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Pharmacotherapies for PTSD and Substance Use Disorders
Published in Anka A. Vujanovic, Sudie E. Back, Posttraumatic Stress and Substance Use Disorders, 2019
Lorig K. Kachadourian, Kevin P. Jensen, Mehmet Sofuoglu, Ismene Petrakis
In relation to SUD, anecdotal evidence of the effects of MDMA on substance use comes from one of the first reports published by Greer and Tolbert (1986). In this report, the authors suggest that MDMA-assisted psychotherapy may reduce substance use (e.g., alcohol, tobacco) or, at a minimum, interest in use, as such outcomes were reported among several of the 29 clients who were included in that report. However, to date, no published reports exist examining MDMA-assisted psychotherapy for problematic substance use specifically. This may be due in part to its potential for addiction: although research hasn’t provided definitive answers as to whether MDMA is addictive, there are findings to suggest that those who use MDMA report continued use despite negative physical and psychological consequences, tolerance, and withdrawal (Cottler, Leung, & Abdallah, 2009; Cottler, Womack, Compton, & Ben-Abdallah, 2001). This is an important consideration that needs to be made when considering the use of MDMA to treat SUD. Whether MDMA would be of assistance to individuals with comorbid PTSD/SUD remains to be seen.
MDMA-assisted psychotherapy
Published in Philip N. Murphy, The Routledge International Handbook of Psychobiology, 2018
Grinspoon and Bakalar (1986) similarly stated that it was a ‘Misunderstanding to consider psychedelic drug therapy as a form of chemotherapy, which must be regarded in the same way as prescribing lithium or phenothiazines’. They further noted: ‘The claims of psychedelic drug therapy are subject to the same doubts as those of psychodynamic and other forms of psychotherapy. The mixture of mystical and transcendental claims with therapeutic ones in another aspect of psychedelic drug therapy troubling to our culture.’ This quotation was cited in one of my earlier reviews (Parrott, 2007), and it illustrates a fundamental difference between traditional pharmacotherapy (viz: chronic usage of antipsychotic or antidepressant medications), and the totally different approach of psychotherapists (viz: minimal usage of an ‘entactogen’ to enhance self-awareness). In Parrott (2007), it was further noted that: ‘Psychotherapists seem to seek higher-level integrative changes, but these are more intangible.’ Metzner (1998) stated that with MDMA-assisted psychotherapy: ‘The drug is used to amplify and intensify the processes of internal self-analysis and self-understanding.’ To summarize, there seems to be a fundamental difference in theoretical models between psychoanalysts and psychobiologists. Hence the main aim of this article is to present a detailed psychobiological analysis of the processes thought to underlie MDMA-assisted psychotherapy
Hallucinogens
Published in G. Hussein Rassool, Alcohol and Drug Misuse, 2017
MDMA was first manufactured in Germany in 1914 as an appetite suppressant, although it was never actually marketed for this purpose. It has been used in a limited way as an adjunct to various types of psychotherapy in order to facilitate the therapeutic process. In addition, the drug has also been used to some extent with terminally ill patients in order to help them come to terms with their situation and to communicate or ventilate their feelings more easily. MDMA-assisted psychotherapy, where MDMA is only administered a few times, has been used to treat post-traumatic stress disorder (MAPS 2016).
The emerging role of psilocybin and MDMA in the treatment of mental illness
Published in Expert Review of Neurotherapeutics, 2020
Hartej Gill, Barjot Gill, David Chen-Li, Sabine El-Halabi, Nelson B. Rodrigues, Danielle S. Cha, Orly Lipsitz, Yena Lee, Joshua Daniel Rosenblat, Amna Majeed, Rodrigo B. Mansur, Flora Nasri, Roger Ho, Roger S. McIntyre
The psychopharmacological profile of MDMA offers promise as a potential adjunct therapy for PTSD [84,85]. The effects of MDMA (i.e., euphoria and heightened social interaction) may reduce fear and awareness of traumatic memories [86,87]. A pilot trial evaluating the safety and efficacy of MDMA therapy in PTSD populations reported significant improvements in PTSD symptoms (p= .015) with no serious adverse effects [48]. In a follow-up study, Mithoefer et al. demonstrated that MDMA-assisted psychotherapy provided persistent symptomatic relief for chronic, treatment-resistant PTSD. They observed no statistically significant difference in the mean Clinician-Administered PTSD Scale (CAPS) score when comparing results from study completion and in a long-term follow-up (p = .91). Therefore, participants maintained statistically significant symptomatic relief [88]. Similarly, Ot’alora et al. assessed MDMA treatment with psychotherapy in 28 individuals with chronic PTSD. In this double-blind clinical trial, the participants received either two active doses of MDMA (100 and 125 mg) or one low dose of MDMA (40 mg) during an eight hour psychotherapy session. The MDMA treatment reduced PTSD symptoms significantly. Participants receiving an active dose of 125 mg of MDMA showed the greatest reduction in PTSD symptoms (p=0.03). In a 12-month follow-up, PTSD symptoms remained lower than baseline values (p<0.001) [89].
The Past and Future of Psychedelic Science: An Introduction to This Issue
Published in Journal of Psychoactive Drugs, 2019
Richard E. Doblin, Merete Christiansen, Lisa Jerome, Brad Burge
This special issue includes a case report from a MAPS-sponsored Phase 2 trial of Cognitive-Behavioral Conjoint Therapy (CBCT) combined with MDMA for the treatment of PTSD in pairs of people, led by researchers at Ryerson University in Toronto (Wagner et al. 2019). The promise of MDMA-assisted psychotherapy lies in the creation of an environment where patients no longer feel as though they are living with PTSD (Wagner et al. 2019), in which they are free to imagine and conceive of a life that is unburdened by their trauma. This therapy views MDMA as a therapeutic catalyst for participants as they integrate the trauma they experienced. MDMA-assisted psychotherapy allows them to remember that living beyond their trauma-induced pain is within their capacity. “Following this [psychotherapy] session, [primary participant] Stuart reflected, ‘there’s no easy fix – I need to work through the darkness’” (Wagner et al. 2019). This acknowledgment is vastly different from the emotional numbing that the participant reported in the beginning of his treatment. Stuart demonstrated a path toward moving through. The addition of MDMA-assisted psychotherapy allowed the participants to use the tools provided by the cognitive behavioral therapy treatment.
Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments
Published in Expert Review of Clinical Pharmacology, 2020
Kyle T. Greenway, Nicolas Garel, Lisa Jerome, Allison A. Feduccia
Since 2000, MDMA-assisted psychotherapy has been under investigation as a treatment for chronic treatment-resistant PTSD. Six phase 2 trials were sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS) from 2004–2016, with results indicating substantial improvements in PTSD symptoms and adequate tolerability to the treatment protocol [224]. During MDMA sessions, participants can more readily process traumatic memories and engage with the associated challenging emotions, due to their ‘window of tolerance’ being increased [225]. Greater introspection, enhanced compassion for oneself and others, and a larger capacity to feel and talk about traumatic memories have all been proposed as key psychological mechanisms induced by MDMA in a therapeutic context [225]. As with classic psychedelics, integrative non-drug therapy sessions are essential for contextualizing the experience and applying insights to everyday life. Long-term (12 or more months) reductions in PTSD symptoms and other positive outcomes have been observed following treatment [226]. After reviewing data from these trials, the FDA granted a Breakthrough Therapy designation in 2017, and the first of two phase 3 trials commenced in November 2018 [14]. An Expanded Access program for 50 patients with PTSD to undergo MDMA-assisted psychotherapy will start later in 2020. In addition, MDMA-assisted psychotherapy has been explored for use in other indications, including social anxiety in autistic adults and anxiety related to life-threatening illness [227], and current or planned trials will evaluate its use for alcohol use disorders and eating disorders.