MDMA Therapy for Alcohol Use Disorder: Novel Perspectives

Alcohol consumption disorder causes substantial clinical, social, and personal hardship for those who have it, as well as a sizable financial burden on society. After medical detoxification and focused treatment programs, there is a high rate of relapse with current treatments, both psychological and pharmaceutical. Lysergic acid diethylamide (LSD)-assisted psychotherapy, used to treat what was then known as alcoholism, is one of the early examples of psychedelic drug-assisted psychotherapy.

• However, there were mixed outcomes, and because of social pressures and cultural shifts, psychedelic therapy with LSD and other “traditional” psychedelics lost popularity. Psychedelic clinical research is currently being revisited, and this time it’s focusing on alcohol use disorder and other substance use disorders.
• Any type of substance use disorder has never been fully studied as a candidate for treatment with 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. However, MDMA has gained popularity recently as a remedy for posttraumatic stress disorder (PTSD).
• When used in clinical settings, MDMA Therapy’s distinct receptor profile and relatively well-tolerated subjective experience of drug effects make it the perfect tool for enabling patients to explore and cope with upsetting memories without feeling overtaken by unpleasant consequences.

Research is now suggesting that individuals with alcohol use disorder who have undergone a medical detoxification from alcohol can benefit from a course of MDMA-assisted psychotherapy, given that alcohol use disorder is so frequently linked to early traumatic events.

Introduction

Even though drinking is a common social behavior and that many individuals do so without suffering any negative effects, roughly 24% of adults in England consume alcohol in a dangerous way, and 6% of men and 2% of women fulfill the diagnostic criteria for alcohol use disorder. The condition is characterized by withdrawal symptoms after stopping alcohol use, drinking to stave off withdrawal symptoms, tolerance, and an enduring want to drink despite unfavourable effects.

Illness and injuries resulting from alcohol use disorders have a profound social impact on family, friends, and the larger community. High levels of anxiety, despair, and social alienation are prevalent symptoms in sufferers, who also admit to using alcohol as a kind of self-medication. Many people with alcohol use disorders have experienced psychological trauma in the past.

• Considering linked health issues, criminality, anti-social conduct, accidents, loss of productivity and domestic problems, the Department of Health estimates that alcohol use disorder is currently costing over £20 billion a year in England alone.

Alcohol Use Disorder: Current Pharmacological and Psychotherapeutic Options

The huge disparities between patients, the severity of the condition, and the numerous confounding psychosocial factors at play are reflected in the wide variety of treatments available for alcohol consumption disorder. The cost of over 200,000 prescription drugs for the treatment of alcohol use disorder in the UK in 2013 was £3.13 million, and there were 6490 alcohol-related fatalities in 2012.

• Acamprosate, disulfiram, naltrexone, nalmafene, and benzodiazepines are examples of approved pharmaceutical treatments. The competitive opioid antagonist’s naltrexone and nalmafene, as well as the glutamate antagonist acamprosate, are used to lessen the frequency of cravings. Benzodiazepines are frequently recommended as part of an alcohol detoxification program, and disulfiram discourages use by causing an unpleasant bodily reaction if alcohol is consumed.

Numerous psychological therapies are available, but their effectiveness is far from optimal, and they have substantial recurrence rates. 46 therapies were graded according to the rates of abstinence attained in a systematic assessment of 361 controlled studies using both pharmaceutical and psychotherapy treatments.

• The strategy of brief interventions came in first, followed by motivational enhancement therapy. Acamprosate and naltrexone pharmacotherapy came in third and fourth place, respectively. Three-year abstinence rates were found to be 36% for 12-step facilitation (TSF), 27% for motivational enhancement therapy (MET), and 24% for cognitive-behavioral coping skills (CBT) participants in a sizable prospective study.
• Both naltrexone and acamprosate exhibit only modestly beneficial relapse prevention effects, and only when used in conjunction with well-delivered psychosocial interventions, which for alcohol use disorder are infamous for having high drop-out rates of between 50 and 75 percent.

This is according to a more recent review that assessed the effectiveness of relapse prevention medications in various combinations with behavioural treatment. According to some research, recurrence rates after therapy range from 60% at 12 months to 80% at 3 years.

In conclusion, our treatments are far from adequate despite the severe clinical, social, and financial costs of alcohol use disorder. Considering this, research investigations investigating the potential value of a cutting-edge strategy using psychedelic-assisted psychotherapies for alcohol and other substance use disorders have seen a large amount of revisitation in recent years.

The Use of Psychedelics for Treating Substance Use Disorders Throughout History

Alcohol consumption disorder has been a recognized target for psychedelic-assisted therapy since the 1950s, when the idea first emerged that a powerful, drug-induced spiritual or mystical peak experience could be developed as a means of triggering sobriety. With varied degrees of efficacy, LSD-assisted psychotherapy was investigated, although there was significant heterogeneity among the trials conducted.

• Early uncontrolled investigations revealed abstinence rates between 30 and 50%. Some researchers questioned the assertions made by the earlier researchers and discovered no appreciable variations in drinking patterns between the randomized groups or any long-lasting changes.
• To counteract the heterogeneity of the early studies, a meta-analysis paper from 2012 reviewed six randomized trials of LSD for alcohol use disorder from the 1950s and 1960s. The results were generally positive, with 59% of the LSD-treated participants significantly improving compared to 38% of the controls.

Methods of MDMA Therapy

When discussing MDMA’s mechanisms of action, it is crucial to stress that there is still debate among academics about the drug’s pharmacology. It is very difficult to link MDMA to anticipated psychological effects and, secondly, how these effects might affect MDMA-assisted psychotherapy due to its known pharmacology, which has been elegantly described as “messy.” The following, however, makes an effort to consider this challenge.

MDMA is a phenethylamine with a substituted ring that stimulates serotonin, dopamine, and noradrenaline levels to rise. A decrease in the amygdala’s fear response and an increase in confidence are all effects of increased 5-HT1A and 5-HT1B receptor activity.

• The effects of MDMA include modest changes in perception that enhance creativity and memory, as well as a person’s pleasant mood, emotions of intimacy, compassion, and empathy. Like “traditional” psychedelics, Additionally, MDMA has an impact on 5-HT2 receptors, which intensifies the feeling of wellbeing.
• Increased levels of dopamine and noradrenaline raise arousal and consciousness, which has been found to encourage the extinction of fears and may encourage a patient to participate in therapy.
• Additionally, MDMA’s activities at alpha-2 receptors, which support the drug’s thermoregulatory benefits, may also support a paradoxical relaxation/sedation effect, which may be advantageous in the setting of trauma-related hypervigilance.
  • Oxytocin, a hormone associated with early infantile bonding, has been shown to be produced more readily by MDMA, suggesting that this substance may increase feelings of empathy and connection. Other research suggests that oxytocin lessens the amygdala’s sensitivity to fear, lowering the stress response and social anxiety.

When used clinically, MDMA has certain effects that have led to the terms “empathogen” and “entactogen.” The results of psychotherapy therapies for alcohol use disorder and concomitant psychological disorders may be impacted by these changes in social cognition, interpersonal proximity, and communication when they are all considered together.

Can MDMA Treat Addictions?

Patients with alcohol consumption disorder typically describe pre-morbid trauma, which MDMA Therapy has been demonstrated to be a useful technique for treating. Recent fMRI research has shown the potential mechanistic action of MDMA’s ability to help users withstand their worst memories. Additionally, MDMA has been researched as a means of treating underlying trauma since the 1980s, and as a result, substance abuse has decreased. More recently, statistically and clinically substantial improvements have been reported using MDMA-assisted psychotherapy for persistent, treatment-resistant PTSD, and the effects have lasted for 3.5 years.

• MDMA’s capacity to heighten feelings of empathy and compassion for oneself and others may aid in increasing one’s self-awareness and, as a result, diminish the propensity to deny misusing alcohol. Mindfulness techniques, which were derived from Vipassana meditation and emphasize awareness and acceptance of thoughts, feelings, and bodily sensations, have gained increased attention recently as a potential treatment for alcohol consumption disorder.

While MDMA-assisted psychotherapy and mindfulness as a clinical tool have not been officially tested as a therapeutic combination, experts in the field have noted similarities between the two philosophies, citing MDMA’s ability to “make yourself present in the moment,” a key component of mindfulness.

MDMA is often simpler to tolerate than these drugs because to the fact that it has fewer spiritual effects. In comparison to LSD and psilocybin, it also has less perceptually disrupting effects. Due to the fact that not all patients can tolerate the classic psychedelic experience, compliance is crucial in addiction therapy.

Summation

In conclusion, MDMA might improve and amp up psychotherapy techniques used to treat alcohol consumption disorder. It is well tolerated and could be used to treat symptoms of other illnesses that frequently coincide with substance use disorders, especially those symptoms connected to a history of psychological trauma.