Understanding MDMA (Ecstasy) Addiction

For many people, taking ecstasy is a normal part of a weekend’s activities, seen as no more harmful than a couple of drinks. However, taking ecstasy can kill you; it can also lead to addiction, with potentially very serious consequences for health and happiness.

Ecstasy – also known by its chemical name 3,4-Methylenedioxymethamphetamine, and more commonly by the abbreviation MDMA – is a hallucinogenic stimulant in the substituted amphetamine class of drugs. First synthesised in 1912, ecstasy rose to prominence as a dance/rave drug in the 1980s [1] and ‘90s thanks to its euphoric and invigorating effects and the feelings of extreme empathy and closeness that it produces in users. This very effect gained it the moniker “the love drug”.

Ecstasy is found in tablet form, in pink-brown crystals, and much less commonly as a powder or solution. Both the tablets and crystals are usually swallowed, though some users also grind them up and snort the resulting fine powder for a more immediate (although very painful) effect. Ecstasy can also be injected or taken rectally or vaginally. The name “ecstasy” typically refers to the drug in tablet form, while “MDMA” (and other nicknames) has traditionally more frequently been used to describe the crystalline form of the drug. However, the active ingredient is the same and these names are increasingly interchangeable.

Ecstasy is one of the more commonly consumed recreational drugs in the UK, despite the fact that it is both illegaland potentially highly dangerous, even on the first occasion on which it is taken. This is a class-A controlled substance, with penalties of up to seven years’ imprisonment and an unlimited fine, and life imprisonment and an unlimited fine, for possession and supply respectively [2]. As such, ecstasy claims over 50 lives per year on average in the UK and has been associated with numerous high-profile fatalities. Ecstasy is a staple ingredient of rave, festival and nightclub culture, and Home Office figures show that over 550,000 Britons admitted to taking the drug in 2017 (the true figure is thought to be much higher).

Street Names for Ecstasy

As well as “ecstasy” and “MDMA”, the drug is known on the street by a wide variety of other names [3], including:

  • E
  • Molly
  • Mandy
  • X
  • XTC
  • beans
  • Adam
  • pills
  • Jack and Jills
  • Jacks
  • Gary Abletts
  • Garys
  • slow burners
  • wangs
  • wangers
  • disco biscuits
  • Mitsis
  • doves
  • candy
  • Scooby snacks
  • Eve
  • dancers
  • eccies
  • tabs
  • Eminems
  • bangers

What Happens When I Take Ecstasy?

When taken orally (i.e. when ecstasy tablets or crystals are swallowed), the effects of ecstasy usually take between half an hour to an hour to begin to be felt. Taking the drug by other routes, including snorting, can provide different results. When ecstasy starts to take effect, users may begin to light-headed and dizzy, sometimes accompanied by a sudden (though short-lived) nausea, known as “coming up”. Within a few minutes, feelings of pronounced euphoria and energisation (often prompting users to want to dance or engage in other physical movements) will begin to be felt. These are typically followed by increased talkativeness and feelings of intense empathy and positive emotion towards companions, which may manifest in extremely tactile behaviour (the desire to hug and touch others) and, frequently, in lowered inhibitions and a degree of sexual arousal. Some auditory, visual and other sensory hallucinations may also result, especially seeing vibrant colours and “trails” of lights.

Physiologically, users may experience increased body temperature and heart rate, which may cause perspiration and the desire to shed clothing. Jittery eyes and a rapid jaw movement, as well as clenching (a phenomenon known as “gurning”) are also reported effects of the drug. Dilated pupils, muscle tension, and a pronounced thirst, especially when perspiring heavily,are other symptoms of ecstasy consumption. However, this latter sensation can lead to the consumption of dangerous quantities of water, one of many health risks which can also result from the consumption of ecstasy.

Is MDMA addictive?

What many people think of as “addiction” is often a conflation of two distinct (though related) phenomena. The first one is addiction proper, which is a primarily psychological condition resulting from a disorder of the brain’s reward centres. The second is the physical dependence, which develops when someone takes a particular substance regularly over a period of time and their system thereby becomes reliant upon a certain level of that substance in order to function normally. Usually, in this second case, various unpleasant and possibly dangerous

physical symptoms manifest when the substance is withdrawn from the system.Ecstasy is not proven to be physically addictive without a doubt. However, it has a moderate psychological dependence liability and therefore a low-to-moderate overall addiction liability. For those who do become psychologically addicted, however, ecstasy addiction can be a very serious, dangerous and destructive condition, with a high risk of harm to physical health despite the primarily psychological nature of the addiction. [4]

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What makes ecstasy addictive?

Addiction is a disorder of the brain’s reward system, in which areas of the brain known as the reward centres adjust their behaviour in response to the repeated engagement in rewarding stimuli. Taking ecstasy creates intensely pleasurable feelings and experiences, both physically and psychologically, and many users describe their initial exposure to ecstasyas being positively “life-changing”.

Some users may feel the compulsion to take more of the drug to recapture the experience they enjoyed so much. Doing so can initiate the aforementioned adjustment of the brain’s reward centres, as chemicals including dopamine (associated with feelings of pleasure and reward) are released upon consumption of the drug. In consequence, their absence during periods when ecstasy is not taken begins to create negative sensations and emotions which the user seeks to drive off via further consumption of the drug. This is a phenomenon which is enhanced by the dopaminergic effects of ecstasy in particular, and the pronounced “crash” or “comedown”, characterised by reduced levels of dopamine and other chemicals including serotonin, in the days following ecstasy consumption.

Over time, this neurochemical adjustment can lead to habituation and addiction, as users become more and more reliant upon the experience of taking ecstasy to feel the rewarding sensations they desire, and the negative psychological consequences of abstinence become more and more pronounced.

Development of addiction as a result of ecstasy abuse

Ecstasy abuse is any use of ecstasy which results in harm to the user or anyone else. Ecstasy abuse can occur independently of addiction. For example, someone who is not addicted to ecstasy but takes sufficient quantities of the drug to require hospitalisation would be said to have engaged in ecstasy abuse. However, the repeated abuse of ecstasy over a period of time entails a moderate risk of addiction. Engaging in the consumption of ecstasy at levels which lead to addiction by definition qualifies as ecstasy abuse.

The Signs of Ecstasy Addiction

It can be very difficult to identify an addiction, even in someone very close to you, as the stigma associated with the condition means that addicts typically work very hard to conceal their condition from those around them. In the case of ecstasy in particular, addicts are not necessarily intoxicated all or even most of the time. Therefore, the addiction might not be identifiable via the most immediate and obvious symptoms of substance abuse.

Symptoms of ecstasy addiction

Some of the most prominent symptoms of ecstasy abuse and addiction include:

  • a preoccupation with obtaining and consuming ecstasy
  • changes in peer group
  • altered tastes in music and clothing
  • new vocabulary relating to ecstasy and related cultures
  • frequent profound tiredness
  • altered sleeping and eating patterns
  • noticeable weight loss
  • mood swings
  • pronounced low mood/depression, especially following weekends
  • absenteeism from work or academia
  • growing distant from loved ones and friends
  • changed sexual habits and sex drive
  • unexplained disappearances
  • health problems resulting from ecstasy abuse
  • financial problems including frequent requests to borrow money
  • unexplained muscle spasms and tics
  • suicidal ideation
  • cognitive impairment
  • engagement in criminal activity
  • loss of interest in previously enjoyed activities

How to spot MDMA addiction

If you observe any of the signs of ecstasy abuse and addiction in someone, that does not necessarily mean that they have that cause specifically: there could be various other reasons for the manifestation of some of these symptoms. Moreover, confronting someone about your suspicions may end up doing more damage than good, including alienating the person in question (potentially at a time when companionship and support could be especially valuable). It is always best to get the advice of a professional prior to taking any action. Contact an addiction specialist to discuss your concerns and to get advice on how to proceed, if at all.

Demographics

Although ecstasy use is reported across all age ranges, ethnicities and genders, it is more strongly associated with a younger demographic than almost any other recreational drug. The United Kingdom Country Drug Report 2018 by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) states that “in general, MDMA users are younger than cocaine and amphetamines users”. This differentiates MDMA from other amphetamines and related drugs. This puts the proportion of UK 15-to-24-year olds taking ecstasy in 2016 at 4.3%, compared to 1.3% of 25-to-34-year-olds, 0.7% of 35-to-44-year-olds, and less than 0.2% of Britons aged 45 or over.

This may partly be a result of changing tastes in recreational drugs as users age, and partly because ecstasy is closely identified with certain cultures and subcultures which are not as attractive or feasible for older Britons as they may be for younger people. These include all-night or multiday raves and festivals, and subsequent periods of low mood and impaired performance which may not be desirable or even possible for older people, especially those with families.

However, it is important to note that even the comparatively low percentages of older users recorded by the EMCDDA translate to tens of thousands of individual users. While ecstasy may be viewed as being predominantly a “young person’s drug”, it is by no means exclusively so – and many of the more serious health effects of ecstasy abuse are more visible and more damaging in older users.

Teen ecstasy abuse

Ecstasy is especially popular amongst teens and young people generally for a variety of reasons. Firstly, despite its illegal status, it is extremely widespread and easily obtainable compared with many other substances of abuse. It is also much more affordable: an ecstasy tablet typically costs between £5 and £10, though is often available at a much lower cost, especially when bought in bulk, compared with ten times that for a gram of cocaine.

Secondly, ecstasy use is associated with activities, such as clubbing, going to raves and festivals,  which are more commonly associated with young people than with their older peers. Experimentation and formative experiences, for example, the development of emotionally close peer groups, are not typically the domain of older and more experienced people.

Unfortunately, adolescence and youth are also frequently associated with immature decision-making and a lack of awareness of one’s limits. This can make taking any drugs, including ecstasy, significantly more dangerous. A relatively high proportion of ecstasy-related casualties come from younger cohorts whose members may not have the wisdom or self-confidence to “know when to stop” or to deal with challenging and/or dangerous situations effectively.

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Clubbing culture

Clubbing and raving are the home territory of ecstasy use and abuse. The loud repetitive music, bright lights and colours, close crowded environments and lowered inhibitions are all extremely conducive to the consumption of ecstasy. Indeed, whole genres of music and types of clubbing experience have been designed with ecstasy use in mind.

Despite many precautions taken by producers and promoters, police and security staff, it is effectively impossible to prevent every single dose of ecstasy from being smuggled into venues.

Yet, many of these same promoters, it should be borne in mind, have a vested interest in their customers having as good a time as possible including the consumption of ecstasy. Most of the precautions, however, focus on stopping people taking the drug prior to entering events.

While rates of ecstasy consumption have declined somewhat since their peak at the height of rave and club culture, it is still very common to see people under the influence of ecstasy in nightclubs, at parties and during festivals.

Despite the close association between club/dance culture and ecstasy, an interest in the former does not necessarily imply the consumption of the latter. If someone close to you, including a child, starts to display the signs of being involved in club culture, it does not inevitably mean they are abusing drugs. This includes the music, clothing, dance styles and vocabulary which characterise it

Signs of Ecstasy Use and Abuse

Ecstasy is often taken for its ability to create the following effects in the user:

  • euphoria
  • heightened senses
  • calmness and relaxation
  • long-lasting energy
  • empathy for others
  • lowered inhibitions
  • increased sexual desire
  • feelings of intense physical pleasure
  • heightened appreciation for stimuli including music

The Unwanted Signs of Ecstasy Use

Some unwanted effects of ecstasy include:

  • higher heart rate
  • increased blood pressure
  • muscle tension
  • tightness in mouth and jaw
  • feeling faint
  • hot or cold flashes
  • organ complications due to increased body temperature
  • loss of motor control
  • impaired emotional regulation
  • feelings of depression and dysphoria after the ecstasy high subsides
  • sexual dysfunction
  • poor decision-making
  • impaired concentration
  • insomnia
  • heavy sweating
  • dehydration (increasing the risk of death through water intoxication)
  • lethargy
  • nausea and vomiting
  • an inability to urinate
  • anxiety
  • paranoia
  • anhedonia
  • suicidal ideation

Adverse Effects of Ecstasy Abuse

While for many people the occasional consumption of ecstasy results in few or no observable negative consequences, taking the drug to an extent which constitutes abuse can have numerous negative and potentially dangerous results.

Short-term

In the short term, taking ecstasy can pose a serious risk to the health of the user. Death through ecstasy overdose can result from a wide range of causes including hypertension, hypotension, seizures, loss of consciousness, respiratory distress, hyperpyrexia and many more. Even first-time users can die from allergic reactions to the drug. [6] Accidents due to ecstasy intoxication can cause death or permanent injury, while risky sexual behaviour can cause permanent harm and potentially fatal illness even on the first instance of ecstasy consumption.

Taking ecstasy in combination with any of many other substances of abuse, including alcohol, can be dangerous and even fatal, as can the excessive consumption of water due to a feeling of pronounced thirst, body heat and heavy sweating. Temporary cognitive and memory impairment can lead to a host of problems including getting lost, misplacing valuableand potentially life-saving items, and getting into perilous situations.

Anxiety and panic resulting from ecstasy consumption can lead to injury, while depression can result in suicidal ideation. Depressive conditions are especially pronounced one or two days after taking the drug. They are giving rise to the phenomenon of “Suicide Monday/Tuesday” referring to a spike in suicides in the days following weekend parties and raves.

Long-term

The long-term impact of ecstasy abuse on physical and mental health can be profound. While the full impact of MDMA on the brain has not yet been established, there is a weight of evidence showing neurological damage (including brain lesions) in heavy ecstasy users. Many of them display symptoms of heavy abuse including tics, muscle spasms, stutters and stammers. Deficiencies in memory, attention, learning ability, and visual processing, among other faculties, have also been associated with ecstasy consumption. Depression and anxiety are common in moderate to heavy users, even some time after a complete cessation of ecstasy use.

Frequent ecstasy abuse over time can also result in addiction, posing its own wide range of serious risks.

During pregnancy

Ecstasy is known to be moderately teratogenic (toxic to a foetus). Taking ecstasy whilst pregnant can cause damage to the unborn child’s heart and brainresulting in impaired motor functioning and cognitive faculties. Potential miscarriage is also a serious risk. The risk and severity of harm increase in proportion to the quantity of ecstasy consumed and the frequency of consumption.

Reinforcement disorders

A majority of around 60% of ecstasy users experience withdrawal symptoms upon cessation of use. Ecstasy is considered to have a dependence potential between three fourths and four-fifths that of cannabis. One study has found that around 15% of chronic ecstasy users meet commonly accepted diagnostic criteria for substance dependence. [7]

Overdose

Although the rate of ecstasy overdose is low compared with the rate of overall consumption, the condition is extremely dangerous. This illegal drug is also a factor in numerous fatalities resulting from polydrug abuse. Some especially dangerous symptoms of ecstasy overdose include:

  • severe hypertension or hypotension
  • hypotensive bleeding
  • loss of consciousness
  • coma
  • convulsions
  • serotonin syndrome
  • respiratory distress
  • kidney failure
  • cerebral oedema
  • rapid muscle breakdown
  • hallucinations
  • hyperpyrexia
  • hepatitis
  • confusion
  • distress
  • hyperventilation

If you see any of these symptoms in anyone you know to have consumed ecstasy, contact the emergency services immediately: any unnecessary delay increases the likelihood of permanent damage and even death.

Ecstasy tolerance

When someone consumes a substance of abuse over time, their system adapts and adjusts to the presence of certain levels of that substance, becoming more familiar with it and normalising to it. As a result, that person needs to consume more and more in order to feel the desired effects. This is known as tolerance.

Tolerance has various ramifications including the need to spend more on the substance in question in order to be able to consume it more often and in higher dosages than

previously.Moreover, someone who has developed tolerance and then stops taking their substance of abuse for a period of time is at greater risk of overdose if they recommence taking the drug, as they may take it in the quantities to which they were previously accustomed, but which their system can no longer process effectively.

Risks of Using Ecstasy

There are various risks associated with the use of ecstasy specifically which set it apart from some other substances. These include:

  • People using ecstasy commonly take multiple doses in one session.
  • With uncontrolled drug manufacturing, it is impossible to tell how much of the drug one is consuming.
  • Frequently, there are other drugs mixed into the tablets.
  • Ecstasy can stimulate physical activity, which can lead to dehydration and the consequent danger of water intoxication.
  • Long-term brain injury can result from the use of ecstasy.

How Ecstasy Addiction Is Treated

One silver lining to the proliferation of substance abuse and addiction in the UK is the emergence of a number of high-quality treatment facilities and organisations operating around the country with great expertise in treating all manner of substance use disorders, including ecstasy addiction. The treatment of addiction is typically a holistic process involving detoxification, therapy and a broad range of other elements, which can be delivered in residential rehabilitation.

Do you need an intervention?

Interventions are a common technique for making someone with a substance use disorder aware of the damage they are doing to themselves and others, as well as of the need to get treatment. Typically, however, interventions are given in cases where the affected individual either does not realise the extent of the problem or has hitherto been unwilling to seek the help they need. Keep in mind that, however, interventions are not typically something that an addict requests for themselves.

If you are an ecstasy user and believe you have a problem with the drug, contact your GP and/or an addiction specialist to discuss your concerns and, if necessary, to find out about treatment options which may be available to you.

Detoxing from ecstasy

Detoxification (detox) is a crucial aspect of the treatment of addiction, as only if an addict is free of substances of abuse and of any associated dependence will they be able to focus only on their recovery and the therapy which is a vital component of it. During detoxification addicts may go into withdrawal as their systems are cleansed of substances of abuse. Withdrawal can be extremely dangerous. It is vital that, if you are suffering from a substance use disorder, you do not attempt to go through it independently. Seek medical assistance before attempting an ecstasy detox. Doctors will be able to make the process safer and will potentially be able to alleviate symptoms of withdrawal with the help of medication.

Dependence and withdrawal

Ecstasy addiction does not typically involve physical dependence, and withdrawal symptoms are therefore usually psychological in nature. However, some physical symptoms may manifest psychosomatically. They can be extremely unpleasant and, in some cases, self-harm and suicide ideation have been known to develop. Therefore, getting medical help for withdrawal from ecstasy addiction is absolutely imperative, and it is advised that you go through a managed and medically assisted detox such as that provided in rehab.

Signs and symptoms of ecstasy withdrawal

Some of the most common symptoms of ecstasy withdrawal include [8]:

  • depression
  • anxiety
  • insomnia
  • aggression
  • mood swings
  • paranoia
  • attention deficit
  • impaired memory
  • fatigue
  • impaired motor control
  • confusion
  • loss of appetite
  • loss of sex drive
  • sexual dysfunction
  • psychosis
  • hallucinations
  • delusions
  • panic attacks
  • suicidal ideation

While most symptoms of withdrawal from ecstasy addiction last a matter of a couple of weeks, in some cases individuals may develop post-acute, or protracted, withdrawal syndrome (PAWS) which can persist for months or even years, and typically requires specialist care.

Ecstasy addiction rehab

Rehab is commonly considered to be the most effective means of treating addiction in terms of providing the greatest chance of long-term abstinence. In inpatient treatment, addicts are provided with holistic treatment programmes in a calm, secure, confidential and friendly environment in which they can focus completely upon their treatment and recovery, with high-quality medical expertise on hand 24/7.

It is important to note, however, that rehab and recovery are not synonymous. Addicts who go through rehab successfully are not “cured” the moment they leave the facility, but have embarked upon a process of recovery which can last many years or even the rest of their lives, and which needs to be attended to with diligence and dedication.

How are MDMA use disorders treated?

Medication management: there are currently no medications approved for the treatment of ecstasy addiction specifically. However, medicine can be prescribed to alleviate various withdrawal symptoms both during and after the detox process – especially in the case of more persistent psychological withdrawal symptoms including depression and anxiety.

Therapy: therapy lies at the heart of addiction treatment, revealing and tackling the underlying psychological causes of addiction and remediating the negative behaviours. A broad range of therapy models and methodologies are provided in addiction treatment. These include one-to-one and group environments.

Inpatient rehabilitation: inpatient stays in rehab facilities typically last for between 30 and 90 days. More intensive, and/or longer, residencies may be appropriate in some cases. The holistic treatment programmes provided in rehab consist of detox, therapy, and numerous other elements including bespoke dietary and fitness plans, and are typically followed by after-care plans covering up to a year after leaving the facility.
Outpatient rehabilitation: some may feel that they are unable to take the time out from personal or professional responsibilities, as required by inpatient rehabilitation programmes. For them, outpatient treatment may be appropriate, with therapy and other appointments conducted on-site but other elements of the treatment plan being carried out independently. Outpatient rehab can be somewhat problematic, however, as it does not take the addict out from their daily environment of addiction-related temptations.
Outpatient individual, group, and family therapy: therapy sessions need not end following the completion of the treatment programme in rehab. Many of those in recovery choose to participate in therapy for long after they conclude treatment. Therapy in a wide variety of forms can be engaged in outside rehab, and can involve family members who can both help with and benefit from treatment.
Group meetings: for many recovering addicts, attending support group meetings, such as those provided by Narcotics Anonymous (NA), is an indispensable adjunct to treatment and a vital component of recovery. Meetings are typically held weekly, with chapters found across the country, and the only criterion for attending is a commitment to leading an abstinent life.

Ecstasy Addiction Statistics

  • At least 550,000 people take ecstasy each year in the UK – the true figure is thought to be significantly higher.
  • Ecstasy is responsible for at least 50 deaths each year in the UK.
  • Ecstasy is becoming stronger over time: a report published in the Guardian stated that the average ecstasy tablet sold in 2009 contained between 20mg and 30mg of the drug, whilst in 2014 that figure had risen to 100mg.
  • Nearly half (49%) of children and young people who take drugs say they were provided by a friend on the most recent occasion on which they took them.
  • Amongst people aged between 16 and 24 in the UK, ecstasy is the second most popular illegal drug (after cannabis).

Get Help Today

If you are struggling with an ecstasy addiction you may despair that your condition will prove permanently damaging. However, do not give into negative emotions: a number of high-quality treatment facilities around the country are able to help you overcome your addiction and turn your life around.

If you are ready and willing to request the help you need, reach out to your GP and/or an addiction specialist to discuss your situation and to find out what treatment options might be available to you. Picking up the phone and making a call might be your first step on the path to recovery, back to the happy and healthy life you want and deserve.

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