
is not sustainable. While high, your serotonin system is being powerfully
strengthened by the MDMA. When the high fades, there is a price to
be paid: Your brain's supply of serotonin (and sensitivity to it)
has been reduced. Not only do you lose the serotonin enhancement
of the MDMA, you get dropped down to below-normal levels. It can
weeks to fully recover from this effect, and it can add up. The more
frequently you use, the less time you give yourself to recover between
uses, the more badly your serotonin system will be disrupted. Hangovers
grow longer and more severe, simple post-use fatigue gives way to
depression, memory problems, and more. This isn't a game you can
win: You can cheat on your boyfriend, cheat on your taxes, even
you just can't beat your own biology (at least in this case.) The
user that seeks frequent escape in MDMA will be ground down; the
they sought to escape will only be made worse by frequent use.
So what happens when somebody becomes compulsive
in their use?
Compulsive users seem to follow
one of two possible patterns. The first (and typical) pattern is
of escalating use until the side effects and hangovers become so
severe that the user reaches a crisis point. They crash, swear it
seek psychiatric help and prescription medications instead of more
MDMA to deal with their problems. It's not a pretty process, but
is self-limiting by the severity of drug side effects.
In the second (apparently
very rare) pattern of abuse, the user 'makes peace' with MDMA, accepting
severely and chronically suppressed serotonin function by propping
themselves up with massive frequent doses. Under this scenario,
MDMA becomes much more like methamphetamine: Its ability to draw
a strong serotonin effect from the brain has been largely lost,
it retains the ability to release dopamine in significant amounts
if the dose is high enough. This too is not a very sustainable condition;
the longest case I've heard of is about a year. The fate of such
is not well known; it is likely that they too eventually crash and
In the first case,
full recovery is generally expected, although it may take months
for the user's brain to get back to normal (depending on how severe
the pattern of abuse was.) Frightened users may assume that the lingering
effects are the result of brain damage (neurotoxicity).
There is no need to assume the worst; although their brains have
clearly undergone temporary changes, it is unlikely that true structural
damage has occurred.
In the second group, there
isn't enough data to even speculate. If anybody is a good candidate
for neurotoxicity, it's somebody who was taking thirty pills in a
Is there any treatment for MDMA abuse?
popular antidepressants like Prozac, Paxil, etc. can provide the
enhancement of the serotonin system the abusing user is seeking without
the severe side effects and disruption of life caused by heavy MDMA
cases, serotonin-elevating supplements like 5-HTP
may be enough to suppress drug cravings. However, this sort of maintenance
treatment doesn't really address the underlying question of why
became abusers in the first place. If they were motivated by emotional
problems, those issues must be addressed to prevent a return to
abuse. Drug addiction is not a criminal problem. It isn't a law enforcement
problem. It isn't even primarily a physical health problem (although
that can be a side effect.) At its core, drug abuse is usually a
matter of people with psychological issues trying to treat themselves
with the tools available to them (prohibited drugs which, in spite
of all government efforts, are still often easier to get than common
antidepressant prescriptions.) Putting addicts in prison for their
drug use is
vicious and unproductive: About
hope to accomplish is to reduce the chances of them using drugs while
For the sake of clarity,
let me repeat that drug use (occasional, controlled) is not
the same thing as drug abuse (frequent, compulsive, destructive to
the user's regular life.) The person that enjoys a few beers on
Friday night is not an alcoholic, nor is the occasional user of prohibited
drugs an addict. Whether the law approves of a particular drug or
not is irrelevant when the question is one of responsible vs. unhealthy
patterns of use. Treating most users of prohibited drugs as addicts
is not justified; the vast majority of users are not dependent, and
neither want nor would benefit from treatment programs.
How addictive is MDMA compared to other drugs?
There's not as much data
to go by as I would like, but what we do have suggests that MDMA
is one of the less addictive recreational drugs.
In spite of MDMA being used recreationally in the US for over thirty
years, the first addicts weren't documented in the literature until
We also have some field
research evaluating how dependent users were to different drugs.
of Dependence scores (a scale used to gauge how addicted a user is)
have been gathered for a number of popular drugs: 
Severity of Dependence (contact)
Severity of Dependence (no contact)
group was drug users who were known to police or getting services
(needle exchange programs, etc...'addicts' in the traditional
The "no contact" group was users who were not seeking or
getting treatment, were not known to police, etc. Perhaps the most
interesting finding is that the "ecstasy" scores for severity
of dependence (addiction) were actually half those of marijuana.
only wish they had included alcohol (I expect it would score at least
as highly as marijuana.) Also missing are cigarettes, which some
has suggested are similar to heroin in addictiveness.
In a large German study,
ecstasy was found to have a lifetime rate of abuse (patterns of
that interfere with normal activities/obligations) of roughly one
in five users, comparable to that of other psychedelics such as
The same study claimed that, over the lifetime of users, about one
in ten would meet the DSM-IV requirements for dependence.
The latter number may be somewhat inflated due
to some of MDMA's unusual characteristics, such as the common occurrence
of a 'hangover' period that can last for several days (which might
be inaccurately identified as a withdrawal symptom.)
Also of interest,
animal behavioral research has found that rats in a social environment
(with other rats to play with and interact with) do not find MDMA
addictive, but socially isolated rats do. This
fits very well with anecdotal reports of human abusers; it seems
factor in the development of MDMA dependence is an underlying emotional
need for a sense of connection and acceptance.
The first step in avoiding
addiction is understanding that it does happen, and can
happen to you. Some people are at very little risk of addiction while
others are at high risk, but anybody can become addicted under the
Second, be sensitive to
what your mind and body are telling you. Pay attention to drug cravings;
the more you want a drug, the less wise it is to give in to that urge.
The worst of addiction problems always start with "well...just
one more time/line/pill can't hurt." Drugs can be a lot of fun,
so it's understandable that people can get carried away when they
discover a new one...but if you don't control your use, it may end
up controlling you.
And finally, don't
be shy about asking for help. If you feel drugs have become too big
part of your life, talk to a friend, doctor or psychologist. Sometimes
just talking helps, and they can prescribe medications that can help
anxiety, depression, or other issues that may be contributing to
the problem. Drug addiction happens. It's not a sin, and doesn't
mean you were weak or are a bad person. Never be afraid to ask for
medical professionals are there to help you, not to judge you.
 Jansen KL, "Ecstasy
(MDMA) Dependence", Drug and Alcohol Dependence, 1999;53,2:121-124.
 Robson P, Bruce
M "A comparison of 'visible' and 'invisible' users of amphetamine,
cocaine, and heroin: two distinct populations?" Addiction,
 Schuster P, Lieb
R, Lamertz C, Wittchen HU "Is the Use of Ecstasy and Hallucinogens
Increasing?" European Addiction Research 1998; 4:75-82.
 Meyer A, Mayerhofer
A, Kovar K, Schmidt W "Rewarding effects of the optical isomers
of [MDMA] and [MDEA] measured by conditioned place preference in rats",
Neurosci Lett 2002; 330(3):280-4. Abstract