MDMA (ecstasy) treatment for alcoholism could reduce relapse

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AlcoholThe first study looking into the use of MDMA – commonly known as ecstasy – to treat alcohol addiction has shown that the treatment is safe, writes Helena Blackstone for The Guardian. Early results show encouraging outcomes from the approach, UK scientists said.

Doctors in Bristol are testing whether a few doses of the drug, in conjunction with psychotherapy, could help patients overcome alcoholism more effectively than conventional treatments. Those who have completed the study have so far reported almost no relapse and no physical or psychological problems.

In comparison, reports The Guardian, eight in 10 alcoholics in England relapse within three years after current treatment approaches.

Dr Ben Sessa, an addiction psychiatrist and senior research fellow at Imperial College London, and who led the trial, said: “With the very best that medical science can work with, 80% of people are drinking within three years post alcohol detox.”

Eleven people have so far completed the safety and tolerability study, which involves nine months of follow-ups. “We’ve got one person who has completely relapsed, back to previous drinking levels, we have five people who are completely dry and we have four or five who have had one or two drinks but wouldn’t reach the diagnosis of alcohol use disorder,” Sessa said.

Most addiction is based on underlying trauma, often from childhood, he explained. “MDMA selectively impairs the fear response. It allows recall of painful memories without being overwhelmed. MDMA psychotherapy gives you the opportunity to tackle rigidly held personal narratives that are based on early trauma. It’s the perfect drug for trauma-focused psychotherapy.”

After preliminary screening, including medical and psychological tests, the participants are given an eight-week course of psychotherapy, reports The Guardian. In weeks three and six, they are given a powerful dose of MDMA, and then spend eight hours with the specialists, mostly lying down, wearing eyeshades and headphones.

After the MDMA-assisted sessions, patients stay overnight and are telephoned every day for a week to collect data on sleep quality, mood and potential suicide risk. Significantly, this data has shownno evidence of drug withdrawal or comedown symptoms from the MDMA.

According to The Guardian, MDMA was used as a legal prescription drug to enhance the effectiveness of psychotherapy in the US from the 1970s to 1985 and in Switzerland up until 1993. In recent years, MDMA therapy has been studied extensively as a treatment for post-traumatic stress disorder (PTSD). Full report on The Guardian site.

Preliminary data presented on MDMA treatment for alcohol use disorder

The preliminary data in the Bristol-Imperial MDMA-for-Alcoholism (BIMA) study, an ongoing open-label safety and tolerability proof of concept study exploring the potential role for 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in treating patients with alcohol use disorder (AUD) has been presented. At this stage, eleven participants have completed the full 8-week MDMA-assisted psychotherapy course, including two therapy sessions each with MDMA.

The study by researchers at the Imperial College London and the Avon and Wiltshire Mental Health Partnership NHS Trust, focuses primarily on the safety and tolerability of the therapeutic course for this population of patients with AUD. Results so far show all participants have successfully tolerated the treatment. There have been no serious adverse events related to MDMA, no unexpected physiological responses to the MDMA sessions or changes to blood results or electrocardiograms, measured before and after the 8-week course.

In recent years, MDMA-assisted psychotherapy has been studied extensively as a treatment for post-traumatic stress disorder (PTSD). And since the 1950s, it has been well known that the ‘classic’ psychedelic drugs (particularly psilocybin and LSD) have shown impressive safety and efficacy to treat a range of different addictions. But to date there are no previous studies exploring MDMA-assisted psychotherapy as a treatment for AUD – or any other addictions.

Carrying out clinical research on patients with AUD is difficult because of the high incidence of comorbidities in this population. Physical problems include alcohol-induced hypertension and impaired liver functioning. Psychological comorbidities include high levels of trauma, polysubstance drug misuse and personality disorders. Unstable social factors, such as unemployment, insecure housing and poverty, are also common in this group of patients – all of which added to the complexity of this project.

Despite these challenges, the massive personal, clinical, societal and financial burden of AUD makes this diagnosis an important target for innovative research. This is especially imperative, given the current poor rates of lasting recovery with current best-approved treatments.

We conclude that the treatment is well-tolerated and are making plans to expand the project into a randomised placebo-controlled study. We are also considering further applications for MDMA-assisted psychotherapy for the treatment of other substance use disorders.

Abstract
We present the preliminary data in an ongoing open-label safety and tolerability proof of concept study exploring the potential role for 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in treating patients with alcohol use disorder. At this stage, seven participants have completed the full 8-week MDMA-assisted psychotherapy course, including two therapy sessions each with MDMA. This paper focuses on the safety and tolerability of the therapeutic course for the first four participants to complete treatment. Longer-term outcomes of drinking behaviour will be presented later when the full project data are published. Results show all four participants have successfully tolerated the treatment. There have been no serious adverse events related to MDMA, no unexpected physiological responses to the MDMA sessions or changes to blood results or electrocardiograms, measured before and after the 8-week course. We conclude that the treatment is well- tolerated and are making plans to expand the project into a randomised placebo-controlled study.

Authors
Sessa B, Sakal C, O’Brien S, Nutt D

MDMA treatment for alcoholism could reduce relapse, study suggests

Drug Science material
BMJ Case Report abstract


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