MDMA Assisted Therapy for Alcohol Abuse & PTSD

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A new study provides preliminary evidence that MDMA-assisted therapy may help reduce alcohol use in people with severe PTSD.

Key facts:

  • MDMA-assisted therapy was tested in a phase 3 clinical trial for treating severe PTSD.
  • Participants were allowed to have mild alcohol or cannabis use disorder.
  • Compared to placebo therapy, MDMA therapy led to greater decreases in alcohol use and risk.
  • MDMA therapy did not increase illicit drug use.
  • The findings suggest MDMA therapy could be useful for integrated treatment of PTSD and alcohol use disorder.

Overview of the Clinical Trial

The study was a randomized, placebo-controlled phase 3 trial testing MDMA-assisted therapy for severe PTSD.

90 participants with chronic PTSD were randomly assigned to receive either MDMA therapy or placebo therapy.

The MDMA therapy consisted of 3 sessions where participants were given MDMA or a placebo, along with 8 hours of psychotherapy on each session day.

The placebo group received the same psychotherapy sessions without MDMA.

All participants had severe PTSD at the start.

They were allowed to have mild alcohol or cannabis use disorder. Other substance use disorders were excluded.

Measuring Changes in Alcohol and Drug Use

Participants completed standardized questionnaires on alcohol and drug use at the start and end of the study.

The Alcohol Use Disorders Identification Test (AUDIT) measures hazardous alcohol use.

Higher scores indicate more problematic drinking.

The Drug Use Disorders Identification Test (DUDIT) assesses illicit drug use patterns and problems.

Higher scores mean more frequent drug use and drug-related issues.

MDMA Therapy Reduced Hazardous Drinking

The MDMA therapy group showed significantly greater reductions in AUDIT scores compared to placebo therapy.

This suggests the MDMA treatment led to decreases in hazardous alcohol consumption.

On average, AUDIT scores decreased by 1 point in the MDMA group, versus a slight increase in the placebo group.

The reductions were independent of changes in PTSD, depression, or functioning.

MDMA Therapy Did Not Increase Drug Use

There was no significant difference between the MDMA and placebo groups in terms of changes in DUDIT drug use scores.

On average, DUDIT scores decreased slightly in both groups from start to end of the study.

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This indicates MDMA therapy did not lead to increased problematic drug use.

Importance for Co-Occurring PTSD and Substance Use

PTSD commonly occurs alongside substance use disorders.

The self-medication hypothesis suggests that substances are used to relieve PTSD symptoms.

Effective PTSD treatments may therefore also reduce substance misuse.

The current findings lend some support to this theory.

The results suggest MDMA-assisted therapy could be useful as an integrated treatment approach for co-occurring PTSD and alcohol use disorder.

Further research is still needed.

Mechanisms Behind the Changes in Alcohol Use

It is unclear exactly why MDMA therapy led to decreased alcohol use in this trial.

A few potential explanations are:

  • The therapy resolves underlying PTSD driving alcohol use.
  • MDMA provides PTSD symptom relief during the sessions, reducing alcohol cravings.
  • MDMA enhances the psychotherapy process.
  • Participants feel less need to self-medicate after recovering from PTSD.

Further research is required to understand the mechanisms involved.

Limitations and Additional Questions

While promising, there are some limitations to consider:

  • No participants had a current alcohol use disorder diagnosis. The sample limits conclusions about treating alcohol use disorders.
  • The absence of severe substance use disorders makes the findings less generalizable.
  • The lack of diagnoses and narrow distribution of scores reduced ability to detect significant effects.
  • It is unknown if effects are sustained long-term after completing therapy.
  • Future studies should examine MDMA therapy in participants with active alcohol and substance use disorders.
  • Research is needed on the long-term outcomes and abuse potential.

Conclusion

This phase 3 trial provides initial evidence that MDMA-assisted therapy for PTSD may lead to reductions in hazardous alcohol use without increasing illicit drug use.

The findings suggest MDMA therapy could be an effective integrated approach for treating co-occurring PTSD and alcohol misuse.

Additional research is warranted to replicate the results and clarify the mechanisms involved.

References