The world’s first clinical study into the use of MDMA to treat alcohol addiction has been approved in June 2017. The small trial was granted ethical approval despite MDMA being the main psychoactive ingredient in the recreational drug ecstasy.

The aim is to determine whether MDMA would have any beneficial effects in people with alcohol addiction who have failed other treatments.

Twenty patients will be recruited through the recreational drug and alcohol services in Bristol. Participants will be heavy drinkers who consumer an equivalent of five bottles of wine a day and have relapsed into alcoholism in a recurring manner despite other treatments.

After undergoing physical detox, patients will be given two standard therapy sessions without the drug. This is followed by an all-day session where a high dose of MDMA (99.9%) will be given in capsule form. During this session, some time will be spent talking to a therapist and the rest of the time, lying down with an eye-mask in a state of quiet meditation.

MDMA cannot directly influence behavioural problems

“MDMA is a designer drug; it is a hallucinogen and a stimulant,” says Dr Philip George, an Honorary Consultant and Substance Abuse Psychiatrist at Hospital Tuanku Jaafar, and presently a Professor at the Clinical School of the International Medical University.

“Using this is not new in therapy and treatments,” he adds.

Dr George explains that hallucinogens “brings the person into a different realm and they can then get into an unconscious part that has been kept away from reality or consciousness.” The therapy can then start to deal with vulnerability issues.

“MDMA is not necessary in this. Hypnotherapy can sometimes be used, or even free associations, where a rapport is built with a patient,” he asserts.

“So, I am a bit sceptical with this trial, I don’t think this trial will change dramatically how we do things, it is just taking the patient to a different conscious level to be able to work with therapy,” he added.

Consultant psychiatrist, Dr Sivakumar Thurairajasingam concurs, relaying that “we grapple in addiction psychiatry because we have very, very little drugs to work with. Alcohol addiction has been one of the oldest problems lying around, but it is sad to say that we have no gold standard drug to rely on.”

This is because treatment has so far been symptomatic and the cause of alcohol addiction is multifactorial.

“There are other behavioural components of alcoholics, so they are more prone to relapses,” says Dr Sivakumar.” The way alcohol works in the brain is amazing as it affects multiple receptors," he adds.

Breaking the cycle of addiction and relapse

“With alcoholics, you treat and manage them, but when they go out into society, there are environmental cues that are triggers,” explains Dr Sivakumar. “So, the triggers bring back the urge, and once people are not well-equipped to manage the urge, they start drinking and relapse.”

That having sad, cues are not limited to the environment – as they can include people, things and places.

Cues are not limited to the environment as they can include people, things and places; for example, spending a night out with a former drinking partner.
Cues are not limited to the environment as they can include people, things and places; for example, spending a night out with a former drinking partner.

Dr Sivakumar gives an example, “I have been drinking with a partner my entire life, that makes the person a cue. So, whenever I see the person, it triggers the urge or emotion within me. Even if there is no alcohol involved, just by seeing him, it triggers memories of the past.

“When I start having urges and I don’t know how to control them, I tend to have my first drink. Once I take my first drink, I go on to the second and I enter a lapse.”

This cycle or pattern of addiction is similar for most substance addictions, based on the same model. The common way to address this include a combination of medication and psychological methods – a bio-psycho-socio mode of treatment, which provides support for a lifestyle change.

“The main goal is a lifestyle change. People who have been using drugs for a long time, have gotten accustomed to it, it is part of their life and the only way that can be ceased, is if they make a lifestyle change,” Dr George says.

“No medication can do that,” adds Dr Sivakumar, “It is not easy [to change their behaviour]. It is easy to treat an illness but it is very difficult to change a behaviour.”

Prochaska and Di Clemente’s model of change

Andrew Carnegie, a Scottish-American industrialist in the late 19th century once said, “There is no use whatever trying to help people who do not help themselves.”

To a certain extent, this applies to substance-dependent patients, as explained by the transtheoretical model of behaviour change suggested by James O. Prochaska of the University of Rhode Island and Carlo Di Clemente in 1977.

“What was postulated was that humans – not those with drug or substance abuse problems – like to stay the way they are, they dislike change,” explains Dr Sivakumar. “So, we go through many phases of change.”

The model of change comprises six stages: precontemplation, contemplation, preparation, action, maintenance and termination.

Prochaska and Di Clemente’s Transtheoretical Model of Behavioural Change that many psychiatrists base their treatment methods on.
Prochaska and Di Clemente’s Transtheoretical Model of Behavioural Change that many psychiatrists base their treatment methods on.

“When they are in precontemplation, they think there is nothing wrong with their drug use. So, at that stage, intervention may be just advising them how to minimise harm.

“When they move on to contemplation – where they think they are doing something bad to themselves and are willing to make a change – we can then move on to treatments,” elaborates Dr George.

While it’s definitely better when the patient is ready to change – Dr Sivakumar echoes that “it doesn’t mean that we say “the patient is not ready, I wash my hands. No.” We still engage, because we can help them move from that phase,” he clarifies.

Moving on to preparation, action and then maintenance – when they are drug-free – it becomes an easier process; but a ‘relapse’ can still occur.

Dr George says that it is important to note that “every chronic medical condition can relapse.” But “it doesn’t mean that treatment does not work. They just go back to learning again how to prevent a future relapse.”

Referring to the MDMA trial, he adds that “the most important thing is the therapy, not the MDMA. If there are other methods that are safer, rather than giving a drug, then why not use that?”

However, he was careful to say that the results of the trial should be seen before any final judgement is made.

“Ultimately, it is a long-term process and people can do it – and have done it. They just need to work with the right professionals who can provide the right treatment,” he concludes. MIMS

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