Problematic versus non-problematic ecstasy/MDMA use: the influence of drug usage patterns and pre-existing psychiatric factors

People who report problems from their ecstasy use show higher levels of psychiatric symptoms such as depression, anxiety, and somatization compared to those who use ecstasy without problems, polydrug users, and people who have never used illegal drugs. In contrast, non-problematic ecstasy users do not differ from controls on these measures. Problematic users also report greater lifetime consumption, average dosage, and binge use, and are more likely to have personal and family psychiatric histories. The findings suggest that ecstasy-related psychological problems are linked to dosage and pre-existing mental health vulnerabilities, not ecstasy use alone.

Study at a glance

Abstract

Recreational ecstasy (3,4-methylenedioxymethamphetamine; MDMA) use has been increasingly associated with a number of psychiatric symptoms and psychological problems. However, previous studies assessing possible psychopathological effects have not identified whether users consider their ecstasy use ‘problematic’ or not. In addition, research has generally failed to address the potential role of premorbid psychiatric status. This study aimed to assess whether premorbid psychiatric history and/or patterns of ecstasy use would be associated with the degree of selfreported problems attributable to ecstasy. Problematic ecstasy users (n 53) who had reported problems attributable to their ecstasy use were compared with non-problematic ecstasy users (n 62), polydrug controls (n 62) and illegal drug-naive controls (n 111) on a recreational drug use questionnaire; a questionnaire, which ascertained personal and family psychiatric histories, and the Brief Symptom Inventory (BSI). Problematic ecstasy users exhibited significantly higher scores on a number of dimensions of the BSI compared to illegal drugnaive and/or polydrug controls. Problematic ecstasy users also exhibited significantly elevated scores on somatization, depression, anxiety and negative psychobiology compared to non-problematic ecstasy users. BSI scores for the non-problematic ecstasy users did not differ from polydrug or illegal drug-naive controls. Problematic ecstasy users reported significantly higher levels of ecstasy use, including lifetime consumption, average dosage and binge consumption compared to non-problematic ecstasy users. Additionally, a greater number of problematic ecstasy users reported personal and family psychiatric histories compared to controls and non-problematic ecstasy users. This study demonstrates two distinct ecstasy using groups: non-problematic ecstasy users who are not showing signs of psychopathology and problematic ecstasy users who are showing evidence of a range of symptoms. This data therefore partially supports the link between ecstasy dosage and negative psychological sequalae, but highlights the importance of the need to consider ecstasy-related attributions, pre-existing mental health status and vulnerability.