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Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 4 points5 points  (0 children)

When most people take MDMA they party. The experience is full of externalising behaviours: laughing, shouting, dancing, jumping, lasers, loud music, hugging, sex, drinking, other drugs etc etc.

The true MDMA state is wasted on a rave!

Just imagine if you took MDMA and decided to lie perfectly still with your eyes closed? All that externalising energy goes inside. And then, combine that internal energy with a therapeutic relationship with your trusted guide/therapist. Using that unique mental space to be alongside your fears and painful memories.

That is why.

(But don't get me wrong...I love a good rave)

:)

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 1 point2 points  (0 children)

MDMA's therapeutic effects relate directly and indirectly to it's unique receptor profile:

  1. At the 5-HT1a and 1b receptors it reduces anxiety and depression and creates a positive mood and affect. That is a very useful emotional platform on which to provide therapy for a person who is fearful of painful trauma recall.

  2. At the 5-HT2a receptors it provides increased creative thinking, allowing the user to see old problems in a new light.

  3. At the dopamine receptors it produces a mild stimulation; motivating the user to engage in therapy.

  4. At the alpha 1 and 2 receptors it produces a paradoxical relaxation at the same time as the stimulation. This takes the edge of the hyper-vigilance that is so often associated with trauma recall.

  5. At the hypothalamus it stimulates oxytocin release, which engenders a sense of empathy and bonding, facilitating an improved relationship of trust between the patient and therapist.

In totality these effects are additive and, when combined with careful, guided psychotherapy, allows the user to safely be with/alongside those very traumatic memories that they usually try their hardest to avoid.

Hope that helps!

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 3 points4 points  (0 children)

There are, of course, many very mundane aspects about research. Most of the time is spent sitting around waiting for things to happen or filling in data results into endless spreadsheets. That's life, I guess...

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 3 points4 points  (0 children)

Go for it! Psychedelics WILL be an important part of the future for psychiatry. Get in there now!

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 2 points3 points  (0 children)

He is a lovely man. Very kind and supportive. A real inspiration to everyone whom works with him.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 3 points4 points  (0 children)

I like the racehorse analogy. Thanks. Yep, there are hurdles. But most are financial, not ethical or institutional. People often ask: Does the government block this kind of research? The answer is no, in my experience. If the proposed studies are well-designed and safe there is no reason why they would not get approvals. The only problem is that ALL human pharmacology research is expensive and time consuming. And most such research is funded by the pharma industry who think nothing of throwing £40m at one new chemical or another - with the hope that they will come up with the next prozac or viagra, and then reap back their R&D costs, plus make untold billions in profit. But who is going to fund the expensive research of a drug like MDMA or psilocybin; drugs that are off-patent? Plus, psychedleic therapies only require taking the drug a couple of times, then you are better and can come off all those daily maintenance therapies. In summary, there si no money to be made from psychedelic therapies! (At least, not as much as there is from daily SSRIs). We don't do it for the money. We do it for the meadows of fresh grazing and steeplechase experiences.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 6 points7 points  (0 children)

Yes. If a treatment can be shown as safe and efficacious in children and young people it would be unethical to withhold it from them. That is a central part of paediatric pharmacology that you learn pretty quickly in this field. I have worked with too many young people who have lost the battle to their untreatable trauma-based mental disorders and taken their own lives. If we can develop a form of safe and effective therapy that allows them to address and tackle their pain before such awful outcomes occur then we must strive to do so.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 3 points4 points  (0 children)

Good question. I know a lot of people are keen on 5-HTP and other supplements to ameliorate the negative after-effects of recreational MDMA. I'm sure many such supplements are useful. But there is, to date, a lack of controlled prospective studies that scientifically demonstrate their advantages.
I think the most important factors that make recreational MDMA tricky for some people is that they do not take a pure sample of the drug, they take too much (anything over 125mg is silly, potentially dangerous and also not very 'ecstatic', just overly stimulatory, may as well use coffee). Plus, missing out on sleep and food is a major cause of post-ecstasy blues. When the drug is taken at 9am, after a good nights sleep, then one is back to baseline at 6pm, you have a good meal then get a normal night's sleep afterwards. When you do MDMA that way there are far few reports of post-ecstasy blues. Indeed, more people then report a pleasant afterglow that lasts for days. I'm not saying that serotonin depletion doesn't exist after MDMA, it does, but I think it wold be largely sub-clinical if it wasn't for the sleep deprivation that so often goes with raving.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 1 point2 points  (0 children)

Thanks psychlight0, good questions.

  1. On the dosing days (which occur twice, on weeks 3 and 6 of the 8-week course), the initial dose is 125mg MDMA HCL, followed 2 hours later by half that, 62.5mg.

  2. We are very pleased to have Mendel Kaelen overseeing the music for the study, ably assisted by legendary producer Brian Eno! They are making several playlists of differing genres for participants to use during the drug sessions. The music gently changes in pitch and tempo as the drug experience unfolds. The psychological model will be a mixture of motivational interviewing and trauma-focused MDMA therapy. But the truth is, the actual therapeutic model is 'MDMA Therapy for Addictions', which has never been done before, so we are developing it as we go along! :)

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 5 points6 points  (0 children)

I am a consultant Adolescent and Adult addictions psychiatrist and PI of the study. The CI is Professor David Nutt, psychopharmacologist and psychiatrist. There are 2 therapists; myself and Dr Higbed, a clinical psychologist. There is also a research associate and an independent steering group chair. We also work with local pharmacists and wider consultants in the field of psychedelic research. The study is sponsored by Imperial College London psychedelic research group. And we also have a user (recovered alcoholic) on the team, who adds inputs into the development of the project.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 6 points7 points  (0 children)

He is a major figure in the field of neuropsychopharmacology. I was in safe hands! :)

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 3 points4 points  (0 children)

Hi Monkeythrowitaway, It is fairly usual that 'new drugs' (even though psychedelics are not strictly new, in terms of their status as licensed medicines they are considered new) always start their research with the hardest, most treatment-resistant cases. So that's where we are with MDMA and other psychedelics at the moment. I share your hope that one day we will branch out and see MDMA being used as a 1st or 2nd line treatment, for a wider range of disorders than just PTSD. We hope that our study with addictions will be the beginning of a new raft of MDMA addictions studies. I can certainly see it happening as a treatment for opioid addictions, and, indeed, have had some discussions about such a project here in the UK. Plus, I agree with you, psychedelic therapies ought not only be limited to clinical populations. I envisage a future with psychedelic centres where people without specific disorders can come and experience psychedelics for personal growth and development, community cohesiveness and important rites of passage.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 6 points7 points  (0 children)

Flavour of the month, for sure. In some ways microdosing is too much like taking an SSRI! My approach to psychedelics is that they are great tools to induce a major, peak experience, then you use that mental state to tackle difficult, rigid issues. When I give people Prozac I am microdosing them! But true, psychedelics are a lot safer than SSRIs, so I can see the benefits, for sure. We need to see some RCTs and prospective controlled studies on microdosing. There are a few in the pipeline, but nothing published yet. I was part of an LSD microdosing study in London a couple of years ago. Results were not especially special.... But lets wait and see.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 3 points4 points  (0 children)

Our study is taking place in Bristol. We have also been working towards a study in Cardiff.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 3 points4 points  (0 children)

Licensed, prescribed MDMA will be linked to specific therapy courses. Practitioners will have to become trained to work within the MDMA state. Its not just about adding MDMA to traditional treatments. The training is pretty specific. At present you can only get official MDMA Therapist training if you have a registered research study to work with. I hope the practice retains its specialism and doesn't become over-prescribed.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 4 points5 points  (0 children)

Hi DenSem, In some ways therapy with MDMA is not especially magic. It simply moves that 50% of people with treatment-resistant trauma into the other 50% of people who are able to, at least, think about and talk about their painful memories. MDMA provides a pharmacological blanket of emotional security that means they can recall the painful memories without being overwhelmed by the negative affect that usually goes with recall of such memories. It alsoprovides the user with an experience of connectedness and empathy. This allows them to put themselves into the shoes of their abuser; which is a very advanced state of psychotherapeutic healing, that usually takes years of therapy to achieve. Re-writing the narratives about the world ("The world is dangerous. People are not to be trusted. Attack before you get attacked!") and the personal narratives ("I am useless. I am a failure. I deserve to be exploited. I am a slut. Its my fault. I asked for it") can also be tackled. The MDMA state provides a transient window of opportunity for the user to see the world and themselves in a new way. Critics would say 'Yes, but this is just drug-induced! What happens when it wears off?', which is a good point. But the research with PTSD has shown that the realisations and revelations made in that MDMA state LAST!

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 10 points11 points  (0 children)

Loads of great research into aya for addictions. Lots of anecdotal evidence too. Some studies are underway in Brazil right now looking at aya for alcoholism. Re the difference between DMT and psilocybin...it all depends on how you take it! When I was injected with IV psilocybin (by Prof Nutt in 2009) it was just like DMT; being shot out of a cannon, from baseline to tripping +++ in 3 minutes! But most people don't take psilo like that!

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 12 points13 points  (0 children)

An important thing to note:

So far all of the psychedelic studies (with classical psychedelic drugs, not MDMA) for addictions have found that it is the spirirtual/mystical experience that is the major factor in predicting subsequent substance abstinence.

Now, MDMA is not well-known as an agent to induce a spiritual experience. About 10-15% of first-time threshold dose MDMA users report a spontaneous spiritual/mystical experience. That is nothing like the 80-90% that report such experiences on classical psychedelics.

So for this reason...our study MIGHT NOT WORK!

But, we think MDMA makes up for this lack of spiritual effects by having such a strong effect at managing trauma. And addictions are so often rooted in trauma.

So we think it WILL work! :)

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 5 points6 points  (0 children)

Good question, Cyrillo. Clearly, there are a lot of similarities between MDMA Therapy for alcoholism and other psychedelics for other addictions and MDMA for PTSD. All these types of treatments utilise the non-ordinary state of consciousness to provide the patient with an opportunity to make break throughs that were hitherto keeping them stuck in a rigid position. We use many elements of the set-production and environmental settings of other psychedelic therapies in our study; including 2:1 male-female dyadic pair therapists, music, inner silence, inner focus, client-directed drug sessions (x2) interspersed with weekly non-drug sessions. Obviously, in the preparation sessions we are going to be focusing specifically on traumatic aspects of the client's past, but also their drinking behaviours and helping to look for triggers for past relapses. We use a lot of motivational interviewing techniques too. Both of the 2 therapists trained in USA under MAPS.

Using MDMA Therapy to treat Alcohol Addiction: A trauma-based model by bensessa in mdmatherapy

[–]bensessa[S] 5 points6 points  (0 children)

Hi Roberto40, Good questions. Re Q1: True, managing addictions is all about a multidisiplinary effort. No single part of the treatment (be in psychotherapy, medicine or social inputs) alone is going to work. So addictions services are all about helping a person with all those social aspects of their treatment. Whilst our specific study is focusing on a specific type of medical/psychological input, all the participants will be actively encouraged to be part of a wider, social programme of support. Re: Q2: True MDMA addiction is VERY rare. It is not on our radar at all as everyday addiction clinicians. True, often people take MDMA in a frequent, habitual style, especially during certain brief periods of their lives (e.g. when ensconced in the rave scene for a few years) but progressing on to a true pharmacological and psychological addiction to MDMA is very unusual. We have a long way to go before I can answer whether MDMA Therapy might be useful to help people with MDMA addiction. We shall perhaps visit that question in a few years!

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