Rationale: Research exploring the effects of the widely used recreational drug Ecstasy or MDMA (3,4-Methylenedioxymethamphetamine) has produced some evidence that this substance may be associated with neurotoxic changes (in animals and humans) and with possible psychiatric sequalae. However, few large-scale surveys have been carried out in the general population.
Aims: The aim of this doctorate programme of research was to explore in-depth the psychological well-being of two large non-clinical samples of ecstasy polydrug users
and identify factors associated with increased risk of developing psychological problems following ecstasy use.
Method: The research project consists of two cross-sectional studies. In the first study, 768 questionnaires were analysed; participants were allocated into 5 groups according to their history of drug use: Non-drug users (N=126), Alcohol/tobacco users (ISM 17),
Cannabis/alcohol/tobacco users (N=71), Light ecstasy users who had consumed ecstasy less than 20 times in their lifetime (N=52), and Heavy ecstasy users who had consumed ecstasy more than 20 times in their lifetime (N=45). The UEL Drug use questionnaire was used to assess drug use; Psychological well-being was assessed by the SCL-90, with 25 additional positive-feelings items and 5 MDMA side-effects items.
Ecstasy users were also asked to report whether they had ever experienced sideeffects following ecstasy use.
In the second study, 501 participants were divided into 4 sub-groups: Alcohol/tobacco users (1X1=123), Polydrug no-ecstasy users (N=102), Light ecstasy users who had taken
ecstasy for less than 20 times in their lifetime (N=116) and Heavy ecstasy users who had taken ecstasy for more than 20 times in their lifetime (N=160). Drug use and ecstasy dependence were assessed using a modified version of the UEL Drug use questionnaire and psychological well-being was assessed using the BSI (Brief Symptoms Inventory). Additional items were used to explore positive feelings (N=20)sexual functioning, (N=4) and cognitive failures (N=5). A more detailed demographic questionnaire was also used in order to identify pre-existing mental heath disorders in the family.
Results/Discussion: In line with other studies, the present data demonstrated a link between ecstasy polydrug use and some psychiatric symptoms. Findings from both studies suggest that ecstasy use might be particularly related to increases in anxiety, somatization and anger/hostility symptoms. However, the work presented here also highlighted the complexity of the subject matter and the limitations of using theoretical approaches to studying this drug that are based on notions of unidirectional causality of
psychopathology. Study Two highlighted three main predictors of psychiatric symptoms following ecstasy use: presence of mental illness in the immediate family, perceived dependence on ecstasy and perceived stress. In contrast, moderate cannabis use was identified as a possible protective factor against increased anger and somatization symptoms following ecstasy use. Finally, this thesis provides evidence that responses to ecstasy polydrug use may differ by gender. Specifically, it was proposed that
psychological problems might be more likely to precede drug use in females, but follow drug use in males.
Conclusions: It is suggested that a better understanding of these (and other possible) risk factors for ecstasy-related psychopathology are vitally important for the development of effective prevention and/or harm reduction strategies, and for the processes of diagnosis, treatment and management of drug-related mental health problems.
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