Ecstasy instead of booze
MDMA helped with alcoholism
Oleg Lischuk, N+1
Preliminary results of the world's first clinical trials of methylenedioxymethamphetamine (MDMA, MDMA) for alcoholism have shown the safety and good tolerability of such therapy, as well as a pronounced long-term effect. A publication about this appeared in the Journal of Psychopharmacology (Sessa et al., First study of safety and tolerance of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder).
MDMA, known in popular culture as "ecstasy", produces empathogenic, entactogenic, euphoric and psychostimulating effects. Due to this, it was used in experimental psychotherapy in the 1960s and 70s to facilitate contact with the patient and consolidate the effect. Similar experiments have shown the ability of the drug to give a positive color to perception and reduce the effects of traumatic memories, but after the substance was added to the lists of controlled substances in most countries in the 1980s, such studies stopped.
Given the high therapeutic potential, in the past decade, the American and British authorities have begun to issue individual permits for testing MDMA, as well as some psychedelics (LSD, psilocybin) and dissociatives (ketamine and its enantiomer esketamine, salvinorin) for some neuropsychiatric disorders, such as depression and post-traumatic stress disorder. The effectiveness of MDMA with the latter turned out to be so high that the US Food and Drug Administration (FDA) awarded such a therapy the status of "breakthrough" and allowed the drug to be prescribed to the first 50 patients even before the end of clinical trials.
Alcohol use disorder, according to ICD-10 and DSM-5, includes alcohol dependence and regular consumption of excessive amounts of alcohol (Eng. binge drinking). In many cases, it develops against the background of experienced psychotrauma. With this in mind, in 2017, the staff of Imperial College London under the leadership of David Nutt, having received the approval of the ethics committee, began the first work of its kind, called the Bristol Imperial Study of MDMA in Alcoholism (BIMA). Ben Sessa, a member of the scientific team, then noted that the effectiveness of existing treatment methods is low, and the probability of relapse within three years reaches 90 percent.
As follows from the new publication, 14 BIMA participants after detoxification (therapeutic measures to remove ethanol metabolites from the body and prevent acute withdrawal syndrome) underwent an eight-week course of ten sessions of psychotherapy. In two of them, 187.5 milligrams of MDMA were used, paying special attention to the tolerability of the drug. After that, the condition of the participants was monitored for nine months, registering possible side effects, mental well-being and alcohol consumption.
It turned out that MDMA psychotherapy of alcoholism is well tolerated without significant side effects. During the observation, the researchers noted an improvement in the mental functioning of the volunteers. The average alcohol consumption of participants in the ninth month after detoxification decreased from 1306 to 187 milliliters per week in terms of pure alcohol. At the same time, only three (21 percent) had this indicator exceeding 140 milliliters per week against 75 percent with standard therapy.
Sessa noted on Twitter that there was no "ricochet" decrease in mood within a few days after taking MDMA, which is often reported by recreational consumers, in the experiment was not observed.
The authors emphasize that the published preliminary results of an open (without a control group) study serve only as a confirmation of the concept. Phase 2b of randomized controlled clinical trials of MDMA in alcoholism is currently being prepared. According to Sessa's estimates, it will require investments in the amount of two million pounds (2.79 million dollars at the current exchange rate) and will last three years.
MDMA is not the only "banned" drug that has proven to be highly effective in neuropsychiatric disorders. The psychedelic psilocybin has demonstrated great potential: its use in resistant depression has become another "breakthrough therapy" according to the FDA. In clinical trials, this drug has proved effective for the treatment of migraines; studies are underway on its use for a number of other indications.
The FDA also approved the treatment of depression with the dissociative anesthetic esketamine; moreover, the drug can not only improve mood, but also reduce suicidal tendencies. Positive results were also obtained in various LSD trials.
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