Can Ecstasy, Primarily Known as a Club Drug, Help People Suffering From Trauma?
Israeli drug trials are investigating whether MDMA can be a useful psychiatric tool in treating post-traumatic stress disorder
PTSD began being recognized as a serious mental condition in Israel after the 1982 Lebanon War, two years after it was first identified in the Diagnostic and Statistic Manual of Mental Disorders. Naftali Halberstadt, a cognitive psychologist who serves as one of five therapists in the current MDMA study, became active around that time in a fast-growing community of trauma-treatment professionals in Israel, and he eventually became the director of trauma programs for the American Jewish Joint Distribution Committee.
Trauma, he explains, is basically a problem of processing a negative event into a regular bad memory. “If you have a bad memory, it sits in your brain and it can even be painful, but it’s not like it’s happening right now,” he said. “The traumatic memory stays very much in the here and now. The part of the brain that’s trying to care of you, the limbic system, is saying, ‘You’re in danger,’ because the trauma material is still sitting there. It hasn’t been transferred into the place where permanent memories are supposed to reside.”
The most successful treatment for the condition is exposure therapy, which systematically and gradually exposes sufferers to their traumatic memory and guides them through processing and making a complete narrative out of it, which takes the limbic system off high alert and turns it into something that be accepted as in the past. For many people this works. For a certain percentage, it doesn’t. MDMA is thought to essentially facilitate the same sequence by allowing a person who is resistant to traditional exposure therapy to safely access their traumatic event. By flooding the brain with serotonin, the chemical associated with pleasure and trust, and relaxing the amygdala, the part of the limbic system that regulates fear—the same neurological process that makes Ecstasy feel so amazing on the dance floor—the PTSD sufferer is more easily able to confront and process trauma.
Not everyone in the psychiatric community is comfortable with the idea of Ecstasy in their therapeutic toolkit. It is, after all, an illegal drug with real risks, as underscored by a spate of recent deaths attributed to MDMA overdoses in the electronic dance music scene. But Halberstadt, like other therapists, sees it through the dispassionate eyes of a clinician as well as the compassionate eyes of a healer. Having worked with trauma in Israel for two decades, he is hopeful that the study will amass enough data to someday support offering MDMA-assisted therapy as a viable treatment option for those in need, untainted by its dance-drug reputation.
In 1999, MAPS hosted a seminal international conference near the Dead Sea on MDMA psychotherapy, and in subsequent years, Doblin and his partners in Israel’s mental-health community pushed the ball steadily forward to win approval from the country’s Ministry of Health and its Anti-Drug Authority for a study there of MDMA-assisted therapy for PTSD. (A similar study that MAPS simultaneously tried to help establish at the largest mental hospital in Amman, at the behest of the Jordanian military’s former chief psychiatrist, was officially declined, although Doblin still speaks of a quixotic hope for “joint Israeli-Arab cooperation on healing” through MDMA.)
To Doblin, the receptivity to the study in Israel speaks to politics as much as to deep-seated patterns in the collective national psyche. “There are very few places in the world that have more PTSD than Israel,” he said. “There’s the awareness that missiles can reach everywhere now and the entire country is vulnerable. There’s the leftover trauma from all the wars. There’s multigenerational PTSD from the Holocaust and before. I think it’s the prevalence of trauma, combined with the focus on healing and compassion toward the sick in Judaism, and the pragmatic nature of Israel that has made what we’re doing there completely mainstream.”
After a false start in 2010, the Israeli study began in earnest earlier this year, funded by MAPS (at a total anticipated cost of about $450,000) and overseen by Dr. Moshe Kotler, the chairman of the Israeli National Council for Mental Health and former chief psychiatrist for the Israeli Defense Forces. Although the study has sought referrals from the IDF of people with war-related trauma, it’s open to all Hebrew-speaking adults who suffer from chronic, treatment-resistant PTSD of any origin (and who need not be Jewish—the study’s recruitment poster was recently translated into Arabic).
The protocol is set up to treat patients for three to four months, beginning with three preparatory meetings, followed by two doses of MDMA taken a month apart, with integrative psychotherapy sessions and regular telephone follow-ups after each dose. Patients are to be assessed 12 months after completing the study on the extent of their PTSD symptoms as well as other factors like depression, quality of life, and quality of sleep. Doblin foresees the Israeli study’s results ultimately being bundled with those from similar studies in the United States, Canada, Spain, Switzerland, and elsewhere as MAPS and its clinical partners move ahead to propose a Phase 3 drug trial—a large, multisite, multimillion dollar trial involving hundreds or even thousands of patients. If successful, that would likely be the last major hurdle to MDMA’s approval by the U.S. Food and Drug Administration as a medication to treat PTSD. “It’s 27 years since I started to try and bring back MDMA as a prescription medicine,” said Doblin. “We’re probably 10 years away.”
For now, the Israeli study is being closely watched. “At the end of the day, I’m a huge believer that the proof is in the pudding,” Halberstadt said. “It’s certainly unorthodox. But there are very often treatment situations in which, if you’re not going to be unorthodox, you’re not going to have a breakthrough. Unorthodox doesn’t mean unethical. When you’re talking about people who aren’t being successfully treated by more traditional methodologies, then ‘unorthodox’ is merciful.”
It’s a type of mercy that Josef, the war veteran, thinks could help many in Israel. “The wars didn’t do good to most of the people I know,” he said. “In their past is trauma. It’s a kind of handicap. We call this a ‘scratch.’ Here, there are many scratched ones.”
Like this article? Sign up for our Daily Digest to get Tablet Magazine’s new content in your inbox each morning.
I enjoyed some very expensive restaurants when my parents were treating. But as I approached 30, I wanted to pay my own way.