This commentary (2017) proposes that MDMA can be used as a safe and effective adjunct for psychotherapy in the treatment of alcohol use disorder. Given that alcoholism is often associated with early traumatic experiences, it is argued that MDMA therapy may be applied efficaciously to a wider range of mental disorders beyond that of only PTSD.

Abstract

“Alcohol use disorder represents a serious clinical, social and personal burden on its sufferers and a significant financial strain on society. Current treatments, both psychological and pharmacological are poor, with high rates of relapse after medical detoxification and dedicated treatment programs. The earliest historical roots of psychedelic drug-assisted psychotherapy in the 1950s were associated with Lysergic acid diethylamide (LSD)-assisted psychotherapy to treat what was then called, alcoholism. But results were varied and psychedelic therapy with LSD and other ‘classical’ psychedelics fell out of favour in the wake of socio-political pressures and cultural changes. A current revisiting of psychedelic clinical research is now targeting substance use disorders – and particularly alcohol use disorder – again. 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy has never been formally explored as a treatment for any form of substance use disorder. But in recent years MDMA has risen in prominence as an agent to treat posttraumatic stress disorder (PTSD). With its unique receptor profile and a relatively well-tolerated subjective experience of drug effects when used clinically, MDMA Therapy is ideally suited to allow a patient to explore and address painful memories without being overwhelmed by negative affect. Given that alcohol use disorder is so often associated with early traumatic experiences, the author is proposing in a current on-going UK-based study that patients with alcohol use disorder who have undergone a medical detoxification from alcohol might benefit from a course of MDMA-assisted psychotherapy.”

Author: Ben Sessa

Summary

Abstract:

Alcohol use disorder is a serious clinical, social and personal burden on its sufferers and a significant financial strain on society. A current UK-based study is exploring the use of MDMA-assisted psychotherapy to treat alcohol use disorder.

Although drinking alcohol is socially acceptable, 24% of adults in England consume alcohol in a way that is harmful, and 6% of men and 2% of women meet the diagnostic criteria for alcohol use disorder. Alcohol use disorder causes significant social impacts to family, friends and the wider community. There are many different treatments for alcohol use disorder, including acamprosate, disulfiram, naltrexone, nalmafene and benzodiazepines. These treatments are used to reduce cravings, reduce the severity of the disease and to help with alcohol detoxification. There are a range of psychosocial interventions for alcohol use disorder, but the efficacy of current available treatments is far from satisfactory, with high rates of relapse. The Brief Intervention approach was ranked highest and Motivational Enhancement Therapy second, with pharmacotherapy third and fourth. The treatment of alcohol use disorder is far from satisfactory. A significant revisiting of research studies has been done on psychedelics.

The History of Psychedelics in Treating Substance Use Disorders:

Since the earliest days of psychedelic research in the 1950s, LSD-assisted psychotherapy has been explored with varying rates of success in treating alcohol use disorder. However, a meta-analysis of six randomized trials of LSD-for-alcohol use disorder from the 50s and 60s demonstrated generally favourable results. In the 1950s, Bill Wilson, the founder of Alcoholics Anonymous, underwent several LSD-assisted psychotherapy sessions and concluded that ego reduction makes the influx of God’s grace possible. Contemporary psychedelic research for addictions includes Ketamine-assisted psychotherapy for both alcohol and opiate use disorders, and a revisiting of psychedelic psychotherapy for treating alcohol use disorder is currently underway in Exeter, UK.

A recent study on 10 volunteers with alcohol use disorder showed that psilocybin increased abstinence significantly, and the gains were maintained at follow-up to 36 weeks. A study is currently being conducted on more severe, physically-dependent daily drinkers to investigate the effectiveness of MDMA Therapy.

There is a lack of scientific consensus around the pharmacology of MDMA, which makes it even more difficult to relate its pharmacology to predictable psychological effects. MDMA is a ring-substituted phenethylamine that promotes raised levels of serotonin, dopamine and noradrenaline. It also promotes slight alterations in perception, which facilitate imagination and memory, increased positive mood, increased feelings of closeness, greater compassion and increased empathy for oneself and others. MDMA has been shown to increase levels of empathy and closeness, and dampen fear-related amygdala activity, which may influence the outcome of psychotherapeutic treatments for alcohol use disorder and comorbid psychological disorders.

The popular press is abundant with anecdotal reports of how LSD and magic mushrooms have helped drinkers to overcome their alcohol use disorder, but not how MDMA has. Since the 1950s, researchers have shown that the stronger the induced mystical / spiritual effects of LSD or psilocybin, and similarly with ketamine, the greater the maintained abstinence from substance use. MDMA Therapy has been shown to be effective at tackling trauma, which is frequently described pre-morbidly by patients with alcohol use disorder. MDMA’s capacity to increase empathy and compassion for the self and others may contribute to improved self-awareness and reduced denial of alcohol misuse.

MDMA has been explored as a potential approach for treating alcohol use disorder, and may also address symptoms of other conditions that are frequently comorbid with substance use disorders, particularly those symptoms associated with a history of psychological trauma.

MDMA Therapy is not without its challenges, including increased anxiety, neurocognitive effects, and mild abuse potential. However, subjects did not express a wish to use MDMA outside of the clinical setting, and illicit use of ecstasy after having used it clinically is very rarely observed.

The recreational drug ecstasy can cause poor concentration, impaired balance, hyperthermia, liver disease and hyponatraemia, but these can be easily controlled in a clinical setting. Some studies have reported transient verbal memory deficits, slow processing speeds and a range of executive impairments amongst recreational ecstasy users, but other studies have reported a lack of such deficits, or have demonstrated that residual neurocognitive impairments are normalised after cessation of use of recreational ecstasy. The Bristol-Imperial MDMA-for-Alcoholism (BIMA) study will recruit alcohol-dependent participants who have recently undergone a medical detox from alcohol and will use MDMA as an adjunct for psychotherapy.

On two occasions, participants will receive MDMA-assisted therapy, spaced two weeks apart. Vital signs will be monitored throughout the drug-assisted session, and mood and suicide risk will be monitored daily for a week. MDMA Therapy is being explored as a treatment for a range of mental disorders beyond that of only PTSD, with an FDA license for MDMA Therapy for PTSD envisaged by 2021. MDMA has a long-standing label of controversy in the UK, but it is safe and effective in the clinical setting. The government and medical profession must be convinced of this, and regulatory approvals must be removed to allow research to progress.

Psychedelic culture is enjoying a palpable renaissance in both medicine and the media, and MDMA Therapy may be an innovative option for treating patients with alcohol use disorder.