Doweiko (2015) describes substance use as a normal learned behavior that falls on a continuum of total abstinence to limited use to excessive use and dependency. He defines dependency as using a substance that is not prescribed and being marked by withdrawal syndrome, which is when an individual either stops, or drastically decreases his or her intake of a specific substance. There are many different reasons an individual may begin to start using and abusing substances. It could be to cope with emotional or physical pain, explore alternative realities, feelings of euphoria, to fit in socially, or to rebel. The substance abuser could be blind to the actual or negative effects of a substance or they may continue using because of the rewarding effects elicited in the brain. There are many reasons people begin and continue using a substance, more specifically I will be discussing MDMA or 3,4 methylenedioxymethamphetamine.
MDMA was first isolated in 1912 and in 1914 it was patented. Chemists were hoping it would be useful for losing weight by creating it for suppressing the appetite. In the 1950s the U.S. Army asked the University of Michigan to determine the toxicity for possible use in chemical warfare, however the decision was made to discontinue that research and in the 1960s few psychotherapist began to research it for therapeutic uses. In the 1970s and 1980s psychotherapist thought because it alters the conscious, increases empathy, self-confidence, and well-being it could be used in therapy. MDMA can cause derealization and depersonalization, which was thought to increase responsiveness to emotions and create a sense of closeness to others. However, research on MDMA ended in 1985 when the Drug Enforcement Administration (DEA) classified is as a Schedule I compound, meaning it has no medical uses and a high potential for abuse.
Back to the early 1980s MDMA or ecstasy (another name for MDMA) quickly spread through Spain, Germany, France, the UK, and then USA. MDMA or ecstasy paved the way for a generation of dancing, house and techno music, and raves. MDMA is considered a club drug due to its effects on psychomotor drive, self-confidence, heightened sensory awareness, and increase energy, empathy, and perception of closeness to others. It rapidly spread in the 1990s, but soon after use leveled off. Research began to show possible psychiatric problems caused from ecstasy such as reduced cognitive processing, sleep and eating disorders, and dependence and tolerance in regular users. Although MDMA or ecstasy use decreased because of potential harm in recent years use has picked back up. The possible reason is because the increase of the term Molly being used in popular culture in the U.S. The term Molly is a nickname for the powder or crystal form of MDMA, which is thought to be more pure than ecstasy pills. MDMA has always been popular with EDM or techno music, but recently the term Molly has been associated in rap and hip hop music, which could have caused a shift in sociodemographic characteristics of users. Unfortunately little research has been done on the differences in Molly and ecstasy, but some recent research done on the purity of Molly actually show it is potentially more dangerous because it is not a more pure form of MDMA but often contains “bath salts” or other synthetic substances that cause harm. Also with it being in a crystal or powder form dosing is not always accurate and can more easily contribute to overdose when the dosing or substances your ingesting are largely unknown. But because of its perceptions as being safer than ecstasy pills, it may be more appealing to individuals with the effects of MDMA already being appealing.
MDMA causes a large increase in serotonin concentration in the synaptic cleft by inhibiting presynaptic serotonin transporter and monoamine oxidase while also causing more serotonin to be released for the presynaptic vesicles. Dopamine, norepinephrine, cortisol, prolactin, and oxytocin are also increased. The duration of action is usually 4 to 6 hours and normalized serotonin levels aren’t reached again until about 24 to 48 hours after use. Acute effects already mentioned above include euphoria, heighten sense of self-confidence, compassion, well-being, empathy, libido, and perception of closeness to others. You may also experience increase psychomotor activity, energy, suppressed appetite, increase blood pressure, heart rate and body temperature, bruxism (clenching of the jaw), rarely hallucinations, dehydration, and hypothermia. Long-term effects include depressive symptoms during days after use, anxiety, impulsivity, and problems with working memory, attention, sleep, reduced grey matter in the brain, decreased hippocampal activity, toxic influences on serotonin and dopamine systems, and possible thinning of the parietal and orbitofrontal cortex. It is well absorbed in the gastrointestinal tract like and extensively metabolized in the liver like many other substances or compounds. Another noted issue with MDMA use is that many users also report other substance use making it hard to determine the dependence potential.
With all of the perceived positive effect or acute effects of MDMA it can be rewarding for an individual to use the substance, however the rewarding effects are weaker than the rewarding effects of cocaine. MDMA has a weaker basis of physiological dependence, but has a strong psychological basis for dependence when compared to other drugs and behavioral reinforcement or learning could be essential as well. Although many users report using infrequently many still report dependence symptoms, but findings indicates DSM criteria may not be sufficient in assessing for MDMA dependence. Gender, age, and social factors could be more important when discussing MDMA dependence and abuse, and could be larger factors when considering treatment planning and interventions. However many studies show different finding in regards to gender. A study done by Lazenka, Suyama, Bauer, Banks, and Negus (2017) on female and male rats found female rats had a larger effect in the brain when compared to male rats, but in another study on humans done by Palamar and Kamboukos (2014) they found adolescent females were more likely to initiate use, while adolescent males were at high risk for recent or past year use and they found males tend to ingest larger amounts. These finds make sense to me given the difference in sexual dimorphism and differences in female and male brains causing females and males to have different effects from substances. Many other studies find no sex differences, but it appears the age group is congruent across the board.
When integrating MDMA use with the biopsychosocial model of substance use it appears to fit in each aspect of the model. Biologically MDMA affects the brain which has rewarding effects, and from the psychological perspective it could be due to individual personality. In the study done by Linden-Carmichael et. al. (2016) they found young age adults with higher levels of sensation seeking reported being more likely to use Molly or MDMA, which could be contributed to identity exploration in college aged individuals and the fact some young adults with more sensation seeking qualities are drawn toward new and exciting experiences. From the social model perspective sometimes people in this age group do things just to fit in with the crowd and the term Molly has become more prevalent in U.S. popular culture. Each study I looked at found prevalence rates to be higher in adolescents and young adults, therefore the possible best approach could be harm reduction rather than told abstinence. Because some individuals in this age group can have more difficulties abstaining from drug use education and training on ways they can protect themselves from problematic drug use may be more useful approach. With perceptions of Molly being a safer form of MDMA and Molly becoming more popular in use makes it’s dangerous because it is in fact not a more pure form, and educating individuals on what it could actually contain is important for harm reduction. Targeting potential users in this age group could also prevent them from long term use of MDMA and focusing on the adverse effects and explaining what you should do and look out for when using MDMA could help combat overdose rates in this population.
In conclusion MDMA was more frequently used in the 1980s and 1990s, but with recent emergence of the term Molly in popular culture use has gone up. Also the perceptions that Molly is a safer version of ecstasy pills and a more pure form of MDMA has made it more attractive to use for young adults. MDMA does have the potential for dependence but due to the mechanisms of action in the brain there is less dependence potential, and age, gender, social factors, and individual differences play a role in initial use and frequency of use. Due to it being more popular with young adults and college age individuals a harm reduction approach could be more beneficial than advocating for total abstinence.
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