Harry Sumnall

Altered states: the clinical effects of Ecstasy

Ecstasy is the second most widely abused illegal drug in Europe. Ecstasy is the colloquial name for 3,4-methylenedioxymethamphetamine (MDMA), but not all Ecstasy tablets contain MDMA. When taken in hot, crowded environments, Ecstasy/MDMA users have developed acute complications that have had fatal consequences. Epidemiological evidence indicates that adverse reactions to Ecstasy/MDMA intoxication are rare and idiosyncratic. Potential mechanisms of action are reviewed. In animal studies, MDMA damages serotonergic fibres and reduces the number of serotonin transporter sites within the CNS. Demonstration of neurotoxicity in human users of Ecstasy is hampered by a number of confounds that the majority of published studies have failed to address. These confounds are reviewed and their impact is discussed.

The pre-clinical behavioural pharmacology of 3,4-methylenedioxymethamphetamine (MDMA).

3,4-Methylenedioxymethamphetamine (MDMA) is a relatively novel drug of abuse and as such little is currently known of its behavioural pharmacology. This review aims to examine whether MDMA represents a novel class of abused drug. MDMA is known as a selective serotonergic neurotoxin in a variety of animal species but acutely it is a potent releaser and/or reuptake inhibitor of presynaptic serotonin, dopamine, noradrenaline, and acetylcholine. Interaction of these effects contributes to its behavioural pharmacology, in particular its effects on body temperature. Drug discrimination studies indicate that MDMA and related drugs produce unique interoceptive effects which have led to their classification as entactogens. This is supported by results from other behavioural paradigms although there is evidence for dose dependency of MDMA-specific effects. MDMA also produces conditioned place preference but is not a potent reinforcer in self-administration studies. These unique behavioural effects probably underlie its current popularity. MDMA is found in the street drug ecstasy but it may not be appropriate to equate the two as other drugs are routinely found in ecstasy tablets

Multiple behavioural impulsivity tasks predict prospective alcohol involvement in adolescents

Aims We investigated reciprocal prospective relationships between multiple behavioural impulsivity tasks (assessing delay discounting, risk-taking and disinhibition) and alcohol involvement (consumption, drunkenness and problems) among adolescents. We hypothesized that performance on the tasks would predict subsequent alcohol involvement, and that alcohol involvement would lead to increases in behavioural impulsivity over time. Design Cross-lagged prospective design in which impulsivity and alcohol involvement were assessed five times over 2 years (once every 6 months, on average). Setting Classrooms in secondary schools in North West England. Participants Two hundred and eighty-seven adolescents (51.2% male) who were aged 12 or 13 years at study enrolment. Measurements Participants reported their alcohol involvement and completed computerized tasks of disinhibition, delay discounting and risk-taking at each assessment. Cross-sectional and prospective relationships between the variables of interest were investigated using cross-lagged analyses. Findings All behavioural impulsivity tasks predicted a composite index of alcohol involvement 6 months later (all Ps < 0.01), and these prospective relationships were reliable across the majority of time-points. Importantly, we did not observe the converse relationship across time: alcohol involvement did not predict performance on behavioural impulsivity tasks at any subsequent time point. Conclusions Several measures of impulsivity predict escalation in alcohol involvement in young adolescents, but alcohol use does not appear to alter impulsivity.

The varieties of ecstatic experience: an exploration of the subjective experiences of ecstasy

Previous investigations of the subjective effects of MDMA (material sold as ecstasy) have conducted interviews and surveys of various groups of ecstasy users within particular sub-populations. This study examined subjective drug effects reported by different sub-populations of ecstasy users and explored whether the function or purpose served by using ecstasy influenced the nature of the drug experience. Drawing on previous measures of alterations in consciousness, psychedelic drugs and cannabis, and informal interviews with ecstasy users and MDMA researchers, a 130-item survey assessing subjective effects of ecstasy/MDMA was developed. Principal components analysis of responses of ecstasy users revealed six components; perceptual alterations, entactogenic effects, prosocial effects, aesthetic effects, negative effects and sexual effects. The derived scale was used to predict ecstasy use behaviours, and functions and experiences of use. A variety of component scores were related to ecstasy use parameters; in particular, heavier users expected fewer negative, perceptual and aesthetic effects from taking the drug. The reasons given for using ecstasy (use function) also influenced reported drug effects. Abstainers expected greater negative, perceptual, aesthetic and sexual effects than users. These data indicate that the subjective ecstasy experience is influenced by a variety of extra-psychopharmacological factors. Drug intervention strategies may be made more effective by targeting particular user groups defined by reasons given for substance use, as it is likely that their experiences of ecstasy effects will differ. Future research into ecstasy may be improved by recognizing user diversity.

Self-reported depressive symptomatology in community samples of polysubstance misusers who report Ecstasy use: a meta-analysis

National drugs information strategies convey the message that use of Ecstasy is associated with an increase in both the incidence and severity of major depressive disorder. However, very little primary research supports this. Unlike apparent deficits in higher cognitive functions, most published studies have found no difference in self-reported depressive symptomatology between Ecstasy users and controls. To investigate this further, we conducted a meta-analysis of studies investigating depressive symptomatology in recreational users of Ecstasy. According to selection criteria, we identified 25 relevant studies. A statistically significant effect size (ES) of 0.31 (95% confidence interval 0.17-0.37, p< 0.001) was calculated. Significance remained after examining the small number of studies that controlled for cannabis use (n = 9, p< 0.001) but, in general, drug histories were poorly reported. There was an association between ES and lifetime Ecstasy exposure (p< 0.001), but not for other use parameters or abstention (p> 0.05). These data indicate that there is an association between Ecstasy use and depressive symptomatology, but this is small and unlikely to be clinically relevant. In addition, the self-report scales used may be heavily confounded by the somatic effects of substance misuse. Public health strategies derived from psychopharmacological investigations should acknowledge the potential negative effects of substance misuse but qualify the difficulties in interpreting research studies.

Self-reported psychopathology in polydrug users

There is a large body of work investigating concurrent associations between polysubstance use and psychopathology, but much of this work has either pre-dated or failed to account for the complex and culturally specific patterns of contemporary drug use. In particular, attendees of dance music events report a greater drug history than their peers and engage in a unique lifestyle. To further investigate the consequences of this type of drug use, 100 subjects who regularly attended dance music events were administered a battery of self-report psychiatric symptom scales. This battery contained the Anxiety Sensitivity Index, the Beck Anxiety Inventory (BAI), the Center for Epidemiologic Studies Depression scale (CES-D), the Dissociative Experiences Scale, the Padua Inventory Revised and additional questions about substance use. Our study population included abstainers and drug users with a wide history of use. We demonstrated strong associations between use of many different drugs, suggesting that polydrug use is the norm in this type of population. We found weak, but statistically significant, correlations between use of alcohol (p < 0.05), amphetamine (p < 0.01) and ecstasy (p < 0.01) with self-reported score on the BAI. There were also positive associations between dissociative symptomatology and the use of amphetamine (p < 0.05) and cocaine (p < 0.05). Furthermore, weekly unit intake of alcohol positively correlated with score on the CES-D (p < 0.05). As polydrug use was the norm in this sample, we performed regression analysis to investigate the contribution of multiple drug use on self-report. This showed that weekly use of alcohol, and frequency of use of amyl nitrate and cigarettes were significant predictors of BAI score. However, the majority of subjects reported being unworried by these symptoms, which may represent a lack of self-awareness, or acceptance of them as the subacute effects of substance use. It remains to be determined at what point adverse effects of drug use begin to interfere with day-to-day life.

The confusing case of NRG-1

Since the recent ban on mephedrone,1 2several alternative products have been introduced on internet websites. One of the most prominently discussed second generation products is Energy 1 (NRG-1), also advertised as naphyrone (naphthylpyrovalerone, O-2482), which originated from a group of compounds previously described in the medicinal chemistry …

The effects of stereotype threat on cognitive function in ecstasy users.

Stereotype threat occurs when individuals, believed to be intellectually inferior, perform badly on cognitive tests they perceive to confirm stereotypes about them. Due to the wide media coverage of studies purporting to show cognitive deficits in ecstasy users it is possible that they experience stereotype threat. This study tested ecstasy and nonecstasy using polysubstance misusers on a variety of cognitive tests after they had been exposed to stereotype threat. This priming consisted of exposing them to information about the long-term effects of ecstasy which either stated that ecstasy caused memory loss or that it did not. Ecstasy users that had been primed that ecstasy did not cause cognitive deficits performed better than the other three groups on the delayed portion of the prose recall task from the Rivermead Behavioural Memory Test battery. There were no other statistically significant differences between any of the groups on any of the other cognitive tests used. This suggests that stereotype threat exists in ecstasy users and may be influencing their performance in experiments designed to identify cognitive deficits. In order to prevent this occurring in future studies, experimenters must be careful how they conduct their experiments and discuss their results with the media.

A systematic review of parent and family-based intervention effectiveness on sexual outcomes in young people

Limited evidence exists about the effectiveness of parent/family-based interventions for preventing poor sexual health outcomes, thus a systematic review was conducted as part of a wider review of community-based sex and relationships and alcohol education. Method guidance from the UKs National Institute for Health and Clinical Excellence was adhered to. Overall, 18 databases were searched. In total, 12 108 references were identified, of which 440 were retrieved and screened. Overall, 17 studies met the inclusion criteria. Findings showed that parent-based interventions were inconsistently effective at reducing young peoples sexual risk behaviours. Parent-based interventions had greater impact on parent/child communication than family-based interventions, which showed no evidence of effectiveness. However, increasing parent/child communication showed no effect on sexual risk behaviours. Preliminary evidence suggests that effectiveness was greater in those studies aiming to affect multiple risk behaviours. However, this may be due to longer programme delivery and follow-up times; further evidence is required. Sexual health communication was sensitive to intervention. Studies addressing multiple risk behaviours may be as effective as targeted interventions at affecting sexual risk behaviours. Longitudinal controlled studies, examining broader sexual activity outcomes, are needed in countries such as the United Kingdom to inform the evidence base, which is primarily US based, and contribute to related policies and practices.

Self-esteem and self-efficacy: Associations with alcohol consumption in a sample of adolescents in Northern Ireland

Cross-sectional and longitudinal studies have reported equivocal findings regarding the association between self-esteem, self-efficacy and adolescent alcohol use. Data were collected from a sample of 11–16-year olds in Northern Ireland (n = 4088) over two consecutive academic years measuring global self-esteem, academic, social and emotional self-efficacy and alcohol involvement. Results showed a domain-specific association between alcohol involvement and self-efficacy, with more problematic alcohol use associated with higher social self-efficacy but lower emotional and academic self-efficacy. Additionally, regression analyses revealed that all self-concept measures significantly predicted drinking group membership. The results are discussed in terms of reported drinking behaviour, interventions with adolescent groups and general development.