Ecstasy (MDMA) is a dissociative hallucinogenic compound that produces exhilaration, sedation, hallucinations (seeing, hearing, or experiencing things in other sensory modalities that do really exist in reality), and feelings of dissociation (feeling as if one is not connected to their body, as if one is not real, or as if things are not real). The effects of the drug are dose-dependent, and at low doses, there may be more stimulant effects whereas at higher doses, there may be more hallucinogenic and dissociative effects.
The drug was initially developed as a treatment for specific types of mental health disorders due to its ability to calm some individuals with trauma- and stressor-related disorders, such as posttraumatic stress disorder; however, the drug had numerous side effects, and its use was discontinued for these purposes. Research continues to ascertain the potential medicinal effects of MDMA on psychological issues, such as anxiety, stress, etc.
Ecstasy’s Classification and Use
Despite any potential medical uses, the Drug Enforcement Administration (DEA) classifies MDMA as a Schedule I controlled substance. Per this designation, the federal government assumes that the drug has no known medicinal value (despite some research studies suggesting that it may), is highly prone to abuse, and is very capable of producing physical dependence in individuals who use it. Substances classified in this category (Schedule I) are not considered to be safe to use under any circumstances, even if they are taken under the supervision of a physician. Therefore, these substances cannot be legally obtained by private citizens and may only be legally obtained with special permissions from the government. Typically, researchers can get permission to obtain or manufacture small amounts of the substance.
MDMA, often referred to by street names such as ecstasy, XTC, or Molly, became a popular club drug (often referred to as a “rave” drug) on the West Coast in the 1980s. The use of the drug declined significantly after the early to middle 2000s as a result of crackdowns by state and federal authorities and significant attempts by the media to educate individuals in the dangers of its use.
According to data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA):
- In 2015, it was estimated that 18.3 million individuals over the age of 12 had experienced any lifetime use of MDMA, whereas in 2016, this figure was 18.5 million.
- Of the 131,000 individuals who admitted to lifetime use of MDMA in 2016 who did not admit to it in 2015, it appears that the majority of these people were over the age of 26.
- The number of individuals between the ages of 12 and 17 reporting lifetime use of MDMA in 2016 declined compared to the number in 2015.
- Thus, it appears that MDMA is not being abused by teenagers and very young adults as much it once was, most likely because it is not nearly as available as it used to be and other drugs of abuse have captured the attention of younger individuals.
Mixing Ecstasy and Alcohol
According to the DEA and the National Institute on Drug Abuse (NIDA), ecstasy’s primary mechanism of action is to increase the amount of serotonin in the brain. Alcohol is a central nervous system depressant that primarily works by increasing the level of the primary inhibitory neurotransmitter in the brain (gamma-aminobutyric acid) and decreasing the availability of a major excitatory neurotransmitter in the brain (N-methyl-d -aspartate). The use of both drugs increases levels of dopamine in the brain due to dopamine’s function in the experience of reinforcement. The euphoria that occurs as a result of these drugs is reinforcing, which leads to an increase in dopamine.
Because ecstasy is a drug that is commonly used at parties, clubs, and social gatherings, it is very commonly used in conjunction with alcohol. Some of the signs that occur when individuals take ecstasy and alcohol together include:
- Increased sociability and friendliness
- Issues with motor functioning, such as problems with coordination, balance, walking, etc.
- Belligerence or aggressiveness
- A loss of inhibitions that can lead to poor judgment or accidents
- Accelerated heart rate
- Increased blood pressure
- Muscle cramping
- Significant muscle tension
- Teeth grinding
- Blurred vision
- Extreme sweating
- Nausea, vomiting, and sometimes chills and fever
Continued use of alcohol and ecstasy together can lead to some significant issues.
- Serious dehydration is a potential risk. The use of ecstasy often results in hyperthermia (increased body temperature), and individuals begin to sweat profusely. Alcohol is a diuretic. This can lead to dehydration that can result in cardiovascular issues (high blood pressure, heart attack, and even stroke), delirium, aggressiveness, confusion, psychosis, kidney failure, and seizures.
- Combining these substances results in a significant potential to develop liver damage.
- People who abuse ecstasy often have problems with insomnia once they crash.
- There is a significant potential to overdose on either drug. Most likely, individuals with overdose on alcohol, but overdose of either drug can be potentially fatal or lead to long-term damage to areas of the brain that may produce significant cognitive issues, such as problems with memory, attention, problem-solving, and emotional regulation.
- Individuals who combine alcohol and ecstasy often begin to experience issues with severe anxiety and paranoid thinking that can become quite pronounced.
- Once the individual stops taking the drugs and they begin to leave the system as a result of normal metabolism, a massive depletion of neurotransmitters in the brain occurs. This can lead to significant issues with apathy, depression, and even suicidality.
- Chronic use of either drug is associated with the potential for numerous neurological and cognitive issues as a result of damage to the brain.
- When an individual combines different types of drugs, such as a central nervous system depressant and a dissociative hallucinogenic that has stimulant properties, the risk of overdose on either drug is increased. In most cases, overdosing on alcohol would be the most common occurrence as a result of mixing these two drugs, as individuals continue to drink more and more alcohol. However, it is possible for one to overdose on either drug as a result of the effects that occur when one takes both drugs.
- When different drugs are combined, there is always the risk for unusual or unpredictable side effects from either drug or from the combination of the drugs.
- The development of physical dependence on one or both drugs is markedly increased.
- The development of a substance use disorder to one or both of the drugs is substantially increased.
Individuals who develop physical dependence on alcohol or illicit drugs often struggle with obtaining enough of the drug to avoid withdrawal symptoms. This can lead to impulsive, irrational, criminal, and other types of behaviors that can to significant distress for the individual. Any individual who develops any type of substance use disorder is experiencing significant distress in life, impairment in their functioning, and issues controlling their use of the drug. This can lead to numerous complications and other situations that may last for years.
Concerns of Mixing Alcohol with Other Drugs
- Crystal Meth
- Crack Cocaine
- Bath Salts
Whenever an individual develops a substance use disorder, the general approach to the treatment protocol is well-defined, but adjusted to fit the needs of the individual. Any individual who has developed physical dependence on ecstasy and alcohol would most likely require significantly more time in an inpatient withdrawal management program (medical detox) than the standard 30-day stay. The treatment approach would have to be very carefully planned after the individual is assessed to determine if there any other co-occurring conditions, such as psychiatric/psychological disorders.
The first step in the overall treatment program is to help the individual maintain abstinence from both drugs without experiencing significant withdrawal symptoms. Typically, this would be performed on an inpatient unit and supervised by an addiction medicine physician or addiction psychiatrist. Following completion of the medical detox treatment, the person would be required to become involved in a treatment program that consists of continued medical management of drug cravings and other issues (most often via the use of medicines) and an intensive substance use disorder therapy program.
Treatment should focus on short-term goals that, over time, contribute to long-term abstinence from drugs and alcohol. This would include the implementation of relapse prevention techniques, stress management techniques, psychoeducation regarding substance abuse, and other cognitive-behavioral techniques, such as relaxation training, diaphragmatic breathing, cognitive restructuring, etc. The person would be expected to be actively participating in treatment-related activities for many years after they have discontinued use of both drugs in order for their long-term outlook to be favorable.