ECSTASY EXPERTS WANT REALISTIC MESSAGES

Bethesda - As the popularity of the drug ecstasy (MDMA) continues to climb
- -- 11% of high school seniors have tried it, according to a National
Institute on Drug Abuse (NIDA) survey -- behavioral researchers are
recommending control strategies that may seem antithetical to
ever-expanding law enforcement efforts. Instead of focusing on eradication
and punishment, these social scientists take another tack: they encourage
harm reduction that acknowledges the realities of ecstasy.

At a recent NIDA conference, a half-dozen speakers advocated this immediate
action approach. Providing plenty of water at rave parties to prevent
dehydration (a common adverse effect), offering purity testing to help
users avoid ubiquitous adulterants, and developing peer-led programs will
go a long way toward reducing dangers, they said.

Ecstasy pills sold in the United States generally contain 100 mg or less of
MDMA. According to the social scientists, typical users take no more than
one pill at a time during a "session" and most limit their use to once or
twice per week.

(Photo credit: National Institute on Drug Abuse) Social science researchers
say that blunt prevention messages like this one fail to reduce ecstasy
use. They advocate less extreme campaigns that users can identify with.

"Ecstasy is seen as relatively benign," said Robert Carlson, PhD, an
addiction researcher at Wright State University of Medicine in Dayton,
Ohio. "[Prevention] messages are not getting across, and something needs to
be done."

Skepticism about government studies, perception that ecstasy is safer than
other drugs (including alcohol and tobacco), and willingness to take
calculated risks all factor into the ecstasy equation, said Patricia Case,
ScD, director of the program in urban health at Harvard University. "A lot
of [ecstasy users] make clear decisions, despite the known or unknown
risks, that the benefits outweigh those risks," she said.

With considerations like these, Carlson and his colleagues are emphatic
that one-size-fits-all campaigns hyping the dangers of ecstasy fail to sway
users. Instead, they want messages that reflect reality: the effects of
ecstasy feel good, different groups use it for various reasons in a range
of settings, and evidence of addiction remains scant.

Claire Sterk, PhD, professor of behavioral sciences at Emory University's
Rollins School of Public Health, Atlanta, Ga, would drive proponents of
"Just Say No"style campaigns crazy. "We'll be better off having a campaign
[poster] that says, 'Ecstasy can . . . make you feel really good. It
increases your sensory awareness, it makes you feel music.' It's okay to
acknowledge that," she said. "And then have a big comma and say, 'But there
are consequences.'"

In contrast, NIDA's prevention campaign uses scare tactics. The oft-seen
image of a brain before and after ecstasy provides a prime example. Split
in half, a brain scan displays a lurid orange hemisphere on the left -- the
"plain brain." On the "brain after ecstasy" side, muted tones and a missing
chunk of cortex offer vivid testimony of the drug's propensity for
destroying serotonin neurons, according to NIDA, which has distributed
thousands of postcards and handouts displaying the graphic.

What the materials don't say is that the "after" scan comes from someone
who abused multiple drugs and took several hundred doses of ecstasy, a huge
amount the average user will never approach (Lancet. 1998;352:1433_1437).
"We need to stop exaggerating the negative consequences and stop using
extreme cases," said Sterk. "I'm not saying there aren't consequences, I'm
saying we don't know what they are."

Sterk and colleagues say that effective campaigns will take shape only
after researchers come to grips with why people take ecstasy. This
application of ethnography teaches that understanding springs from getting
to know users. It's a social, not clinical, approach.

Case and her team spent hundreds of hours in New York City bars and clubs,
gauging drug habits in the gay community. Carlson explored the lives of
young adults who took ecstasy in Ohio. And Jean Schensul, PhD, executive
director of the Institute for Community Research in Hartford, Conn, tracked
networks of ecstasy-involved urban teenagers.

Their conclusion: each group is driven by unique motivations. Whereas older
New York City gay men may use ecstasy "as part of a posttraumatic stress
response" to having "lived through the 'death years' of AIDS," midwestern
youth may simply be rebelling, and Hartford's poor teens may be yearning
for an escape. Targeting all of them with the same message doesn't make
sense. "We know people will continue to use," said Sterk. "What we can do
right away is come up with appropriate, targeted messages to reduce the risk."

Brian Vastag