Inside an Innovative Study of MDMA Therapy for Alcohol Use Disorder

April 10, 2019

Dr. Ben Sessa, a UK-based psychiatrist, is currently running Britain’s first ever clinical study with MDMA, in Bristol, for people with alcohol use disorder. So far, seven people have completed the course with no relapse.

Dr. Sessa works with children and adults in his general practice, and specializes in addiction. In the field of psychedelic research, working through Imperial College, London, he has been involved in trials with LSD, psilocybin, DMT, MDMA and ketamine over the last 10 years.

So how might MDMA help people with alcohol use disorder? Many such patients with alcohol use disorder have a history of psychological trauma, notes Sessa. He says between 60 and 70 percent of his patients in addiction services have another psychiatric diagnosis—and adds that psychological trauma, of some kind, is apparent in the history of up to 90 percent of addictions. There is a strong association between alcohol use disorder and PTSD.

MDMA therapy is aimed at reducing the patient’s fear response—allowing them to address and overcome past traumatic memories.

MDMA is known and classified an an “empathogen” or “entactogen”—it increases feelings of empathy and compassion, boosting levels of self-awareness. This explains the sense of “oneness with the universe” that users often report. As MDMA raises levels of serotonin and other neurotransmitters in the brain, it promotes a sense of trust and openness, which some researchers believe make it powerful and very useful in drug psychotherapy.

MDMA therapy is aimed at reducing the patient’s fear response—allowing them to address, reflect upon, challenge and overcome past traumatic memories that they would usually avoid and therefore not be able to tackle with psychotherapy alone.

Dr. Sessa’s therapy, performed at a university-based research facility in Bristol, is an eight-week course of weekly psychotherapy sessions. Most of it is not drug-assisted; MDMA is taken just twice orally, in capsule form, on weeks three and six, interspersed with the weekly talk therapy sessions.

Dr. Ben Sessa [Photo via Dr. Ben Sessa/Twitter]

For each of the two MDMA sessions, the patient initially takes a dose of 125mg, followed two hours later by a booster dose of 62.5mg, equalling 187.5mg total. (For comparison, a typical “ecstasy” pill might contain between 100-150mg of MDMA.) Sessa is planning to recruit a total of 20 people with alcohol use disorder for the current study. Candidates should be willing to travel and commit to the full study period; they’re also required to be English-speaking and literate. The list of exclusions include those who suffer from a personality disorder or cardiac disease.

I asked Dr. Sessa whether there might be a danger in MDMA use for people who already have an addiction; could they in turn develop an addiction to MDMA? He responded that despite MDMA’s widespread use—an estimated 750,000 people use it each weekend in the UK—MDMA addiction is virtually unheard of.  

“Addiction is a complex situation due to long-term trauma and a host of complex psycho-social issues,” he continued. “So simply taking MDMA a couple of times as part of a therapeutic trial will not turn a person into an MDMA ‘addict.’ No evidence for that. After 15 years of clinical MDMA research—and over 1,600 therapeutic sessions with MDMA, not one single patient has gone on to seek illegal MDMA [to my knowledge] because they have become addicted. It simply doesn’t happen.”

“Truth is, the psychedelic drugs are considerably less toxic than pretty much any other drug I use with my patients on a daily basis.”

According to statistics from the UK’s National Health Service, in 2016/7, the year with the most recently available data, there were an estimated 337,000 hospital admissions where the main reason was attributable to alcohol. Yet despite this dire situation and the untapped potential of drugs like MDMA to help people with alcohol problems, the societal consensus is that psychedelics are unsafe. MDMA remains illegal in the vast majority of countries around the world.

Unlike marijuana—which is now legal in Canada and 10 US states for recreational use, and the majority of states (33) for medical use—MDMA is only just beginning to be recognized for its potential therapeutic benefits, with increasing numbers of US trials conducted or planned.  

But aren’t there still grounds for concern over the potential dangers of prescribing a drug that has been so under-studied in the past? Not one to mince his words, Dr. Sessa replied, “Yes, that’s true. I ought not to promote all those toxic drugs such as Quetiapine, Olanzeopine, Seroxat, Ritalin, Lithium, Diazepam, Prozac, Penicillin, Carbamazepine and cancer chemotherapy drugs. They are indeed all very toxic. Truth is, the psychedelic drugs are considerably less toxic than pretty much any other drug I use with my patients on a daily basis. The reason why I am interested in psychedelic medicine is because I don’t like those toxic drugs listed above. Psychedelic therapy offers patients the best opportunity we have to get them off all that stuff and live a drug-free life.”

Sessa also points that clinical MDMA is different from illicit version of the drug—street ecstasy is often cut with other chemicals, which can be harmful.

The use of psychedelics to treat alcohol use disorder is not exactly new. Bill Wilson, the founder of the abstinence-based fellowship Alcoholics Anonymous, famously underwent a few sessions of LSD-assisted psychotherapy in 1956. He said, “It is a generally acknowledged fact in spiritual development that ego reduction makes make the influx of God’s grace possible. So I consider LSD to be of some value to some people, and practically no damage to anyone.”

“It’s like saying: ‘Why do you listen to jazz? Can’t you get everything you need from life without jazz?’ It’s meaningless.”

But most research came to a halt in the 1970s, as the US-led War on Drugs cranked into gear. However, in 2012, six randomized trials from the ‘50s and ‘60s of LSD-assisted therapy for alcohol use disorder were reviewed in a meta-analysis, illustrating commendable results (59 percent of LSD-patients significantly improved), and things have moved forward from there. Until now, however, there have been no published studies proposing MDMA-assisted therapy as treatment for any substance disorder.

Yet much resistance remains. I put it to Dr. Sessa that many people might still question whether LSD or MDMA use—whether under medical supervision or illicit—is really necessary, and ask what people can get from these drugs that they can’t find in everyday life.

“That’s a very patronizing viewpoint,” he replied. “It’s not an either/or situation. People don’t use LSD because they lack something in everyday life—other than LSD! It’s like saying: ‘Why do you listen to jazz? Can’t you get everything you need from life without jazz?’ It’s meaningless. LSD use isn’t an alternative to normal life for people who lack something. LSD users also enjoy a wide variety of other activities; they simply want to add LSD to their rich tapestry of life experiences. And good for them!”

“I think we should be more suspicious of people who don’t want to try LSD,” he continued. “They are the ones who—for no good reason other than the irrational fear that has been drummed into them from immoral drug policy laws—have decided to omit a potentially interesting and profound experience from their lives. A ‘heavy and regular’ LSD user might be just twice a year—or far less. LSD isn’t an alternative to life. It’s an addition.”

In spite of such resistance to seeing illegal drugs in new ways, I asked Dr. Sessa if he thinks the public’s narrative around drugs—particularly psychedelics—has started to change.

“Yes, the narrative is starting to change. After 48 years of the failed War on Drugs, the prisons full, the mafia made rich and usage of and harms of drugs not even dented by years of social oppression, people are indeed beginning to question the clinical and social efficacy and moral authority of failed drug policy.”

Photo by Michael Browning on Unsplash

Kiran Sidhu

Kiran is a tobacco harm reduction fellow for Filter. She is a writer and journalist who has written for publications including the Guardian, the Telegraph, I Paper and the Times, among many others. Her book, I Can Hear the Cuckoo, was published by Gaia in 2023. She lives in Wales. Kiran's fellowship is supported by an independently administered tobacco harm reduction scholarship from Knowledge-Action-Change—an organization that has separately provided restricted grants and donations to Filter.

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