Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use

Treating concurrent PTSD and substance use with psychedelics is controversial due to a lack of empirical evidence and strict substance scheduling. Traditional treatments compartmentalize these conditions, are costly, slow to take effect, and have debilitating side effects, leading to poor retention and outcomes. This manuscript explores how PTSD and substance use are linked through the Self-Medication Hypothesis and Adverse Childhood Events, and argues that MDMA-assisted therapy offers a promising integrated alternative. MDMA-assisted therapy involves a few supervised doses, is more cost-effective than traditional treatments, has virtually no adverse effects compared to psychotropic medications, and achieves positive outcomes within weeks that last years. Recommendations include rescheduling MDMA for research and clinical practice, and improving therapist training and access.

Study at a glance

Abstract

The importance of treating concurrent Post-Traumatic Stress Disorder (PTSD) and substance use with psychedelics is a controversial topic, hampered in part by a lack of empirical evidence and rigidity of substance scheduling. Traditional treatments for concurrent PTSD and substance use concerns are compartmentalized, with clinicians focusing on one condition over the other. In addition, traditional medication treatments are costly, requires significant time to take effect, and often come with debilitating side effects, resulting in decreased treatment retention and outcomes. Here, the aim of this manuscript is to explore the intricate mechanisms keeping concurrent PTSD and substance use in place and how traditional treatment methods are ineffective in treating the root cause of these conditions. The link between PTSD and substance use as a coping strategy is explored through the Self-Medication Hypothesis in combination with the prevalence of Adverse Childhood Events. The use of 3, 4 Methylenedioxymethamphetamine (MDMA)-assisted therapy is explored as a new and promising integrated treatment focusing on the safety, internal process, trust, and therapeutic rapport of the client and clinician. MDMA-assisted therapy consists of only a couple doses of a psychoactive substance administered in a controlled environment and under strict supervision. MDMA-assisted psychotherapy is more cost-effective than traditional treatments with virtually no adverse effects when compared to psychotropic medications. MDMA-assisted psychotherapy is shorter in length and more effective than traditional therapy with positive outcomes achieved within weeks, and lasting multiple years. Suggestions for future research include involving individuals who use substances and greater diversity and number in study samples. In addition, this manuscript contains recommendations for clinical practice for therapist training, an integrative treatment approach, and affordable access to MDMA-assisted treatment for PTSD and concurrent disorders. Finally, recommendations are made for the rescheduling of MDMA to allow for more significant research and clinical practice opportunities.