Could returned servicemen with war-ravaged hearts and minds soon be given MDMA to smooth their way back into society? Is using MDMA for post-traumatic stress disorder (PTSD) a legitimately good idea, and is it ever going to be common practice? ImportantCool spoke to Dr Stephen Bright of Curtin University to learn more about this Huxley-esque development.
(This interview has been edited for brevity. The full audio can be accessed below.)
Dr Bright, speaking from Melbourne, is awaiting research ethics clearance to carry out MDMA-assisted psychotherapy with war veterans diagnosed with treatment-resistant PTSD. Following on from pilot studies in the United States, Dr Bright thinks that MDMA, the active ingredient in the drug commonly known as Ecstasy, could be the key to resolving their trauma.
‘In terms of using MDMA in the context of psychotherapy, it’s advantageous for a couple of reasons,’ Dr Bright says. ‘One is that the primary treatment for people with post-traumatic stress disorder is exposure therapy. So, we talk about traumatic experience over and over again and it allows the person to process the trauma. However, that can be very difficult for both the patient and the therapist. Hearing the story over and over again can cause vicarious trauma for the therapist and patients often drop out of the treatment because they find it too difficult to talk about the trauma, or they engage in defense mechanisms to prevent themselves from actually experiencing the level of anxiety that’s required for the therapy to be effective.’
You probably won’t be surprised to hear that this treatment is ineffective for a significant proportion of patients. Depending on who you ask, it seems that between 30 percent and 50 percent of patients do not resolve their PTSD through this form of therapy.
Traditional treatments, according to Dr Bright,
‘Would usually last for an hour and a half. You start off talking about the trauma in the least anxiety-provoking way, and work your way up to imagery-exposure with your eyes closed, trying to reimagine the trauma in first-person. Some people feel that they can’t sit with the anxiety, and either feel too much or refuse to engage at all. MDMA allows people to turn down the volume on the anxiety, so that they’re able to experience it within that window of tolerance which is necessary for the treatment to be effective, or disengage from the defense mechanisms they may be using to try to turn down the anxiety.’
What Dr Bright is describing speaks directly to reports from patients who have come through MDMA-assisted therapy sessions in the US. As one patient put it: ‘I don’t think I could have dug down so deep without the MDMA. I was so afraid of the fear but in these sessions there was just no fear, and that builds your confidence. When I tried before, it sent me into a tailspin.’
The MDMA reduces some of the anxiety that people have, making it easier for people to talk about the trauma, which is positive. It is also fosters rapport between the therapist and the client, so that the client feels more comfortable being able to talk about the traumatic event with the therapist. There are other drugs that can reduce anxiety–things like valium, benzodiazepines, alcohol, all of these drugs can reduce anxiety–but if a person talks about a traumatic event under the influence of one of these drugs, they tend not to be able to process it. So MDMA is quite unique in that it allows the person to talk about the event with reduced anxiety but also still process that.
It’s a neat comparison, because you would imagine that, whether MDMA therapy is available or not, the majority of traumatized returned servicemen are going to be self-medicating already. It makes no sense to take an anti-drug stance against MDMA-assisted psychotherapy when many patients are regularly getting drunk at the bar in an attempt to deal with their traumas.
We see a really high co-morbidity rate of people with trauma who experience problems with alcohol and other drugs because they actually use alcohol and other drugs as a way to cope with a significant emotion that the trauma experience creates. In turn, their use of alcohol and other drugs can make it very difficult to work with them in terms of managing and treating the trauma. It creates a very vicious cycle.
Alcohol for example works very well for people with trauma as a short-term solution. It turns down the anxiety and allows them to cope with everyday life, but of course it’s not a long-term solution because of all the problems associated with heavy drinking: the toxicity, the dependence that heavy alcohol use can create.
So what about self-medication with MDMA? Many people would claim that there are therapeutic elements to taking MDMA and going out dancing, listening to music, and spending time with their friends. I ask Dr Bright how that differs from being guided through a psychotherapeutic session on MDMA.
With MDMA, and with LSD, the setting is extremely important in terms of the person’s experience. We know that from the ’60s and Timothy Leary: the importance of set and setting. There is quite a big difference in taking MDMA and LSD in a clinical setting and taking it outside of the clinical setting. Within a clinical setting the environment is very controlled, whereas outside of a clinical setting there’s less control over that environment. So in that sense, a person is more likely to have a negative experience outside of a clinical setting,
I’m not saying, however, that a person may not benefit therapeutically from taking MDMA outside of a clinical setting. However because there’s less control over the setting it’s more likely that they would have a negative experience and it’s less likely that they would have a therapeutic benefit from it.
I must admit to being skeptical about the value of trying to control an MDMA experience, so I ask Dr Bright how exactly they do pass the time in an MDMA therapy session. Reportedly, a session can last up to eight hours at a time.
It’s actually a lot less directive than trauma-based cognitive therapy…On our website you can actually download the treatment manual, and it describes an approach in which the MDMA does a lot more of the work than the clinician. So the clinicians–a male and female team within the protocol that’s been developed–gently guide the person to re-experience the traumatic event, but they don’t push them too hard. Most people tend to go down that path through their own volition and they don’t need a whole lot of guidance. A big difference is that a lot of the effects seem to be from the drug itself rather than the therapeutic process. MDMA seems to have some sort of innate therapeutic quality to it.
This therapeutic quality is related to the way MDMA triggers the sensation of love in traumatized patients. MDMA sets off the release of naturally-occurring serotonin in the brain, and also prevents it from being taken out of the bloodstream once it’s released. ‘It works in a similar vein to anti-depressant drugs,’ Dr Bright points out, ‘but they do it very slowly, while MDMA does it in an immediate fashion.’
But in addition to the impact of a rush of seratonin, Dr Bright points to the simultaneous release of oxytocin as central to the therapeutic nature of MDMA.
Oxytocin is often referred to as the love hormone or the bonding hormone. We see really high levels of oxytocin in mothers when they first give birth. It’s assumed to help with the attachment process between mother and child. And so, MDMA increases levels of oxytocin, leading to increased levels of trust and rapport and so forth. So at a chemical level I guess that explains the mechanism of MDMA and how it relates to the natural chemicals within the human brain.
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With all this in mind, in some ways it makes perfect sense for therapy sessions to be experienced under the influence of MDMA. Patients who are able to approach their traumatic from a position of love and trust are bound to have the best chance of being healed. You almost wonder why this method has taken so long to arrive on the scene.
Yet, on another level it’s completely unthinkable. It would probably strike most people as beyond the realms of possibility to be carrying out professional therapy sessions with an otherwise illegal drug. On this point, though, Dr Bright points out that drug prohibition is a relatively new phenomenon.
Most of the drugs that are illegal today have been used as medicines in the past. Prior to MDMA becoming an illegal drug, it was being used in the context of psychotherapy, as was LSD in the ’60s.
In Australia there hasn’t been a lot of research conducted with illegal drugs. The research that has been conducted where illegal drugs have been administered to humans has typically been conducted within the context of a pathological paradigm, so, looking at the problems that the drugs might cause. For example, at Swinburne University [in Melbourne] they administered cannabis, MDMA and methamphetamine to people to look at what impact it might have on their skills when it comes to driving a motor vehicle. They put them in a simulator to determine what deficits there might be when a person is intoxicated on one of those substances.
Does this mean that because of the war on drugs, we’ve been focused on studying the harmful effects of drugs, without looking into their beneficial qualities?
It’s in the interests of research institutions such as universities to show that illegal drugs are harmful,’ said Dr Bright, ‘Since the funding that’s available will be principally made available for research that demonstrates results that provide justification for maintaining the illegal nature of those substances. That’s the idea of this pathological paradigm of drug use.
The focus has primarily been on demonstrating the harmful effects of these drugs. I think what’s really interesting about that though in terms of MDMA, is that in terms of the US and the National Association of Drug Abuse (NADA), they’ve spent something like $100 million researching what the harms might be from MDMA, and in fact they haven’t been able to demonstrate a whole lot of harms associated with that particular drug. In turn, what that allowed was that the Multidisciplinary Association for Psychedelic Studies (MAPS)–which is headed by Rick Doblin–were then able to use that data as Phase 1 clinical trial data so that they could move straight into Phase 2 clinical trials looking at what therapeutic benefits the drug might have.
In other words, thanks to all those studies aimed at demonstrating the harmful effects of MDMA, which came up with very little, researchers like Dr Bright haven’t had to start by proving that MDMA is relatively safe. They’ve been able to move straight to proving the benefits it may have in a clinical setting.
This might surprise those of us who grew up seeing anti-drug billboards showing photos of filthy bathrooms purporting to be bikie laboratories for concocting amphetamines, or were told that ecstasy contains battery acid and drain-cleaner.
‘But of course,’ Dr Bright argues,
‘The hypocrisy is that all of those things are used in the development of pharmaceutical drugs. It’s just we call them sodium hydroxide, hydrochloric acid, and so on and so forth, and they’re in pure form and they’re not being purchased off the shelves at Woolies and Coles [supermarkets].’
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In Australia, 10.9 percent of people have tried ecstasy, so it’s clearly not an instant trigger for a life of addiction and drug-addled stupidity. That said, experienced heads might raise an eyebrow at the idea that MDMA is completely harmless. Medium-term depression, post-rave mid-week illnesses and so-called ‘Suicide Tuesdays’ are a reality for some MDMA regulars. I asked Dr Bright how MDMA therapy comes to terms with come-downs, and if it poses a problem for working with patients who already have plenty of serious issues to cope with.
The come-down tends to be more severe with people who use the drug more frequently, so that’s again one of the reasons why we want to exclude people from the research who have used MDMA a number of times. So far there haven’t been a lot of problems with people experiencing that come-down in the days following the session. So it does seem that the more you use the drug, the nastier the come-down you’re going to have. I’m not explicitly sure why that is, but there seems to be some good anecdotal evidence, and the research that’s been conducted with people who haven’t taken MDMA previously, or at least have used it very few times previously, supports that idea, [namely], that the come-down increases with frequency of use.
In addition to that, I agree that often people will say that the first time they use it is the most salient for them. Often they’ll try to use it at higher doses to replicate that first experience, but they find it very difficult to ever replicate that first experience, which is another good reason for eliminating people from these sort of trials who have used MDMA in the past.
Maybe science doesn’t have anything firm to tell us about the come-down just yet, but I’m betting with Dr Bright’s knowledge of neurochemistry he might be able to make some informed speculations. I wonder if come-downs and lost highs are all a question of having depleted the brain’s natural supply of seratonin, so that perhaps the same amount of MDMA can never quite trigger the same rush.
‘I think it’s probably a little bit more complicated than that,’ replied Dr Bright.
There is some research showing that if animals are administered very high levels of MDMA very frequently it does lead to neuronal death, and so it could be that with frequent use of MDMA there is some depletion or brain damage as a result of that, which could contribute to some of the consequences that we’re talking about. But I don’t think we have enough research to really understand that, particularly within a human population, because we haven’t done enough research with regard to high doses and frequent use. I think that the low doses that we’re talking about in these clinical trials that are being conducted, and the fact that we’re only giving it to people a maximum of three times, means that those concerns don’t relate to the use of it in a clinical setting.
I think any drug if used to frequently can cause harm, be it alcohol or LSD or anything; anything too much is not good for you. Anything. The old adage is to do everything in moderation.
In other words, it’s not just a question of recouping serotonin by eating ten bananas and a bag of almonds for every cap you popped on the weekend. MDMA does have the potential to ‘fry your brain,’ but only with very frequent use at high doses. Sadly, the person most likely to do that is the kid who eats all his six caps at once after the cops scare him with a sniffer dog outside a music festival. But that’s another story.