Can 3,4,-methylenedioxymethamphetamine therapy be used to treat alcohol use disorder ?
Journal of Psychedelic Studies, 2017, 1, (1), pp. 1–9
Treating people with alcohol use disorder has been an important target area for psychedelic research – both in the first studies of the 1950s and during the Psychedelic Renaissance of the last 10 years. To date, most studies have looked at the classical psychedelic drugs as adjuncts to psychotherapy; with attention paid to the psychospiritual aspect of the experience as a central therapeutic process in effecting abstinence from drinking. Psychotherapy assisted with 3,4,-methylenedioxymethamphetamine (MDMA) has never been explored for treating alcohol use disorder. However, MDMA has some unique pharmacological characteristics – particularly its capacity for reducing the fear response and facilitating engagement in therapy around past psychological trauma – that could make it a useful candidate for tackling the core features of alcohol use disorder. This paper briefly describes the burden of alcohol use disorders and the history of psychedelic-assisted psychotherapy in the field of addictions. It gives the theoretical and experimental justification for MDMA-assisted psychotherapy for treating people with alcohol use disorder and introduces a forthcoming study from Bristol and London, UK, exploring the role for MDMA in treating a person with this challenging condition.
Keywords : MDMA, alcohol use disorder, dependence, psychedelic, trauma, LSD
At the turn of the 20th Century, the personal, societal, and clinical burden of alcohol misuse reached a historical peak (Wilson, 1940). There followed a move away from the moralistic “Inebriety Asylum” approach, with a reappraisal of the problem using a medical-/disease-based model (Mann, Hermann, & Heinz, 2000). Since then we have seen a plethora of different treatment approaches from the religious to the pharmaceutical. Despite our current wide range of pharmacological and psychosocial treatments for patients addicted to alcohol, the rates of relapse, a return to drinking after detoxification, remain high (Miller, Walters, & Bennett, 2001). This perennial problem for medicine and society deserves an innovative approach.
People with alcohol use disorder are often stigmatized, maligned by society and blamed. However, many of these patients have experienced adverse psychosocial circumstances. Their trajectory into alcohol use disorder has often resulted from childhood trauma into drug dependence that ties them to a lifestyle of emotional, psychosocial and financial dysfunction. Because of the complexity of etiology and the resulting psychological and physiological dependence that results, treating people with alcohol use disorders can be very challenging (Sessa & Johnson, 2014).
In the 1950s and 1960s, the treatment of people with alcohol use disorder became an important priority for some of the earliest psychedelic drug-assisted therapies with lysergic acid diethylamide (LSD). And now, after a hiatus of almost half a century, this research is being revisited with a number of contemporary studies examining the medicines psilocybin, ketamine, ibogaine, and ayahuasca as potential treatments for people with various drug dependence, all which are described later. To date, 3,4,-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy research has focused primarily on post-traumatic stress disorder (PTSD). However, MDMA has never been explored as a tool to treat people with alcohol use disorder. It could be, however, that delivered in a safe setting, after thorough screening of suitable patients,
careful scrutiny of physiological measures, and intensive integrative follow-up, a course of MDMA-assisted therapy- can assist a patient’s capacity to access, explore, and resolve ingrained negative beliefs about self and others that maintain addictive behaviors. This can provide an important opportunity for people with alcohol use disorder to maintain abstinence, reduce the harms associated with drinking, and achieve improved psychosocial functioning associated with recovery.