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MDMA (Ecstasy) Addiction

Yes, MDMA can be addictive. While it does not generally produce physical dependence, psychological dependence is possible with repeated use.

A comprehensive treatment program can effectively address ecstasy addiction.

What Is MDMA? 

The chemical 3,4-methylenedioxymethamphetamine, or MDMA, is a synthetic intoxicant that elevates mood and induces hallucinations. This substance is also referred to as ecstasy or Molly

It was originally synthesized in 1912 by German scientists searching for a stimulant to control appetite and bleeding. It was called methylsafrylaminc.

History of MDMA

The pharmaceutical company Merck patented the drug in 1914 after finding it had different, unique chemical properties, but little was done with the drug until the Central Intelligence Agency (CIA) began experimenting with it as a potential weapon in the 1950s. It did not function well for government purposes, but in small doses, the dissociative and relaxing properties of MDMA were beneficial to some patients in psychotherapy.

In the 1970s, the drug was used to help patients with high anxiety or other conditions relax during the therapy process and become more willing to communicate and participate. As a therapeutic medication, it was called Adam because it helped patients reach a more innocent state.

Although MDMA was useful in small portions for therapy, in larger portions, it led to an intense, euphoric high, greater physical energy, less sleepiness, and pleasant hallucinations.

By the 1980s, the drug became closely associated with the nightclub scene, sometimes called the yuppie psychedelic, under the assumption that it was like LSD but milder or safer.

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As it became diverted and abused, MDMA was moved to Schedule I on the Controlled Substances Act (CSA) list, per the  U.S. Drug Enforcement Administration (DEA). The federal agency declared an emergency ban on the drug in 1985, which has not been lifted except for a brief period between 1987 and 1988.

Despite the DEA cracking down on the substance, MDMA became very popular in the 1990s. Sold as ecstasy, abuse of MDMA rose 500 percent between 1993 and 1999. Although some medical researchers now want to move the drug’s scheduling to study potential therapeutic benefits, the DEA has not changed the scheduling to allow this research to occur in the United States.

Currently, the DEA lists MDMA, ecstasy, and Molly together as a hallucinogenic substance since that is the chemical’s main effect on the brain. The drug also has stimulating effects like amphetamines, making it a dangerous and highly addictive substance.

How Does MDMA Work in the Brain? 

MDMA impacts neurotransmitters in the brain that are involved in mood, appetite, and the need for sleep. The drug also triggers the reward center, which is part of the brain involved in learning certain behaviors. When the reward center is triggered, the individual will crave that behavior again because it is associated with feeling good.

Compulsive behaviors to generate chemical stimulation in the brain are the hallmark of addiction — both to a substance like MDMA and to certain repetitive behaviors like gambling.

The chemical MDMA specifically affects the brain by triggering the release of:

  • Dopamine. This neurotransmitter is involved in mood regulation, feeling high or low energy, and hallucinations, when there is too much in the brain. The chemical influences the reward system to reinforce certain behaviors, so with a sudden flood of dopamine in the brain from taking MDMA, that area will associate the substance with good outcomes
  • Norepinephrine. This chemical increases blood pressure and heart rate, so the body feels more stimulated and full of energy. This can lead to feeling like one is having a panic attack or heart attack. People with cardiovascular system disorders may be at risk of hospitalization or death
  • Serotonin. In addition to affecting mood, appetite, sleep cycles, and sexual arousal, serotonin stimulates the release of hormones associated with trust. After the brain produces a flood of serotonin from taking MDMA, the person will feel very happy, pleased to be around others, and excited by events. Too much of this chemical creates a crash which will feel like deep depression. 

MDMA triggers the release of these neurotransmitters about an hour after the first dose is consumed. Moderate abuse of MDMA leads to depressive symptoms, and for some, that may lead to stronger cravings for more of the substance to feel better.

It is rare for someone to binge with MDMA the same way that people binge methamphetamine or cocaine because the effects of MDMA last longer. However, the next day, the comedown symptoms can be so strong that the person will try to find another dose of Molly or a similar substance, which leads to a cycle of abuse and addiction.

The chemical physically flattens the filament-like ends of serotonin receptors on neurons, so it becomes more difficult for these brain cells to communicate with each other. Long term, this can lead to changes in mental state that require ongoing counseling or medical treatment.

How Is MDMA Abused?

When taken, MDMA is usually:

  • Swallowed in the form of tablets or capsules
  • Eaten, mixed into drinks, or snorted as a powder
  • Crushed and snorted
  • Smoked, although this is rare

Signs that a person is high on MDMA include:

  • Wide eyes and dilated pupils
  • Excessive energy and moving a lot
  • Restlessness and inability to sit still
  • Being more alert and easily distracted
  • Shaking or tremors
  • Grinding teeth and clenching the jaw
  • Nausea and vomiting
  • Sweating and feeling hot to the touch
  • Extremely happy and excitable
  • Touching people or objects repetitively
  • Lowered inhibitions
  • Intense euphoria
  • Paranoia or fear
  • Paradoxical depression
  • Dehydration

These effects typically begin 30 to 45 minutes after swallowing the drug. If the person snorts or smokes ecstasy, which is rare, then the effects will begin sooner.

The high lasts four to six hours, after which the person is usually exhausted. Sometimes, the individual may take more ecstasy to keep feeling good, although the effects will not be as strong since the drug depletes neurotransmitters. More often, they will go to sleep and feel exhausted for one or two days.

The effects and side effects of MDMA can be harmful, leading to acute problems. If the drug is abused repeatedly, it can lead to long-term damage to one’s health.

Acute and Chronic Effects of MDMA Abuse

Typically, people who take MDMA want lowered inhibitions, elevated happiness, the drive to dance all night, and increased sensitivity to physical sensations like touch.

There are several uncomfortable side effects, which can occur even after one tablet is taken. These may include:

  • Depersonalization, or feeling disconnected from oneself
  • Elevated anxiety
  • Involuntary grinding or clenching of the teeth
  • Muscle tension
  • Blurry vision
  • Feeling faint or very hot
  • Nausea or vomiting

If someone takes too much MDMA or metabolizes the drug more thoroughly than the average user, they may experience serious health consequences.

  • Hypertension, or high blood pressure
  • Hyperthermia, or a body temperature that is too high
  • Seizures, or frenzied electrical instabilities in the brain
  • Cardiovascular damage

Heatstroke, or hyperthermia, can be difficult to manage when it is caused by a chemical. This condition can harm internal organs, including the kidneys and liver. Heart failure may occur due to too much stimulation, heatstroke, or extreme dehydration.

Long-term harm from abusing ecstasy may include:

  • Chronic depression
  • Chronic insomnia and other sleep abnormalities
  • Anxiety or panic disorder
  • Brain damage, affecting memory and learning ability
  • Kidney failure requiring medical treatment
  • Psychosis, or disruptions to thoughts

Risky Behaviors and Overdose on MDMA 

An overdose, or acute toxicity from MDMA, can have devastating consequences.

The most severe outcome of too much MDMA is hyperthermia. The body’s internal temperature becomes so high that the internal organs begin to break down. The drug may lead to an electrolyte imbalance that raises body temperature, damages kidneys, causes the brain to swell, and can lead to dehydration, which has its own harmful risks.

Damage to the heart, kidneys, lungs, and liver are all effects of taking MDMA and failing to regulate body temperature and fluid intake. Mixing MDMA with other substances like alcohol and marijuana is a common practice, but it can make these side effects from MDMA more likely.

Since taking MDMA is associated with social activity and involves dance halls, nightclubs, and other hot, crowded environments, sweating from high room temperature and physical activity can exacerbate the problem.

Taking MDMA, even at “normal” recreational doses, increases risky behaviors. Even if the person does not overdose on the drug or experience acute harm while they are intoxicated from ecstasy, they are more likely to engage in unprotected sex, share needles, or make other poor choices. Their ability to judge motion and distances will be reduced too, so they cannot safely drive or even cross the street. 

Sleep Disorders From Abusing MDMA

Because MDMA has such an extreme impact on neurotransmitters, leading to elevated good feelings and physical stimulation, one side effect of taking the drug is fatigue. As it wears out of the body, depression, and exhaustion will catch up. People who abused MDMA the night before may sleep most of the following day. MDMA can also trigger terrifying sleep disorders. Insomnia from depression, night terrors, and sleep paralysis are all associated with MDMA abuse, even if only used once.

Sleep trials have not been conducted specifically on MDMA since the drug is illegal in the U.S., even for medical research. However, anecdotal reports suggest that the impact on brain chemistry can have devastating, terrifying consequences that make the comedown even more intense.

MDMA releases a flood of serotonin into the brain, and this neurotransmitter is also involved in regulating sleep. When there is enough serotonin in the brain, arousal is mediated and mood is managed. If the chemical is lacking due to a mental illness or substance abuse, the normal wake/sleep cycle will be disrupted. 

Since the serotonin receptors are flattened, the brain may not be able to sleep as well, but the body still falls into sleep paralysis. When the body becomes paralyzed in a normal sleep cycle, but the brain wakes up, the individual may experience terrible visions like being held down by a demon. 

MDMA Withdrawal

Although anecdotal evidence suggests that people who abuse MDMA do so repeatedly and experience comedown symptoms, there is little information on whether ecstasy can lead to physical dependence, which would cause withdrawal symptoms.

For people who consistently or repeatedly abuse MDMA, overcoming the compulsive behaviors associated with addiction may not involve managing physical withdrawal, but managing psychological withdrawal. This still requires medical supervision, and it may include enrollment in an inpatient detox and rehabilitation program to keep the person away from drugs and alcohol.

Some people who detox from ecstasy report feeling:

  • Exhaustion or fatigue
  • Loss of appetite
  • Difficulty concentrating
  • Symptoms of depression

These symptoms may begin 12 hours after the last dose has been consumed, and the drug begins to completely metabolize out of the body.

After 12 hours to one day, the body and brain will crave the drug. Without supervision in a detox program, these cravings can lead to a return to substance abuse, which can cause an overdose.

Treating MDMA Addiction

For most people, the body does not become dependent on MDMA, so withdrawal symptoms are likely to end within a few days or a week. The main problems to overcome are compulsive behaviors to take more MDMA, which requires behavioral counseling in a rehabilitation program.

Entering detox first, to ensure your body is safe, is the most important first step. Then, transferring to a rehabilitation program will get you into the group and individual therapy needed to change behaviors around drugs like MDMA, so you can stay sober.

Sources

(June 2018). What is MDMA? National Institute on Drug Abuse (NIDA). from https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly

(May 31, 2017). MDMA. History.com. from https://www.history.com/topics/crime/history-of-mdma

Ecstasy or MDMA (Also Known as Molly). U.S. Drug Enforcement Administration (DEA). from https://www.dea.gov/factsheets/ecstasy-or-mdma-also-known-molly

(September 2017). What is the History of MDMA? National Institute on Drug Abuse (NIDA). from https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-is-the-history-of-mdma

What are the Effects of the Drug Ecstasy? Scientific American. from https://www.scientificamerican.com/article/what-are-the-effects-of-t/

(September 2017). What are the Effects of MDMA? National Institute on Drug Abuse (NIDA). from https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-are-effects-mdma

(February 14, 2016). Even Small Amounts of Ecstasy Can Cause a Terrifying Sleep Side Effect. Business Insider. from https://www.businessinsider.com/even-small-amounts-of-ecstasty-can-cause-a-terrifying-sleep-side-effect-2016-2?IR=T

Ecstasy (MDMA). Student Health and Counseling Services, UC Davis. from https://shcs.ucdavis.edu/topics/ecstasy-mdma

(September 2017). Is MDMA Addictive? National Institute on Drug Abuse (NIDA). from https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/mdma-addictive

MDMA (Ecstasy, Molly) Drug Withdrawal Symptoms: What You may Experience. Mental Health Daily. from https://mentalhealthdaily.com/2014/03/19/mdma-ecstasy-molly-drug-withdrawal-symptoms-what-you-may-experience/

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