Embracing Neurodiversity in Psychedelic Science: A Mixed-Methods Inquiry into the MDMA Experiences of Autistic Adults

This retrospective survey (n=100) and qualitative interview (n=24) study examined the MDMA experiences of autistic adults and identified that many of them viewed MDMA as a transformative healing catalyst for helping their anxieties of navigating through neurotypical social norms, while none of them expressed the desire for being neurotypical or reported being “cured” from autism.

Abstract

“Introduction: This exploratory inquiry analyzed subjective experiences autistic adults reported after they took the drug 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy, in nonclinical settings.

Methods: Using a secure, globally available website, this study collected data from participants in 13 countries who were experienced with MDMA (n = 100). A subset of survey respondents (n = 24) were then invited to participate in qualitative interviews. The researcher applied thematic content analysis of interview transcripts to create a comprehensive account of emergent themes.

Results: MDMA has well-documented acute effects that promote pro-social attitudes such as caring and trust in neurotypical, or typically developing, populations. Findings from this study suggested that MDMA-assisted therapy may be an effective catalyst in autistic adults for intra- and interpersonal change. In addition, participants reported accounts of lasting transformation and healing from conditions such as trauma and social anxiety that are common in autistic populations. No participants reported long-term adverse outcomes as a result of using MDMA/ecstasy.

Discussion: Qualitative findings support a case for future clinical trials of MDMA-assisted therapy with autistic adults who present with social adaptability challenges.

Authors: Alicia L. Danforth

Summary

This study collected data from 100 participants in 13 countries who were experienced with MDMA. The results suggest that MDMA-assisted therapy may be an effective catalyst in autistic adults for intra- and interpersonal change, as well as healing from conditions such as trauma and social anxiety.

Introduction

A preliminary qualitative study was conducted on autistic adults who had taken MDMA in non-clinical settings to explore how they experienced the subjective effects of MDMA and to highlight themes of clinical relevance to potential future investigations.

Autism is a broad term that describes heterogeneous and pervasive neurocognitive differences. Treatment regimens can be tailored to meet the needs of individual patients, depending on the degree of social skills challenges and presenting symptoms of other conditions.

A growing body of research shows that popular assumptions about affective experiences and empathy related to autism are inaccurate. Autistic individuals often struggle with social relationships in ways that are distressing.

MDMA is a synthetic phenethylamine compound that produces acute psychological effects similar to those of classic hallucinogens, but with less cognitive distortion. MDMA is less likely to cause problematic anxiety and the duration of effects is shorter than with most other psychedelics.

MDMA has some drawbacks, including the potential for risky recreational use and abuse, and the debate over potential neurotoxicity with MDMA.

Riedlinger (1985) was an early proponent of research on MDMA as an adjunctive intervention for individuals on the autism spectrum, but no clinical trials with MDMA have been published to date.

Screening, eligibility, and participants

The Institute of Transpersonal Psychology recruited 100 MDMA/ecstasy-experienced individuals from 13 countries through the Internet. The surveys were completed by individuals who self-reported that they were autistic and received a score of 32 or higher on the Autism-Spectrum Quotient (AQ).

24 autistic adults who had the ability to communicate verbally in English participated in semi-structured interviews about their experiences with MDMA/ecstasy. The interviews were transcribed verbatim using embodied transcription technique to enhance empathic understanding of interviewee experiences.

Applied Thematic Analysis was completed manually and with the aid of an online qualitative data analysis application. Two independent, MDMA-neutral intercoders coded 17% of the transcripts without prior review of the draft codebook.

After 11 months of research, the researcher finalized the list of emergent metathemes, themes, and subthemes and invited all interviewees to participate in a member-checking review.

Summary of quantitative findings

Participants who had used MDMA/ecstasy reported using it 11 – 20 times, with 57% reporting using it 10 or fewer times.

Participants were asked to indicate which acute subjective and physiological MDMA effects they recalled experiencing when they took MDMA/ecstasy. Most participants were highly confident that the substance they took contained MDMA.

Table 2 includes data about the intensity of effects experienced during MDMA/ecstasy experiences. Positive effects were reported as more strongly experienced in all examples, whereas no participants reported strongly experiencing anxiety.

Some participants reported durable benefits from MDMA/ecstasy use, including increased comfort in social settings, feeling at ease in one’s own body, and greater insight into one’s own thought processes.

Undesired effects and outcomes were reported infrequently, including mild to moderate disappointment, transient difficulties or distress, and fears of overdisclosure.

Summary of qualitative findings

The researcher used 24 semi-structured interviews with participants presumed to be on the autism spectrum to create an accurate and rich description of the entire data set.

Three qualitative metathemes of clinical relevance are described, along with corresponding theme constellations and their subthemes.

MDMA/ecstasy as change catalyst

Thirteen percent of participants denied observing any changes as a result of taking MDMA/ecstasy in nonclinical settings, but 87% did report awareness of changes.

All interview participants reported some form of change after their experience(s) with MDMA/ecstasy. Some participants reported non-specific change, while others reported significant change.

MDMA/ecstasy as transformation catalyst

Transformation is the second metatheme. The experiencer’s life was altered in a meaningful and valuable way that was pervasive or permanent, and the change was then-and-now comparisons that suggested a sort of metamorphosis into an evolved version of the old self or identity.

Multiple examples of positive transformation were apparent, and no participants reported lasting harm or regression to a lesser state or deteriorated condition as a result of MDMA/ecstasy use.

MDMA/ecstasy as healing catalyst

MDMA-assisted change or transformation can have an influence on domains relevant to psychotherapy in general, as well as indications of serious mental illness, such as PTSD, depression, and types of anxiety that are common in adult autistic populations.

Discussion

Participants expressed a desire to cure, heal from, or eliminate autism, but none reported no longer being autistic after or as a result of taking MDMA/ecstasy.

Participants reported using MDMA to overcome social inhibitions and hypersensitivities to touch in order to enjoy sexual contact. Intentional, pre-planned use for a specific purpose was less common.

A 36-year-old male reported having minimal effects of MDMA/ecstasy, while 8 moderate responders reported a combination of physiological, affective, and cognitive effects, some of which were unique to autistic perspectives. 13 optimal responders reported life-changing transformation.

Autistic individuals have anxiety responses to inability to anticipate or interpret what happens in social situations. Autistic adults who can speak and whose autism might not be immediately recognizable to others often present with symptoms of anxiety.

Study limitations

Self-selection bias was an unavoidable limitation of this study, but participants were encouraged to provide accurate descriptions of their experiences. The study did not confirm purity, dose, extent of reported or non-reported polydrug use, or concomitant use of other substances, including prescription medications.

Despite the researcher’s efforts to recruit participants from different ethnic groups, 88% of survey participants and 92% of interview participants reported their ethnicity as “White/non-Hispanic”.

The study did not confirm an autism diagnosis. Some eligible respondents might have been excluded and others who do not qualify for an autism clinical diagnosis might have been included.

The researcher approached this research with a hypothesis that MDMA-assisted therapy may be beneficial, and maintained a personal journal of internal dialog, conscious thoughts, personal assumptions, and opinions.

Future research

Research into MDMA-assisted therapy for autistic adults is exploring how best to treat participants who receive placebo during long experimental sessions, and how to train clinicians to work effectively with autistic participants.

MDMA-assisted therapy may be helpful for LGBTQI and autistic populations that experience bullying, social ostracization, and severe discrimination, as well as non-autistic individuals who present with social anxiety or extreme shyness.

Longitudinal studies with MDMA-assisted therapy are necessary to determine whether participants have improved quality of interpersonal relationships over the lifespan, and whether they are at greater risk for problematic drug use.

Conclusion

Study findings may inform larger future clinical studies with adults on the autism spectrum who may benefit from MDMA-assisted therapy.

Individual and collective transformation are reciprocal processes, and research teams will benefit from including adults on the autism spectrum.