Most active Ecstasy users do not associate the drug with risks of neurotoxicity or psychological problems, beyond the danger of obtaining a deadly substitute. Based on audiotaped focus groups and individual interviews with 30 users in Ohio, users instead seek harm-reduction strategies for safe use and largely ignore prevention messages like "just say no." Because Ecstasy is often used in small friend groups, interventions involving peer leaders or social networks may be effective.
Among 402 young adult MDMA users followed for two years, depressive symptoms measured by the Beck Depression Inventory (BDI-II) declined from an average score of 9.8 at baseline to 7.7 at 24 months, decreasing by 0.36 points every six months. People with higher initial scores showed greater declines. Men and white participants had lower scores than women and non-whites; those with some university education had lower scores than those without. Current benzodiazepine or opioid users and people who had used MDMA more than 50 times had higher scores. The low and declining average scores suggest that for most people, MDMA use does not lead to long-term depressive symptoms.