Pubdate: Thu, 30 Sep 2004
Source: Salt Lake City Weekly (UT)
Pubdate: September 30, 2004
Contact:  http://www.slweekly.com/
Address: 60 W 400 S Salt Lake City, UT 84101
Copyright: 2004 Copperfield Publishing
Author: David Adams & Ben Fulton
Bookmark: http://www.mapinc.org/mdma.htm (Ecstasy)

ECSTASY & THERAPY

It may be illegal but the popular "club drug" MDMA is coming back to its 
psychotherapeutic roots.

Sitting on a couch is Melissa, a woman in her mid-20s who has just taken 
125 mg of methyllenedioxymethamphetamine (MDMA), or ecstasy, in a glass of 
juice. Sitting in a rocking chair to the left of Melissa is licensed 
psychotherapist Dr. Jane, who will work intensely with her patient over the 
next few hours, as Melissa's brain bathes in the surplus neurochemicals 
brought on by the MDMA.

Melissa and her therapist aren't part of any currently approved research. 
They consider themselves to be conscientious, law-abiding citizens, but 
have decided to augment traditional psychotherapy with what the U.S. Drug 
Enforcement Agency currently classifies as a Schedule I substance---an 
illegal drug.

But, illegal or not, Dr. Jane (not her real name) has a rationale for using 
this drug with her patient: MDMA eases anxiety surrounding traumatic 
events, allowing them to be recalled with extensive clarity, then amplified 
by a desire to discuss them, perhaps for the first time in the patient's life.

Dr. Jane is one of an informal network of a half dozen or so 
psychologists--licensed social workers and psychiatrists practicing from 
Logan to Provo--with the experience and willingness to work with patients 
who choose to use MDMA in conjunction with other drug-free therapy sessions.

She and her underground clinical colleagues aren't doing anything new. Long 
before its popularity blossomed under the moniker of "ecstasy" in dance 
clubs and warehouses across Europe and North America, and long after its 
first patent by German pharmaceutical company Merck in 1914, MDMA was used 
by scores of psychotherapists during the 1970s and halfway through the 
1980s. With its relatively minimal side effects, therapists classified the 
drug as an "empathogen" for its ability to open the heart, increase 
awareness and foster sensations of self-love and acceptance. In addition, 
the drug has the added benefit of keeping the patient firmly grounded and 
in control, rather than orbiting Pluto as occurs with stronger drugs. From 
the perspective of the analyst's chair, these are all very desirable traits.

 From its ingestion, MDMA takes about 45 minutes to take effect. During 
this time, Melissa nods her head in affirmation, as Dr. Jane reads aloud 
the goals for this session and the safety contract, both of which have been 
developed and agreed upon during six earlier preparation sessions.

It is now 60 minutes past the point when Melissa unwrapped a small triangle 
of tinfoil, emptied the white, powdered contents into a glass of juice and 
drank it down in one long gulp. Her earlier, tense posture has given way to 
a more relaxed position on the doctor's leather couch. The pillow she had 
been clutching nervously in her lap is now resting under her right leg, and 
her head rests gently on the back of the sofa. Melissa is both alert, and 
noticeably relaxed, as she talks openly about abuse that occurred early in 
her childhood. Dr. Jane listens intently, only occasionally asking 
questions that probe lightly into progressively deeper layers of her memories.

Now two hours into her session, tears fall from Melissa's face and into a 
white Kleenex she holds in her hand as she recounts one particularly strong 
memory. Using a succession of questions, Dr. Jane assists Melissa in 
understanding how her earlier trauma caused her to project certain beliefs 
into her present relationships--beliefs that are creating some problems.

Towards the end of her session Melissa says: "Reliving this incident helped 
me free up my emotions in a number of ways. =85 I know that I have a lot 
more to do, but I know now that I molded my views about the world--that I 
now know are not true--because that one incident caused me to distrust my 
parents."

Melissa, who works as a computer programmer, seems visibly relieved, and 
hopeful. Weeks after the sessions, she sent a promised e-mail describing 
the sum of her three MDMA-assisted therapy sessions: "I was able to dump my 
file =85 the medicine cleared my channels =85 insights and memories poured 
through me =85 fragments and pieces of the puzzle all came together. I had 
a cloud of trauma that had seemed in front of me =85 that for almost my 
whole life had been distorting my beliefs about myself =85 it seems behind 
me now, and I've gotten a new sense of who I am."

Don't rush out to your local psychotherapist for sessions on the couch with 
this "love drug" just yet, though.

First of all, these renegade therapists will allow only certain patients to 
use the drug, and only after a careful screening and analysis process of 
several therapy sessions in advance of taking the drug. The drug's 
therapeutic effects have been found especially beneficial to those 
suffering from post-traumatic stress disorder (PTSD).

Second, don't go thinking that your time on the couch will amount to some 
sort of drug-crazed party of one. Most patients take MDMA during therapy 
twice at least, maybe three times at most. Perhaps most discouraging of all 
is the fact that you will have to score the drug yourself. Patients who 
desire this type of therapy assume all the responsibility in obtaining, 
possessing and ingesting the drug. Finding authentic MDMA, free of 
adulterants and of known strength, takes some work, but is not difficult. 
Dr. Jane cautions any prospective MDMA patient against running down to the 
local warehouse or club to buy a hit from a raver sporting an X on his 
shirt. You're more likely to end up with a fake drug or sometimes-harmful 
counterfeit. Some have had luck procuring legitimate samples from 
undergraduate chemistry students who've figured out that MDMA is not all 
that difficult to synthesize.

Once the patient procures the drug, Dr. Jane provides guidance on 
determining potency of the MDMA, and assists with dosing. Preparation 
sessions are crucial. Not only are patients given information on the risks 
and benefits of therapy using the drug, they also establish goals for the 
session, discuss expectations, and how information yielded during the MDMA 
session will be integrated in the patient's life. Dr. Jane follows a safety 
protocol that involves having a trusted friend or relative assume charge 
for the patient after the session, among other things.

In short, MDMA-assisted psychotherapy is serious business, not a dance 
party for which it's commonly used. Those who take the drug recreationally 
to enhance the repetitive beat of dance music and feel closer to other 
people at a party will gain a few pleasant hours with little or no insight 
into themselves. An MDMA session in the confines of an office and under the 
guidance of an experienced professional is something else entirely.

Before the drug was criminalized in 1985, Rick Doblin, an expert on the 
therapeutic and medical uses of marijuana and psychedelics who earned his 
doctorate from Harvard University's Kennedy School of Government, was 
witness to MDMA's effects on patients during psychotherapy. "I saw first 
hand just how helpful it was for certain patients," he said during a 
telephone interview from his Boston home.

But as the drug gained more and more publicity for its pleasurable 
qualities at dance and club parties, as opposed to its less sensational 
benefits during psychotherapy, the DEA moved to ban the drug under Schedule 
I classification. Therapists protested, suing the government in court. An 
administrative law judge agreed that the drug shouldn't be classified as 
such but could only make a recommendation to the DEA. The agency said, in 
effect, "Thanks, but no thanks." As if to buttress the DEA's position, the 
scientific community released study after study questioning the drug's 
safety and long-term effects. The most damning studies by Johns Hopkins 
University researcher Dr. George A. Ricaurte concluded that MDMA use lead 
to permanent brain damage in primates and damaged the brain's dopamine 
neurons. Upping the fear factor, the doctor also concluded that use of the 
drug could lead to Parkinson's disease in humans. But in a stunning 
reversal, Ricaurte himself put those findings to rest September 2003 when 
he admitted in Science magazine that his researchers had not given primates 
used in his studies MDMA, but another drug entirely. However, even some of 
Ricaurte's detractors say his earlier studies demonstrating the drug's 
neurotoxic qualities may have merit. Debate about the drug's long-term 
effects continues, but many hope that with Ricaurte's primate study now 
invalidated, a new era of study surrounding the drug's benefits will soon 
dawn. About time, too, they say.

Doblin founded the Multi-Disciplinary Association for Psychedelic Studies 
(MAPS) in 1986 with just that goal in mind. Based in Sarasota, Fla., his 
organization works to advance the study of MDMA's therapeutic value through 
legitimate scientific studies. The United States isn't the only nation with 
resistance to studying the drug's therapeutic uses. Spain hosted the first 
scientific study of MDMA in the world, testing its therapeutic value on 
women survivors of sexual assault. The study seemed to be advancing quite 
well according to media reports. Then the International Narcotic Control 
Board shut it down.

Although there is considerable anecdotal evidence about the benefits of 
MDMA-assisted therapy, scientific confirmation of its effectiveness is 
admittedly minimal. The most notable of the few studies originate from a 
group of Swiss psychiatrists who used MDMA in conjunction with 
psychotherapy from 1988 to 1993. During this six-year period, 121 patients 
underwent a total of 818 sessions. More than 90 percent of the patients 
described themselves as "significantly improved." During the course of the 
study, there were no adverse incidents, no suicides, no psychiatric 
hospitalizations and no negative reactions.

Doblin's MAPS is working hard to change the drug's research landscape. It 
launched a "$5 million, five-year Clinical Plan" to one day see MDMA made 
into a prescription drug for the treatment of post-traumatic stress 
disorder. The organization is also trying to secure funding for research at 
Harvard University, where the drug might be tested on advanced cancer 
patients to help mitigate their fear of death and other anxieties, Doblin 
said. But the truly big news among MDMA's proponents was the FDA's November 
2001 green light for a study of the drug's effects on people with PTSD. 
Early this year, in February, the proposed study also earned necessary 
regulatory approval from the DEA. Together, both approvals mark the first 
time since the drug was criminalized that it will officially be studied for 
therapeutic value.

For Doblin, this kind of approval for scientific study of MDMA makes the 
perfect bookmark to 1963, when Timothy Leary got the boot from Harvard 
University for his studies regarding LSD.

"The Israelites, so to speak, have been wandering in the desert for 40 
years. Researchers have been locked out of the lab, wandering the 
wilderness for that long. It's really the first time in decades that we've 
had any research on these substances at all," he said. "The quest for 
verification and scientific research is totally appropriate. What's 
fundamentally problematic is that it's taken us so long to even get to that 
point. It's especially difficult to gain traditional funding sources for 
this kind of research, too. The drug is just too controversial for them to 
even touch it."

All this is extremely important news for therapists like Dr. Jane, too. A 
practicing psychotherapist in Salt Lake City for years, one of the degrees 
on her wall boasts the blue and white accents of a relatively conservative 
Utah school. Displayed on the wall just below that degree is a license 
issued by the Utah Department of Occupational Licensing to practice as a 
clinical psychologist. She's gravely aware that her license and livelihood 
could be in jeopardy each time a patient of hers takes MDMA under her 
supervision. One patient with one bad reaction is about all that separates 
her from a bee's nest of legal problems, investigators, and a trip (no pun 
intended) in front of the licensing board.

Nevertheless, she is resolute. "I would rather tender my license and make 
widgets than turn a blind, fearful eye away from an avenue of treatment 
that may help someone," she said. "MDMA has a fantastic ability to scan 
through the unconscious, lock onto areas of emotional tension, and then 
allow the patient to talk about themselves in spite of any defensive walls 
they've created."

Like her patient Melissa, the Utah doctor has her own description of 
MDMA-assisted therapy: "Feelings of self-love and self-acceptance suffuse 
the session and, frequently, they can endure long after the drug has left 
the body," she said.

And any good psychotherapist knows that any long-lasting behavioral change 
has its roots in feelings of genuine self-love.

People ask me all the time if I can refer them to therapists [using MDMA], 
and I cannot. I know it's going on, but I don't know exactly who's doing 
it. I know they're out there."

Those are the words of Julie Holland, M.D. A New York University psychiatry 
professor and psychiatrist in practice at Greenwich Village, she's widely 
considered the most celebrated authority regarding MDMA's therapeutic 
value. And with Ricaurte's studies discredited, her comments are no longer 
seen as those of the naive proponent. Just ask Newsweek, and other 
publications in which her words have gotten a forum. Taking a break from 
vacation in Massachusetts to speak by phone, her voice is measured and 
assured, even if occasionally surprised.

"You found some underground therapists? That's great, and it's not easy to 
do," she said.

Anyone who's ever heard of Prozac or lithium knows that the marriage of 
drugs and therapy is nothing new. That's one of the reasons Holland has no 
qualms about entertaining the use of MDMA with patients on the couch. She 
seems shocked that anyone would consider its use such a radical departure. 
In addition to authoring an exhaustive research paper on the drug, she 
edited articles by 21 of the world's most noted MDMA experts, compiled in 
2001 under the title Ecstasy: The Complete Guide.

One of Holland's favorite quotes from an article included in her book comes 
from George Greer, a therapist who prescribed the drug for patients while 
it was legal, only to find himself forced to stop using it. "I felt like an 
artist who'd just discovered oil paints, but had to put them away and start 
using charcoal again because people were sniffing the oil paint," Greer wrote.

Holland sympathizes with any physician forced to put effective medicine 
aside. And she believes MDMA can be especially beneficial, not just for 
people with PTSD, but also with adults who were physically or sexually 
abused as children. "Psychiatry doesn't really have many good tools in its 
armament when you get right down to it. This is a really good tool," she 
said. "And it's very possible that if the government said this was a good 
drug for therapy, fewer people would be enticed by its illegal status."

The irony of recent FDA and DEA decisions to approve preliminary studies of 
the drug, however, is that now government seems to have taken the lead 
where universities and private companies haven't taken the trouble. 
Universities, of course, are cautious to do anything that smacks of 
illegality. But the reason why corporations never took MDMA's case before 
the FDA or DEA is clear, Holland believes.

"No pharmaceutical company has gotten behind this because [MDMA's] patent 
is expired, and it's a drug that the average patient will take once or 
twice during therapy, and that's it. There's no profit margin in it," she said.

But that doesn't mean there's no connection between current favorites such 
as Prozac and MDMA. Both drugs work to release serotonin, which brings on a 
general sense of openness, energy and well being. But where Prozac merely 
stops the recycling of serotonin, so that it backs up in the brain to make 
more available for the synapses, MDMA, on the other hand, floods the brain 
with serotonin. In addition, like Prozac, it also stops the recycling, or 
uptake, of serotonin as well.

Once again, this isn't the party drug you may have heard of. You're 
certainly not dancing to loud music in psychotherapy. No, you're talking 
about potentially painful events in your life.

"It's a very subtle experience. For most people it's about as subtle as 
having one or two glasses of wine," Holland said. "It's not as big of a 
break from normal consciousness as people might think it is. But give it a 
name like Ecstasy and people have a lot of assumptions about it.

"It's similar to anesthesia during surgery. It's not that you're pain-free, 
but you are very much more relaxed. You have to really peel through layers 
of defenses to get to core therapy. People are pretty much laid out, and 
you're much more likely to get to the malignant core of what's going on. It 
allows you to more readily examine it, and potentially excise it or remove 
it. It makes therapy much more efficient and effective. You don't have to 
spend three years building an alliance with your therapist. It really 
strengthens that alliance, which is really important for future sessions."

And unlike alcohol or other sedatives that would result in blurry 
disinhibition, MDMA has the added benefit of letting a patient recall the 
experience of what was discussed. That's due to the drug's amphetamine 
base, which gives patients greater ability to remember what's happened. And 
when an issue is recalled and remembered, there's no need to talk about it 
over and over. Taken once or twice during therapy, Holland said, MDMA can 
reap multiple benefits in future sessions.

Doblin concurs. "In a way, MDMA is the anti-drug, because Prozac and Zoloft 
are drugs people have to take every day, and when people stop taking them 
their problems come back," he points out. "MDMA in therapy is taken only a 
few times. In the PTSD study, people take it only twice. It was never 
intended to be a regular daily drug in a therapeutic setting, and was never 
intended to be a take-home drug."

Concern over the drug's current status as an illegal substance is that it 
may sit forever in the recreational realm, where it's most often used 
incorrectly. Used in the context of a dance party, users frequently 
experience dehydration, overheating or elevated blood pressure. Used in 
psychotherapy and under professional supervision, those conditions are much 
less likely to occur.

"Millions of people around the world are using it recreationally; it gets 
more popular every year," Holland said. "But people who could really 
benefit from it, can't. It's a real tragedy and a real shame."

Even though "Mike" (not his real name) has been apprised in advance of 
steps that will be taken to protect his anonymity, he's understandably 
guarded in talking about MDMA and his psychotherapy practice. A clinical 
social worker practicing in the Cache County area, he brings hand to chin 
when asked about his initial reasons for using MDMA with select patients.

"There was no big `eureka' moment or anything," he said. "To me, the 
decision to add it to my psychotherapy practice was just common sense =85 
consider a therapist with a strong Jungian orientation. Well, using Jungian 
therapeutic techniques doesn't work with every client and so, unless you're 
neurotically rigid, you use some cognitive behavioral therapy or some other 
modality that is going to make a difference. It was kind of like that. I 
never struggled with it as an ethical question. The greater moral wrong 
seemed to be in denying relief to a human being seeking it."

He estimates that in the years he's maintained a practice in Utah, he has 
treated about 30 people using different psychedelics. He prefers MDMA for 
much the same reasons as other therapists do, but has used psilocybin, 
ayahuasca, and the research chemicals 2ct2 and 2ct7--all with good results.

Mike believes that MDMA's area of greatest promise is in couples or marital 
counseling. "MDMA, with or without couples-counseling, has salvaged a 
handful of marital relationships I had considered doomed," he said.

As evidence, he furnished a written account by one of his MDMA patients, 
who initially presented relationship problems: "During my session I could 
see clearly for the first time in my life =85 many of the patterns or 
cycles of conflict I had been having with [my wife] I realized were 
responsible for our separation, and that my continued happiness in my 
relationship with her depended on me stopping those behaviors completely. I 
saw that she was a caring and loving person, and let old anger and grudges 
fall away. I made a commitment to myself to give up those behavioral 
patterns =85 I would never again focus on our differences or pretend to 
ignore them. I learned that they are necessary, and that I would celebrate 
them =85 at that moment, and now, even five months later I found it was no 
longer necessary for her to change in order for me to be happy in the 
relationship."

Mike, for one, is hopeful that the attitudes of the authorities will change 
regarding his type of work as a psychotherapist. He's well aware of MAPS' 
work in this regard.

Concern by Mike and Dr. Jane for their anonymity is not difficult to 
understand. Being present, much less having a participatory role in the use 
of MDMA, clearly violates a handful of laws and licensing rules. The Utah 
State Department of Occupational and Professional Licensing (DOPL) has not 
been ambiguous about therapists practicing in this manner. Providing 
MDMA-assisted psychotherapy is one of only a handful of major infractions 
that would result in the revocation of a license, as opposed to other 
lesser sanctions.

However, it's fair to say that MDMA, like every other medication, is not 
completely safe, as well as not completely understood in its mechanism of 
action. Chalk that up, again, to its status as an illegal, Schedule I drug. 
As a result, there is not an abundance of research directed at answering 
questions about the drug's mechanism of action and, unfortunately, most of 
the few studies completed to date have focused only on its tendency to 
release the brain chemical serotonin. It's hoped that MDMA's unhindered 
study will be a significant turning point in assembling a comprehensive 
picture of its very unique pharmacological functions. Experts know that 
questions about MDMA having a neurotoxic effect, or a depleting effect on 
the brain's supply of serotonin, need further study.

But in consideration of the universal side effects described by the 
millions of people who've used the drug, MDMA's major risks to any 
individual appear to be the very real possibility of being arrested and jailed.

Still, even proponents such as Doblin know the importance of research, 
whether that be to prove the drug's effectiveness, or demonstrate its 
risks. "That's one of the lessons we learned from the '60s," Doblin said. 
"You can't downplay the risks or emphasize the benefits."

Mike and Dr. Jane in no way perceive themselves as divergent warriors on 
the frontlines in the effort to legitimize MDMA. However, as the resurgence 
of therapeutic research on MDMA begins, it's therapists such as they who 
may one day be in a position to teach other mental health professionals the 
techniques of harnessing the potential of this new but, really, somewhat 
old, treatment tool. If, and when, MAPS provides the FDA with sufficient 
evidence of MDMA's usefulness and it's approved as a prescription 
medication, adults suffering from emotional problems will have the option 
to walk into a local clinic and receive the drug in a setting conducive to 
healing.

For his part, Doblin roots for any Wasatch Front psychotherapist brave 
enough to blaze such a trail while the drug remains illegal. "I feel a lot 
of sympathy and pride that there are two people in Utah who care enough 
about their patients that they're willing to risk their freedom and 
licenses," he said. "That creates a lot of inspiration and responsibility 
in me to work even harder to see this through."
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