Problematic versus non-problematic ecstasy/MDMA use: the influence of drug usage patterns and pre-existing psychiatric factors

Abstract

Recreational ecstasy (3,4-methylenedioxymethamphetamine; MDMA) use has been increasingly associated with a number of psychiatric symptoms and psychological problems. However, previous studies assessing possible psychopathological effects have not identified whether users consider their ecstasy use "problematic" or not. In addition, research has generally failed to address the potential role of premorbid psychiatric status. This study aimed to assess whether premorbid psychiatric history and/or patterns of ecstasy use would be associated with the degree of self-reported problems attributable to ecstasy. Problematic ecstasy users (n = 53) who had reported problems attributable to their ecstasy use were compared with non-problematic ecstasy users (n = 62), polydrug controls (n = 62) and illegal drug-naive controls (n = 111) on a recreational drug use questionnaire; a questionnaire, which ascertained personal and family psychiatric histories, and the Brief Symptom Inventory (BSI). Problematic ecstasy users exhibited significantly higher scores on a number of dimensions of the BSI compared to illegal drug-naive and/or polydrug controls. Problematic ecstasy users also exhibited significantly elevated scores on somatization, depression, anxiety and negative psychobiology compared to non-problematic ecstasy users. BSI scores for the non-problematic ecstasy users did not differ from polydrug or illegal drug-naive controls. Problematic ecstasy users reported significantly higher levels of ecstasy use, including lifetime consumption, average dosage and binge consumption compared to non-problematic ecstasy users. Additionally, a greater number of problematic ecstasy users reported personal and family psychiatric histories compared to controls and non-problematic ecstasy users. This study demonstrates two distinct ecstasy using groups: non-problematic ecstasy users who are not showing signs of psychopathology and problematic ecstasy users who are showing evidence of a range of symptoms. This data therefore partially supports the link between ecstasy dosage and negative psychological sequelae, but highlights the importance of the need to consider ecstasy-related attributions, pre-existing mental health status and vulnerability.

Maximising the highs and minimising the lows: Harm reduction guidance within ecstasy distribution networks

“…Ecstasy hangovers were described from mildly debilitating --feeling tired and a little cranky --to serious depression lasting several weeks or even months. This finding is consistent with other studies that indicate depressive symptomatology is a common problem among heavy Ecstasy users (Curran & Travill, 1997;Hinchcliff, 2001;Lieb et al, 2002;MacInnes et al, 2001;Parrot & Lasky, 1998;Soar et al, 2006;Verheyden et al, 2003). One 28-year-old woman shared her experiences with depressive mood.…”

Attributions for psychobiological changes in ecstasy/MDMA and other polydrug users

“…The common problems reported related predominantly to the psychological effects associated with the drug, such as low mood, depression and anxiety and cognitive difficulties. Additional evidence to suggest this single question has some validity also comes from the psychopathological profiles of these problematic ecstasy users compared to nonproblematic ecstasy users, as measured by a standardised and validated measure -the BSI (Soar et al, 2006), suggesting that the problematic ecstasy users within this study were showing signs of psychological problems over and above the non-problematic ecstasy and cannabis using controls.…”

“…Again all of these questions have previously been utilised to ascertain patterns of ecstasy use and indication of problems in ecstasy users (e.g. Soar et al, 2006).…”

“…Fox et al (2001) and Soar et al (2006) have previously compared 'problematic' and 'non-problematic' ecstasy users, and found differences in the perceived psychological problems attributed to their ecstasy consumption; and to a degree such differences have been accounted for by premorbid characteristics and patterns of ecstasy use. However, the role of other polydrug use has not previously been addressed in these two sub-groups.…”

MDMA (Ecstasy) use and psychiatric problems

“…Singer et al (2004) found that Ecstasy users reported significantly more experiences of childhood emotional and physical neglect and physical abuse in comparison to Ecstasy-naïve controls. Soar et al (2006) found that problematic Ecstasy users reported an elevated history of familial depression, anxiety, and panic attacks in comparison to nonproblematic Ecstasy users and control participants. More specifically, the rate of familial depression in problematic Ecstasy users was about two times greater than the rates reported by the comparison groups; the rate of familial anxiety was about three to seven times greater, and the rate of familial panic attacks was about two to five times greater.…”