ECSTASY & THERAPY

It may be illegal but the popular "club drug" MDMA is coming back to its
psychotherapeutic roots.

Sitting on a couch is Melissa, a woman in her mid-20s who has just taken
125 mg of methyllenedioxymethamphetamine (MDMA), or ecstasy, in a glass of
juice. Sitting in a rocking chair to the left of Melissa is licensed
psychotherapist Dr. Jane, who will work intensely with her patient over the
next few hours, as Melissa's brain bathes in the surplus neurochemicals
brought on by the MDMA.

Melissa and her therapist aren't part of any currently approved research.
They consider themselves to be conscientious, law-abiding citizens, but
have decided to augment traditional psychotherapy with what the U.S. Drug
Enforcement Agency currently classifies as a Schedule I substance---an
illegal drug.

But, illegal or not, Dr. Jane (not her real name) has a rationale for using
this drug with her patient: MDMA eases anxiety surrounding traumatic
events, allowing them to be recalled with extensive clarity, then amplified
by a desire to discuss them, perhaps for the first time in the patient's life.

Dr. Jane is one of an informal network of a half dozen or so
psychologists--licensed social workers and psychiatrists practicing from
Logan to Provo--with the experience and willingness to work with patients
who choose to use MDMA in conjunction with other drug-free therapy sessions.

She and her underground clinical colleagues aren't doing anything new. Long
before its popularity blossomed under the moniker of "ecstasy" in dance
clubs and warehouses across Europe and North America, and long after its
first patent by German pharmaceutical company Merck in 1914, MDMA was used
by scores of psychotherapists during the 1970s and halfway through the
1980s. With its relatively minimal side effects, therapists classified the
drug as an "empathogen" for its ability to open the heart, increase
awareness and foster sensations of self-love and acceptance. In addition,
the drug has the added benefit of keeping the patient firmly grounded and
in control, rather than orbiting Pluto as occurs with stronger drugs. From
the perspective of the analyst's chair, these are all very desirable traits.

From its ingestion, MDMA takes about 45 minutes to take effect. During
this time, Melissa nods her head in affirmation, as Dr. Jane reads aloud
the goals for this session and the safety contract, both of which have been
developed and agreed upon during six earlier preparation sessions.

It is now 60 minutes past the point when Melissa unwrapped a small triangle
of tinfoil, emptied the white, powdered contents into a glass of juice and
drank it down in one long gulp. Her earlier, tense posture has given way to
a more relaxed position on the doctor's leather couch. The pillow she had
been clutching nervously in her lap is now resting under her right leg, and
her head rests gently on the back of the sofa. Melissa is both alert, and
noticeably relaxed, as she talks openly about abuse that occurred early in
her childhood. Dr. Jane listens intently, only occasionally asking
questions that probe lightly into progressively deeper layers of her memories.

Now two hours into her session, tears fall from Melissa's face and into a
white Kleenex she holds in her hand as she recounts one particularly strong
memory. Using a succession of questions, Dr. Jane assists Melissa in
understanding how her earlier trauma caused her to project certain beliefs
into her present relationships--beliefs that are creating some problems.

Towards the end of her session Melissa says: "Reliving this incident helped
me free up my emotions in a number of ways. =85 I know that I have a lot
more to do, but I know now that I molded my views about the world--that I
now know are not true--because that one incident caused me to distrust my
parents."

Melissa, who works as a computer programmer, seems visibly relieved, and
hopeful. Weeks after the sessions, she sent a promised e-mail describing
the sum of her three MDMA-assisted therapy sessions: "I was able to dump my
file =85 the medicine cleared my channels =85 insights and memories poured
through me =85 fragments and pieces of the puzzle all came together. I had
a cloud of trauma that had seemed in front of me =85 that for almost my
whole life had been distorting my beliefs about myself =85 it seems behind
me now, and I've gotten a new sense of who I am."

Don't rush out to your local psychotherapist for sessions on the couch with
this "love drug" just yet, though.

First of all, these renegade therapists will allow only certain patients to
use the drug, and only after a careful screening and analysis process of
several therapy sessions in advance of taking the drug. The drug's
therapeutic effects have been found especially beneficial to those
suffering from post-traumatic stress disorder (PTSD).

Second, don't go thinking that your time on the couch will amount to some
sort of drug-crazed party of one. Most patients take MDMA during therapy
twice at least, maybe three times at most. Perhaps most discouraging of all
is the fact that you will have to score the drug yourself. Patients who
desire this type of therapy assume all the responsibility in obtaining,
possessing and ingesting the drug. Finding authentic MDMA, free of
adulterants and of known strength, takes some work, but is not difficult.
Dr. Jane cautions any prospective MDMA patient against running down to the
local warehouse or club to buy a hit from a raver sporting an X on his
shirt. You're more likely to end up with a fake drug or sometimes-harmful
counterfeit. Some have had luck procuring legitimate samples from
undergraduate chemistry students who've figured out that MDMA is not all
that difficult to synthesize.

Once the patient procures the drug, Dr. Jane provides guidance on
determining potency of the MDMA, and assists with dosing. Preparation
sessions are crucial. Not only are patients given information on the risks
and benefits of therapy using the drug, they also establish goals for the
session, discuss expectations, and how information yielded during the MDMA
session will be integrated in the patient's life. Dr. Jane follows a safety
protocol that involves having a trusted friend or relative assume charge
for the patient after the session, among other things.

In short, MDMA-assisted psychotherapy is serious business, not a dance
party for which it's commonly used. Those who take the drug recreationally
to enhance the repetitive beat of dance music and feel closer to other
people at a party will gain a few pleasant hours with little or no insight
into themselves. An MDMA session in the confines of an office and under the
guidance of an experienced professional is something else entirely.

Before the drug was criminalized in 1985, Rick Doblin, an expert on the
therapeutic and medical uses of marijuana and psychedelics who earned his
doctorate from Harvard University's Kennedy School of Government, was
witness to MDMA's effects on patients during psychotherapy. "I saw first
hand just how helpful it was for certain patients," he said during a
telephone interview from his Boston home.

But as the drug gained more and more publicity for its pleasurable
qualities at dance and club parties, as opposed to its less sensational
benefits during psychotherapy, the DEA moved to ban the drug under Schedule
I classification. Therapists protested, suing the government in court. An
administrative law judge agreed that the drug shouldn't be classified as
such but could only make a recommendation to the DEA. The agency said, in
effect, "Thanks, but no thanks." As if to buttress the DEA's position, the
scientific community released study after study questioning the drug's
safety and long-term effects. The most damning studies by Johns Hopkins
University researcher Dr. George A. Ricaurte concluded that MDMA use lead
to permanent brain damage in primates and damaged the brain's dopamine
neurons. Upping the fear factor, the doctor also concluded that use of the
drug could lead to Parkinson's disease in humans. But in a stunning
reversal, Ricaurte himself put those findings to rest September 2003 when
he admitted in Science magazine that his researchers had not given primates
used in his studies MDMA, but another drug entirely. However, even some of
Ricaurte's detractors say his earlier studies demonstrating the drug's
neurotoxic qualities may have merit. Debate about the drug's long-term
effects continues, but many hope that with Ricaurte's primate study now
invalidated, a new era of study surrounding the drug's benefits will soon
dawn. About time, too, they say.

Doblin founded the Multi-Disciplinary Association for Psychedelic Studies
(MAPS) in 1986 with just that goal in mind. Based in Sarasota, Fla., his
organization works to advance the study of MDMA's therapeutic value through
legitimate scientific studies. The United States isn't the only nation with
resistance to studying the drug's therapeutic uses. Spain hosted the first
scientific study of MDMA in the world, testing its therapeutic value on
women survivors of sexual assault. The study seemed to be advancing quite
well according to media reports. Then the International Narcotic Control
Board shut it down.

Although there is considerable anecdotal evidence about the benefits of
MDMA-assisted therapy, scientific confirmation of its effectiveness is
admittedly minimal. The most notable of the few studies originate from a
group of Swiss psychiatrists who used MDMA in conjunction with
psychotherapy from 1988 to 1993. During this six-year period, 121 patients
underwent a total of 818 sessions. More than 90 percent of the patients
described themselves as "significantly improved." During the course of the
study, there were no adverse incidents, no suicides, no psychiatric
hospitalizations and no negative reactions.

Doblin's MAPS is working hard to change the drug's research landscape. It
launched a "$5 million, five-year Clinical Plan" to one day see MDMA made
into a prescription drug for the treatment of post-traumatic stress
disorder. The organization is also trying to secure funding for research at
Harvard University, where the drug might be tested on advanced cancer
patients to help mitigate their fear of death and other anxieties, Doblin
said. But the truly big news among MDMA's proponents was the FDA's November
2001 green light for a study of the drug's effects on people with PTSD.
Early this year, in February, the proposed study also earned necessary
regulatory approval from the DEA. Together, both approvals mark the first
time since the drug was criminalized that it will officially be studied for
therapeutic value.

For Doblin, this kind of approval for scientific study of MDMA makes the
perfect bookmark to 1963, when Timothy Leary got the boot from Harvard
University for his studies regarding LSD.

"The Israelites, so to speak, have been wandering in the desert for 40
years. Researchers have been locked out of the lab, wandering the
wilderness for that long. It's really the first time in decades that we've
had any research on these substances at all," he said. "The quest for
verification and scientific research is totally appropriate. What's
fundamentally problematic is that it's taken us so long to even get to that
point. It's especially difficult to gain traditional funding sources for
this kind of research, too. The drug is just too controversial for them to
even touch it."

All this is extremely important news for therapists like Dr. Jane, too. A
practicing psychotherapist in Salt Lake City for years, one of the degrees
on her wall boasts the blue and white accents of a relatively conservative
Utah school. Displayed on the wall just below that degree is a license
issued by the Utah Department of Occupational Licensing to practice as a
clinical psychologist. She's gravely aware that her license and livelihood
could be in jeopardy each time a patient of hers takes MDMA under her
supervision. One patient with one bad reaction is about all that separates
her from a bee's nest of legal problems, investigators, and a trip (no pun
intended) in front of the licensing board.

Nevertheless, she is resolute. "I would rather tender my license and make
widgets than turn a blind, fearful eye away from an avenue of treatment
that may help someone," she said. "MDMA has a fantastic ability to scan
through the unconscious, lock onto areas of emotional tension, and then
allow the patient to talk about themselves in spite of any defensive walls
they've created."

Like her patient Melissa, the Utah doctor has her own description of
MDMA-assisted therapy: "Feelings of self-love and self-acceptance suffuse
the session and, frequently, they can endure long after the drug has left
the body," she said.

And any good psychotherapist knows that any long-lasting behavioral change
has its roots in feelings of genuine self-love.

People ask me all the time if I can refer them to therapists [using MDMA],
and I cannot. I know it's going on, but I don't know exactly who's doing
it. I know they're out there."

Those are the words of Julie Holland, M.D. A New York University psychiatry
professor and psychiatrist in practice at Greenwich Village, she's widely
considered the most celebrated authority regarding MDMA's therapeutic
value. And with Ricaurte's studies discredited, her comments are no longer
seen as those of the naive proponent. Just ask Newsweek, and other
publications in which her words have gotten a forum. Taking a break from
vacation in Massachusetts to speak by phone, her voice is measured and
assured, even if occasionally surprised.

"You found some underground therapists? That's great, and it's not easy to
do," she said.

Anyone who's ever heard of Prozac or lithium knows that the marriage of
drugs and therapy is nothing new. That's one of the reasons Holland has no
qualms about entertaining the use of MDMA with patients on the couch. She
seems shocked that anyone would consider its use such a radical departure.
In addition to authoring an exhaustive research paper on the drug, she
edited articles by 21 of the world's most noted MDMA experts, compiled in
2001 under the title Ecstasy: The Complete Guide.

One of Holland's favorite quotes from an article included in her book comes
from George Greer, a therapist who prescribed the drug for patients while
it was legal, only to find himself forced to stop using it. "I felt like an
artist who'd just discovered oil paints, but had to put them away and start
using charcoal again because people were sniffing the oil paint," Greer wrote.

Holland sympathizes with any physician forced to put effective medicine
aside. And she believes MDMA can be especially beneficial, not just for
people with PTSD, but also with adults who were physically or sexually
abused as children. "Psychiatry doesn't really have many good tools in its
armament when you get right down to it. This is a really good tool," she
said. "And it's very possible that if the government said this was a good
drug for therapy, fewer people would be enticed by its illegal status."

The irony of recent FDA and DEA decisions to approve preliminary studies of
the drug, however, is that now government seems to have taken the lead
where universities and private companies haven't taken the trouble.
Universities, of course, are cautious to do anything that smacks of
illegality. But the reason why corporations never took MDMA's case before
the FDA or DEA is clear, Holland believes.

"No pharmaceutical company has gotten behind this because [MDMA's] patent
is expired, and it's a drug that the average patient will take once or
twice during therapy, and that's it. There's no profit margin in it," she said.

But that doesn't mean there's no connection between current favorites such
as Prozac and MDMA. Both drugs work to release serotonin, which brings on a
general sense of openness, energy and well being. But where Prozac merely
stops the recycling of serotonin, so that it backs up in the brain to make
more available for the synapses, MDMA, on the other hand, floods the brain
with serotonin. In addition, like Prozac, it also stops the recycling, or
uptake, of serotonin as well.

Once again, this isn't the party drug you may have heard of. You're
certainly not dancing to loud music in psychotherapy. No, you're talking
about potentially painful events in your life.

"It's a very subtle experience. For most people it's about as subtle as
having one or two glasses of wine," Holland said. "It's not as big of a
break from normal consciousness as people might think it is. But give it a
name like Ecstasy and people have a lot of assumptions about it.

"It's similar to anesthesia during surgery. It's not that you're pain-free,
but you are very much more relaxed. You have to really peel through layers
of defenses to get to core therapy. People are pretty much laid out, and
you're much more likely to get to the malignant core of what's going on. It
allows you to more readily examine it, and potentially excise it or remove
it. It makes therapy much more efficient and effective. You don't have to
spend three years building an alliance with your therapist. It really
strengthens that alliance, which is really important for future sessions."

And unlike alcohol or other sedatives that would result in blurry
disinhibition, MDMA has the added benefit of letting a patient recall the
experience of what was discussed. That's due to the drug's amphetamine
base, which gives patients greater ability to remember what's happened. And
when an issue is recalled and remembered, there's no need to talk about it
over and over. Taken once or twice during therapy, Holland said, MDMA can
reap multiple benefits in future sessions.

Doblin concurs. "In a way, MDMA is the anti-drug, because Prozac and Zoloft
are drugs people have to take every day, and when people stop taking them
their problems come back," he points out. "MDMA in therapy is taken only a
few times. In the PTSD study, people take it only twice. It was never
intended to be a regular daily drug in a therapeutic setting, and was never
intended to be a take-home drug."

Concern over the drug's current status as an illegal substance is that it
may sit forever in the recreational realm, where it's most often used
incorrectly. Used in the context of a dance party, users frequently
experience dehydration, overheating or elevated blood pressure. Used in
psychotherapy and under professional supervision, those conditions are much
less likely to occur.

"Millions of people around the world are using it recreationally; it gets
more popular every year," Holland said. "But people who could really
benefit from it, can't. It's a real tragedy and a real shame."

Even though "Mike" (not his real name) has been apprised in advance of
steps that will be taken to protect his anonymity, he's understandably
guarded in talking about MDMA and his psychotherapy practice. A clinical
social worker practicing in the Cache County area, he brings hand to chin
when asked about his initial reasons for using MDMA with select patients.

"There was no big `eureka' moment or anything," he said. "To me, the
decision to add it to my psychotherapy practice was just common sense =85
consider a therapist with a strong Jungian orientation. Well, using Jungian
therapeutic techniques doesn't work with every client and so, unless you're
neurotically rigid, you use some cognitive behavioral therapy or some other
modality that is going to make a difference. It was kind of like that. I
never struggled with it as an ethical question. The greater moral wrong
seemed to be in denying relief to a human being seeking it."

He estimates that in the years he's maintained a practice in Utah, he has
treated about 30 people using different psychedelics. He prefers MDMA for
much the same reasons as other therapists do, but has used psilocybin,
ayahuasca, and the research chemicals 2ct2 and 2ct7--all with good results.

Mike believes that MDMA's area of greatest promise is in couples or marital
counseling. "MDMA, with or without couples-counseling, has salvaged a
handful of marital relationships I had considered doomed," he said.

As evidence, he furnished a written account by one of his MDMA patients,
who initially presented relationship problems: "During my session I could
see clearly for the first time in my life =85 many of the patterns or
cycles of conflict I had been having with [my wife] I realized were
responsible for our separation, and that my continued happiness in my
relationship with her depended on me stopping those behaviors completely. I
saw that she was a caring and loving person, and let old anger and grudges
fall away. I made a commitment to myself to give up those behavioral
patterns =85 I would never again focus on our differences or pretend to
ignore them. I learned that they are necessary, and that I would celebrate
them =85 at that moment, and now, even five months later I found it was no
longer necessary for her to change in order for me to be happy in the
relationship."

Mike, for one, is hopeful that the attitudes of the authorities will change
regarding his type of work as a psychotherapist. He's well aware of MAPS'
work in this regard.

Concern by Mike and Dr. Jane for their anonymity is not difficult to
understand. Being present, much less having a participatory role in the use
of MDMA, clearly violates a handful of laws and licensing rules. The Utah
State Department of Occupational and Professional Licensing (DOPL) has not
been ambiguous about therapists practicing in this manner. Providing
MDMA-assisted psychotherapy is one of only a handful of major infractions
that would result in the revocation of a license, as opposed to other
lesser sanctions.

However, it's fair to say that MDMA, like every other medication, is not
completely safe, as well as not completely understood in its mechanism of
action. Chalk that up, again, to its status as an illegal, Schedule I drug.
As a result, there is not an abundance of research directed at answering
questions about the drug's mechanism of action and, unfortunately, most of
the few studies completed to date have focused only on its tendency to
release the brain chemical serotonin. It's hoped that MDMA's unhindered
study will be a significant turning point in assembling a comprehensive
picture of its very unique pharmacological functions. Experts know that
questions about MDMA having a neurotoxic effect, or a depleting effect on
the brain's supply of serotonin, need further study.

But in consideration of the universal side effects described by the
millions of people who've used the drug, MDMA's major risks to any
individual appear to be the very real possibility of being arrested and jailed.

Still, even proponents such as Doblin know the importance of research,
whether that be to prove the drug's effectiveness, or demonstrate its
risks. "That's one of the lessons we learned from the '60s," Doblin said.
"You can't downplay the risks or emphasize the benefits."

Mike and Dr. Jane in no way perceive themselves as divergent warriors on
the frontlines in the effort to legitimize MDMA. However, as the resurgence
of therapeutic research on MDMA begins, it's therapists such as they who
may one day be in a position to teach other mental health professionals the
techniques of harnessing the potential of this new but, really, somewhat
old, treatment tool. If, and when, MAPS provides the FDA with sufficient
evidence of MDMA's usefulness and it's approved as a prescription
medication, adults suffering from emotional problems will have the option
to walk into a local clinic and receive the drug in a setting conducive to
healing.

For his part, Doblin roots for any Wasatch Front psychotherapist brave
enough to blaze such a trail while the drug remains illegal. "I feel a lot
of sympathy and pride that there are two people in Utah who care enough
about their patients that they're willing to risk their freedom and
licenses," he said. "That creates a lot of inspiration and responsibility
in me to work even harder to see this through."