Some experts say it could be a valuable tool for couples' therapy.
Science Photo Library / Nicole Mason
It’d be hard to give a detailed account of my 8-year marriage without mentioning the effect that MDMA had on it. We got together while vacationing in Ibiza—the Spanish island practically synonymous with the drug—and took it in both pill and powder form. The former was speedier and likely cut with an amphetamine, exactly what you'd need when you put in two, six-hour dancing shifts every day for ten days straight. The empathogen set our burgeoning relationship on such a fast track that we’d already made plans to cohabitate—and internationally relocate—before we divulged our divergent opinions on monogamy. Looking back, I feel that starting our relationship under the drug's influence is what made it possible to explore polyamory conscientiously, communicatively, and compassionately, possible.
Almost five years into our marriage, a new partner introduced me to the concept of “home rolling.” She used the term to refer to taking MDMA in a safe, familiar, and cozy environment to better connect with another person, a small group of people, or even oneself. I wasted little time in suggesting that my wife and I try our favorite party drug in a setting more conducive to talking and less conducive to throwing some shapes to a Carl Cox banger. Going out and dancing was, until then, the only context in which we’d used it. The at-home experience was as profound and therapeutic as it was enjoyable. It reduced our fear and defensiveness, enhanced communication and introspection, and increased empathy and compassion between us.
While we were noticing how this combination of neurological effects served as a relationship reboot, researchers affiliated with the Multidisciplinary Association for Psychedelic Studies (MAPS) were looking into how that exact same mixture of responses could help people with post-traumatic stress disorder (PTSD). Their work resulted in the Food and Drug Administration (FDA) granting a Breakthrough Therapy Designation for MDMA-assisted psychotherapy for PTSD in August 2017.
This designation allows the FDA to grant priority review to drug candidates if preliminary clinical trials indicate that the therapy may offer substantial treatment advantages over existing options for patients with serious or life-threatening diseases. Put more simply, a US federal agency is now putting MDMA on a fast track to being legally administered to help people in emotional pain. But before we feel too warm and fuzzy about that, we ought to remember that MDMA’s therapeutic potential has been known to therapists for more than 40 years.
MDMA was patented by Merck in Germany in 1914 but a use for “methylsafrylamin” as it was then known was never found. When Alexander Shulgin, a Dow-Chemical-scientist-turned-psychonaut, synthesized the drug the mid 60s, he, too, shelved it. A decade later, Shulgin was reintroduced to MDMA by a student in the medicinal chemistry group he advised at San Francisco State University after she guinea-pigged it and relayed its “special effect” it to him. After testing the drug himself in September 1976 and discovering a new way to synthesize the chemical, a suitably impressed Shulgin introduced it to Leo Zeff.
Zeff, an Oakland-based psychotherapist, then began using MDMA in small amounts to aid talk therapy. He was so enthused by the drug’s ability to facilitate communication and engender empathy that he postponed his retirement and traveled across the country to spread the word. Before his death in 1988, it’s thought that Zeff trained upwards of 4,000 therapists in MDMA-assisted psychotherapy, who in turn treated an estimated 200,000 clients.
It didn’t take long for a growing number of people to understand that using MDMA in a non-therapeutic setting could be, well, fun. Soon, a group of chemists in Boston and later Dallas were working flat out to meet demand for MDMA. Between the late 70s and mid 80s, it’s estimated that a total of around 500,000 doses of MDMA were consumed. Though that’s less than the number of doses sold in a two-week span in Ibiza, it was enough to provoke the Drug Enforcement Agency (DEA) to begin investigating the drug in 1982. In May 1985, in the midst of Nancy Reagan’s “Just Say No” campaign, the DEA took emergency measures to criminalize the drug despite full-throated opposition from therapists. Professor emeritus of psychiatry at Harvard Medical School Lester Grinspoon went as far as suing the agency, claiming that they’d ignored the medical uses of MDMA.
Since then, MDMA has been a Schedule 1 drug along with heroin, bath salts, and surprisingly, marijuana. (A Schedule 1 designation is given when the DEA determines that the substance has a high potential for abuse and has no currently accepted medical use in treatment in the United States). The ban took place before a number of studies in the 90s and 2000’s demonstrated some of the ill effects of chronic MDMA use which include memory loss and depression.
MAPS, whose stated goal is “a world where psychedelics and marijuana are safely and legally available for beneficial uses, and where research is governed by rigorous scientific evaluation of their risks and benefits” was formed in 1986, a year after MDMA was made illegal. MAPS is hopeful that their vision, at least as far as MDMA is concerned, will be realized at early as 2021.
“MDMA is just the most compassionate way to approach trauma,” says Dee Dee Goldpaugh, who MAPS lists as a Psychedelic Integration Therapist. “Healing involves reliving a lot of painful material. You have to go through the dark night and it’s hard. MDMA is like giving people a warm blanket to go through [it]. You still have to deal with the difficult material. It’s just way easier when you have access so many emotional tools that can help you deal with it. We have other effective treatments for trauma—they’re just not as effective as MDMA.”
The analysis of the phase 2 trial data that lead the FDA to expedite development and review showed that, regardless of the original cause, PTSD can be treatable with just two to three sessions of MDMA-assisted psychotherapy. All 107 participants in the trial had chronic, treatment-resistant PTSD, and had lived with it for an average of 17.8 years. Participants did three sessions of MDMA-assisted psychotherapy and, two months following treatment, 61 percent were no longer considered to have PTSD. At the 12-month follow-up, more than two thirds (68 percent) no longer had PTSD. By way of a comparison, nonresponse to cognitive behavioral therapy (CBT)—which often takes takes years—can be as high as 50 percent.
While MDMA-assisted therapy for PTSD is MAPS’ main priority, the organization has also backed research into MDMA-assisted therapy for autistic adults with social anxiety, and for anxiety related to life-threatening illnesses. But the Santa Cruz, California-based organization and affiliated therapists like Goldpaugh have a broader vision of its application including, as it turns out, what it had been used for since Zeff got his hands on it: couples therapy.
“If I were to envision my dream practice of how I would work with a couple, I would have a number of sessions with them both individually and together first to set up the work,” Goldpaugh says, before explaining that an MDMA-assisted session would be an all-day thing. She imagines a structured eight-hour session during which the couple have their own experience with the therapist being there as a supportive force who can steer things when necessary. “This is totally different to the treatment protocol for individuals with PTSD where the therapist is just a supportive observer.”
After the psycholytic portion of the setting—meaning the part in which the couple is in the empathic state engendered by the drug—would come aftercare and processing, which would continue in subsequent sessions, she tells me.
“One of the things I think about is the financial piece of this puzzle,” Goldpaugh says. “Who is this treatment going to be accessible to? I want everybody who could benefit from this medicine to have access to it but it’s going to take a lot of work, preparation, and time.”
Goldpaugh is confident that doctor-prescribed MDMA wouldn’t be something patients could pick up at a CVS but would delivered directly to and administered by the therapist. “Pharmaceutical-grade MDMA is incredibly safe when it’s taken in the right context and in the right quantity,” she says; a point of view backed up by phase 2 of the PTSD study, which reported just one adverse reaction in 780 patients. The study’s authors noted that “MDMA transiently increases heart rate, blood pressure, and body temperature in a dose-dependent manner that is generally not problematic for physically healthy individuals.”
“Almost anything you buy on the street, however, is heavily adulterated,” she says. “That’s partly because it’s very, very hard to get the chemicals you need to produce it. So anything you’re likely to buy on the American market is likely to have been adulterated with a number of different things.”
MDMA that’s commingled with other substances, or substances that don’t contain any MDMA at all, is a danger in to both the recreational users of the drug and people who have sought underground MDMA-assisted therapy during the 33 years since it was made illegal. “Underground therapy with MDMA persists to this day in a very robust way,” Goldpaugh says. “Providers vary between people who are trained and very competent and then people who are just like: ‘I’m going to give you what we hope is MDMA, sit with you, and charge you X amount of money to do that.’”
The other problem with that second scenario, Goldpaugh tells me, is that MDMA can allow unconscious material that had been repressed to come forth; memories that can overwhelm the nervous system and need to be professionally addressed. “I’ve had clients who have done underground work who are left with all this material that they didn’t previously know about,” she says. “Memories of childhood sexual abuse, things in their childhood that they are now stuck with. That’s why proper processing by a trained therapist is so important with this—you just don’t know what’s going to get shaken loose.”
As I said earlier, MDMA had played a seemingly important part in beginning of my longest relationship and helped to deepen it some years later. In retrospect, I can't help thinking its later absence had something to do with our marriage’s end. At a certain point, despite my repeated, plaintive requests, my wife declined to participate in our twice-yearly home roll reset. The reason, she said, was that she didn’t want to waste the following day feeling lethargic. Within a year, we’d separated and sold our home. Her secondary partner became her sole one.
The last time I’d seen Goldpaugh was as my therapist when my wife and I were still married. I was drawn to her because I’d read about her experience working with the LGBTQA people as well as polyamorous individuals and couples.
After speaking for some time about the implications of MDMA’s future in legal therapeutic settings, I asked her if she thought my marriage’s chemically aided beginnings and middle meant that our connection was, to some extent, phony. She professed to having no way of knowing if our connection would have been different if we hadn’t met while on MDMA and quasi-therapeutically used it in later years.
However, she cited the work of biological anthropologist Helen Fisher who noted that, during the initial stages of forming a romantic relationship with a new partner, our brains are flooded with dopamine, norepinephrine, and serotonin—the same neurotransmitters loosed by MDMA. “Falling in love is basically nature's MDMA,” she told me. “If you ended up in a relationship that resulted in a secure, enduring attachment, which you did, then I would not worry about the role MDMA played in your initial meeting.”
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