MDMA-assisted therapy for autistic people

Siobhan: I don’t think MDMA changes your nature at all.
I think it just brings it out to the forefront.^[1]Findings from a Collective Case Study of the MDMA/Ecstasy Experiences of Adults on the Autism Spectrum: Transcript from Psychedelic Science 2013 | MAPS Bulletin Annual Report

As early as 1985 or possibly even earlier, MDMA—or 3,4-Methyl​enedioxy​methamphetamine if you don’t care for abbreviations—was identified as a potential application for treatment of negative symptoms reported by autistic people, and further investigation was recommended.^[2]The Scheduling of MDMA: A Pharmacist’s Perspective (Riedlinger, 2012)

Since then, MDMA has been made illegal, which undermined its use in clinical settings, and so not a lot of research has been done on the subject until more recent years.

However, there is a paper entitled MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults. Might that be something to look into?

Social motivation

Let’s have a look at something else first. If you are only interested in reading about the study I just mentioned—as well as first-person reports from autistic adults—scroll down to the section entitled ‘Autism therapy’.

In an earlier post I wrote about social life and social motivation in autistic people, I described that by administering oxytocin—a hormone that plays a role in social bonding—social behavior can be promoted.^[3]Promoting social behavior with oxytocin in high-functioning autism spectrum disorders (Andari et al., 2010)

Under oxytocin, people with ASD respond more strongly to others and exhibit more appropriate social behavior and affect, suggesting a therapeutic potential of oxytocin through its action
on a core dimension of autism.

Prosocial effects

So oxytocin can help in the social domain of autism deficits. Guess what helps release some of that oxytocinnamon-goodness? That’s right—MDMA.

The prosocial effects of MDMA may result from the release of the “social hormone” oxytocin and associated alterations in the processing of socioemotional stimuli.^[4]MDMA enhances “mind reading” of positive emotions and impairs “mind reading” of negative emotions (Hysek, Domes & Liechti, 2012)

The research from which I just quoted concludes:^[5]MDMA enhances “mind reading” of positive emotions and impairs “mind reading” of negative emotions (Hysek, Domes & Liechti, 2012)

The shift in the ability to correctly read socioemotional information toward stimuli associated with positive emotional valence, together with the prosocial feelings elicited by MDMA, may enhance social approach behavior and sociability when MDMA is used recreationally and facilitate therapeutic relationships in MDMA-assisted psychotherapeutic settings.

In other words, MDMA causes one to more accurately deduce social and emotional information and its mental states, which can be of great benefit to autistic people. Additionally, people become more relatable, more approachable, and social motivation is increased.

Benefits of MDMA

A study from 2012—the same from which I just quoted—also indicated that MDMA:^[6]MDMA enhances “mind reading” of positive emotions and impairs “mind reading” of negative emotions (Hysek, Domes & Liechti, 2012)

• Enhanced the accuracy of mental state decoding for positive stimuli (e.g., friendly) — i.e. friendly expressions and positive motivations are perceived more accurately.
• Impaired mind reading for negative stimuli (e.g., hostile) — i.e. negative expressions and accompanying mental states are overlooked more.
• Has no effect on mind-reading for neutral stimuli (e.g., reflective).
• Did not affect psychomotor performance.
• Increased circulating oxytocin and cortisol levels.
• Produced subjective prosocial effects, including feelings of being more open, talkative, and closer to others.

MDMA also facilitates states of positive mood, and alleviates anxiety.^[7]Human pharmacology of 3,4-methylenedioxymethamphetamine (“ecstasy”): psychomotor performance and subjective effects (Cami et al., 2000)^[8]Subjective and hormonal effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans (Harris et al., 2002)^[9]The subjective effects of MDMA and mCPP in moderate MDMA users (Tancer & Johanson, 2001)

Furthermore, MDMA has been shown to enhance emotional empathy,^[10]MDMA enhances emotional empathy and prosocial behavior (Hysek et al., 2013) and although research shows the emotional empathy of autistic people is intact or even elevated,^[11]The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development (Smith, 2017) they may still benefit from temporary emotional empathy enhancement to combat selective/fluctuating empathy as a result of issues with cognitive empathy (largely stemming from alexithymia).

Researchers and investigators have also noted MDMA’s capacity to help people talk openly and honestly about themselves and their relationships, without the use of defensive mechanisms.^[12]Subjective Reports of the Effects of MDMA in a Clinical Setting (Greer & Tolbert, 2012)^[13]Findings from a Collective Case Study of the MDMA/Ecstasy Experiences of Adults on the Autism Spectrum: Transcript from Psychedelic Science 2013 | MAPS Bulletin Annual Report

MDMA catalyzes shifts toward openness and introspection that do not require ongoing administration to achieve lasting benefits.^[14]MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults (Danforth et al., 2016) Professor of psychiatry Franz X. Vollenweider et al. reported that MDMA produced acute:^[15]Psychological and Cardiovascular Effects and Short-Term Sequelae of MDMA (“Ecstasy”) in MDMA-Naı̈ve Healthy Volunteers (Vollenweider et al., 1998)

Increased responsiveness to emotions, a heightened
openness, and a sense of closeness to other people.

When combined with psychotherapy that supports one or more of these effects, the use of MDMA can help people to confront and consider emotionally intense memories, thoughts, or feelings. Also, through changes in mood and perception, it can elicit empathy and compassion for others and one’s self.^[16]MDMA-assisted psychotherapy using low doses in a small sample of women with chronic posttraumatic stress disorder (Bouso et al., 2008)^[17]Subjective Reports of the Effects of MDMA in a Clinical Setting (Greer & Tolbert, 1986)^[18]The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study (Mithoefer et al., 2011) Note that I am not suggesting that autistic people lack empathy. Rather, MDMA generally elicits feelings of strong interconnectedness and unity, whether you are autistic or not. In my experience, this has been conducive to temporarily alleviating alexithymia, and making me feel connected with others in a way I do not ordinarily experience—whether due to my autism or my trauma history.

The use of MDMA has also proven to be helpful for PTSD,^[19]MDMA-assisted psychotherapy using low doses in a small sample of women with chronic posttraumatic stress disorder (Bouso et al., 2008)^[20]The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study (Mithoefer et al., 2011) which a lot of autistic people have.^[21]A New Perspective in Post-Traumatic Stress Disorder: Which Role for Unrecognized Autism Spectrum? (Dell’Osso, Luche & Carmassi, 2015)^[22]Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders (Hofvander, 2009)^[23]The Phenomenology and Clinical Correlates of Suicidal Thoughts and Behaviors in Youth with Autism Spectrum Disorders (Storch et al., 2013)

Safety parameters

As of 2016, MDMA has been administered to over 1,133 individuals for research purposes, without the occurrence of unexpected drug-related serious adverse events (SAEs).^[24]MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults (Danforth et al., 2016)

Based on this research, safety parameters for the limited use of MDMA in clinical settings have been established, and a case can be made to further develop MDMA-assisted therapy that can promote social adaptability in autistic adults.

MDMA can thus function as a supporting element in establishing the necessary social framework to function among the typically developing (i.e. neurotypical) population.

Autism therapy

Autistic adults often require treatment of conditions such as anxiety, trauma, depression, and social adaptability challenges.

However, responses to conventional prescription medications evaluated in neurotypicals are often ineffective in autistic individuals,^[25]Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism (King et al., 2009) and there are often difficulties establishing therapeutic rapport between clinicians and clients which can interfere with conventional, psychodynamic psychotherapy.^[26]Psychotherapy for Individuals with Autism Spectrum Disorders (Koenig & Levine, 2010)^[27]“Better strangers”: Using the relationship in psychotherapy for adult patients with Asperger Syndrome (Ramsay & Brodkin et al., 2005)

As such, there is an ongoing search for new supportive treatments for anxiety, depression, trauma, and other psychological distress in autistic adults. One treatment is the use of Ketamine, which I wrote about in the article below; and another treatment utilizes MDMA.

Ketamine treatment for autism

A study from 2014 (published in 2016) looked into MDMA-assisted therapy as a potential treatment, and found that:^[28]MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults (Danforth et al., 2016)

• Pure MDMA used in approved clinical settings is far safer than recreational use of Ecstasy or Molly.
• MDMA-assisted therapy could reduce social anxiety symptoms and increase social adaptability.
• The need to develop effective treatments for social anxiety in autistic adults is presently unmet.
• MDMA does not require ongoing administration to achieve lasting benefits.

Part of that research was also the analysis of first-person reports of MDMA/Ecstasy use by autistic adults. Below is a selection of quotes from those reports.^[29]Findings from a Collective Case Study of the MDMA/Ecstasy Experiences of Adults on the Autism Spectrum: Transcript from Psychedelic Science 2013 | MAPS Bulletin Annual Report

Haus (21):

I guess it broke down barriers, is how I would describe it. Yeah, it felt like up until that point, I just sort of always lived in a shell, like in a bubble. The way I isolated from people, and, yeah, I just sort of tore that down, I said, “There’s no need for there to be a barrier.”

George (24):

I wanted to talk to people, but not in the way I usually do, i.e., lecture them. I listened to other people and cared deeply about what they were saying. I was actually enjoying making eye contact.

Suddenly, there was no discomfort at all. Not only no discomfort, but suddenly, it was like I could see the person behind the eyes, and I wanted to sort of know who it was.

And I was sort of just looking in there to look for a slight reaction, slight sort of changes just to see how he was reacting to me.

Begrimed (25):

MDMA didn’t make me unafraid of it, unafraid of conversation. It made me want to actually converse and make friends and Winter 2013 33 all that. It was…it was something else.

Sylvan (24):

There were actually certain friends I had made months previous to that that I really wanted to get to know better, but due to my social anxiety, I was really just, well I was intimidated by them. I really looked up to them and thought they would never really want to be my friends, so I kind of stopped talking to them out of shyness.

But for a while I really wanted to make a connection with them. It felt really important.

So the day after that experience, I was still feeling so open and so changed that I made an effort just to get past my shyness, and make a call to them and I actually ended up seeing them that day and it was really kind of great.

It was a great connection, and I told them about my experience, and since then we’ve been pretty much best friends. And we do all of these things together, and it’s been one of the best places I’ve ever been in my life, to reconnect, and I really feel that that was because I was so changed by that experience.

Fuzzy (23):

I felt more emotionally connected to my friend, and I could understand his situation better.

Jules (32):

I found people much more interesting to be around. I wanted to connect with people. I want to be around people, I want to hang out and commune with like, some aspect of community.

Fuzzy (23):

I have a tendency to just get stuck in thought loops about things, usually things that I don’t want to be thinking about, and this kind of seemed to just not make that happen while I was on it. It didn’t seem to happen at all.

Sylvan (24):

I’ve credited that one experience to nearly wiping out my social anxiety, which at that point had been strong.

From the participants of the study from which the quotes above are taken, 58% reported experiencing what they described as an epiphany: significant new insights, or revelation.^[30]Findings from a Collective Case Study of the MDMA/Ecstasy Experiences of Adults on the Autism Spectrum: Transcript from Psychedelic Science 2013 | MAPS Bulletin Annual Report

Morton (49):

It gave me a complete clarity about things that I didn’t have prior to that. And the reason that I didn’t have clarity prior to that was because I was always worried and anxious.

Begrimed (25):

For the first time, it was very, [sigh], like, like I finally got it. Like, you know how, I guess, autistic people, they don’t really know those unwritten social rules and all that? You know, the nuances in conversation and stu! like that? Like, I got it. Like, it was just like, bing!

My experience

I used to take MDMA a couple of times per year, and although I would not recommend frequent use due to its negative and cumulative effects when ingesting it for a prolonged time (most of which are reversible though), I think there is tremendous therapeutic value to MDMA.

Due to my autism and alexithymia, I was not very in tune with my emotions when I was younger, and my fluctuating empathy confused me. Additionally, I was depressed and anxious.

For those reasons, I found it to be conducive to my well-being to use MDMA a couple of times per year in a safe environment. MDMA allowed me:

• To be in tune with my friends; I would resonate with them and understand them a lot better, and in turn, I felt more understood myself.*
• To feel empathy clearly, whereas it’s selective, contextual, fluctuating, noisy, and confusing generally.†
• To be open with others to a degree I was uncomfortable with before, which can be conducive to relationships with friends.‡
• To speak about my problems, and feel like I am making progress by doing so.
• To blow off steam. All the negative emotions I would build up for months and fail to express/process would finally be processed, or would otherwise disappear.
• To get a break from my fairly constant anxiety.

Frankly, the use of MDMA allowed me to endure the challenges of life, and feel a lot more positive about myself and my life for weeks to months.

• This is potentially an effect of MDMA, rather than that you are actually understood, however. MDMA increases our understanding of and empathy for others, but I reckon there are limits to our understanding and empathy.
• My empathy is no longer confusing to me now, but it took me years to figure it out. The use of MDMA played a significant role in the process of understanding my empathy and how I relate to others, and deepened my understanding of myself in general.
• Though it can potentially make you more vulnerable as well; be sure that you are sharing information with a person you can trust, and that you don’t give information they can’t do anything with and which can potentially negatively impact the relationship.

Setting

It does matter where you use MDMA, and who you use it with, however, as some settings are more conducive to therapy than others. Below I have listed some settings in order of efficacy (from least to most):

• Party/club — If you use it at a party or club, you will have a good time, but the therapeutic value will be rather low, as the environment is stimulating to a degree that you are likely to partake in prosocial behavior, but are less likely to partake in self-reflection.
• Home alone — If you use it alone at home, you will have a good time, but the therapeutic value will depend entirely on your level of self-reflection. Without talking to anyone, you may be more likely to just enjoy listening to music. It will alleviate negative feelings, but the long-term therapeutic benefits may be limited.
• Online — If you are home alone but online, the therapeutic value of MDMA will largely depend on your willingness to chat with someone you trust online. To what degree you will enjoy long-term therapeutic benefits will depend largely on the conversations you have with your friend.
• With a friend — What worked best for me is to be at home with a friend, or at a friend’s place. It’s conducive for both parties involved to take MDMA, and I recommend no more than one friend. Two friends may increase the joy, but will undermine therapeutic potential. The more people are involved, the less likely you are to engage in therapeutic discussion.
• Clinical setting — I have no experience with this, but I can imagine that potentially you will get the most out of taking MDMA in a clinical setting, with a trained professional who can guide you through the process, and ensure that you are doing therapy the right way.*

• On the other hand, for some it may be more beneficial to take MDMA at home with a trusted friend, or perhaps even an open-minded parent. As weird as it sounds, the use of MDMA can even be beneficial to a child–parent relationship, although in principle the presence of a professional is recommended to set boundaries so that the relationship won’t get distorted.

Disclaimer

Do note that the use of MDMA temporarily depletes serotonin levels, which is a monoamine neurotransmitter that contributes to feelings of well-being and happiness. In other words, the day after use of MDMA you may feel down/depressed, usually in correlation with the amount of MDMA you used. This is often referred to as “Blue Mondays”, because it tends to happen after a weekend of partying and drug use. You can combat these effects by taking 5-HTP.

The prolonged use of MDMA can have long-lasting negative effects as well, however, like lasting serotonin level depletion,^[31]Ecstasy Use Depletes Brain’s Serotonin Levels (2000) | ScienceDaily and effects on the serotonin system may underpin the many neurocognitive deficits observed in ecstasy users.^[32]Meta-analysis of molecular imaging of serotonin transporters in ecstasy/polydrug users (Roberts, Jones & Montgomery, 2016)

So don’t engage in the frequent use of MDMA, don’t abuse MDMA, and I don’t recommend acquiring MDMA through illegal means—not just because it could get you into legal trouble, but also because MDMA from the streets is likely not pure, and without doing a lab test, it would be irresponsible to take a drug you don’t know the contents of. But when used in a controlled way, MDMA could have therapeutic value.

Conclusion

Despite its potential benefits for some people, MDMA—like any other drug—can have adverse effects, may be harmful after prolonged use, and it can be addictive.

But in periods of my life where I struggled particularly with my autism, my sense of self, my identity, and my feelings and emotions in general, the use of MDMA a couple of times per year has been highly conducive to me. I don’t know if it will do the same for you; but if you think it could help you, perhaps look into MDMA-assisted therapy by a medical professional.