Substance Misuse – Mindfulness and Ecstasy

I noticed some recent newspaper reports suggesting that MDMA (aka the recreational drug Ecstasy) is effective in helping alcoholics to reduced their drinking.  The research was conducted at University College London by Professor David Nutt.  You may recall Professor Nutt was previously the government’s “Drugs Tsar” as chairman of the Advisory Council on the Misuse of Drugs.  He was fired from this post in 2009 after speaking out to suggest that there was a mismatch between lawmakers’ classification recreational drugs – suggesting that illicit drugs should be classified according to the actual evidence of the harm they caused.  To this end he presented an analysis which revealed that alcohol or tobacco were more harmful than LSD, ecstasy or cannabis.  Further, I have heard Professor Nutt talk about the opportunity to repurpose some drugs that are currently controlled in order to effectively treat mental illness and addictions.

The recent news reports centred on a study by Professor Nutt and his team at University College London showing that Ecstasy can be used to treat alcoholism – as it seems to enable addicts to confront their pasts.

In a trial, addicts were given doses of the Class A drug MDMA during two of eight psychotherapy sessions.  Before the therapy, they had been drinking an average of about 130 units a week – yet nine months later, 79 per cent of those who had taken the MDMA therapy were still consuming less than 14 units of alcohol per week, compared with just 25 per cent of people who had sought standard NHS care.

Prof Nutt’s work made me wonder about trials investigating the possibility of using Mindfulness to help people with substance abuse and addiction problems.

In fact, there are many published papers detailing research into the effectiveness of Mindfulness interventions to help reduced addictive behaviours – alcoholism, binge drinking smoking and drug addictions – to reducing cravings and dependency… and as a mollifiers for stress.  It took me a little longer to find studies looking at the long-term effect (where the effects lasted beyond the period of the study interventions) – but pleasingly there are a number of excellent random controlled trials that show such lasting impact.

One typical example is this 2014 paper “Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders A Randomized Clinical Trial (Sarah Bowden et al – from the Addictive Behaviors Research Center, Seattle, Washington – published in JAMA Psychiatry). (Here).

This research contrasted the use of “Mindfulness-based relapse prevention” (MBRP) with a “cognitive-behavioural relapse prevention program“ (RP)  and  also with “treatment as usual” (TAU)  – a 12 step counselling program. A total of 286 eligible individuals who had successfully completed initial treatment for substance use disorders were randomized to MBRP, RP, or TAU and attended eight weekly sessions for their given program.  They were then monitored for 12 months.

The trail showed that in comparison with TAU, both MBRP and RP significantly reduced risk of relapse risk to drug use and heavy drinking at 6 months; and at the 12-month follow-up, MBRP was more effective than both RP and TAU in reducing drug use and heavy drinking.  The researchers commented:

“Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skilfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes.”

This is just one example of many such research projects to show that Mindfulness interventions really can support people to reduce heavy drinking and drug use over the long term.

It will be interesting to see if Professor Nutt’s “ecstasy treatment” requires “maintenance sessions” to continue the progress made – my hope and expectation is that most of his subjects will have changed their habit for the long-term as a result of his program.

One final comment: most of the research I found was centred on the use of drugs, alcohol and/or tobacco – it would be interesting to look at the effectiveness of Ecstasy on other addictive behaviours like gambling, self-harm, eating disorders etc which have also shown a positive response to mindfulness interventions.

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