Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use

Brenda Tichler

doi:doi:10.11648/j.pbs.20211006.17

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Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use

Brenda Tichler

Published in Psychology and Behavioral Sciences (Volume 10, Issue 6)

Received: 27 October 2021 Accepted: 26 November 2021 Published: 2 December 2021

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Abstract

The importance of treating concurrent Post-Traumatic Stress Disorder (PTSD) and substance use with psychedelics is a controversial topic, hampered in part by a lack of empirical evidence and rigidity of substance scheduling. Traditional treatments for concurrent PTSD and substance use concerns are compartmentalized, with clinicians focusing on one condition over the other. In addition, traditional medication treatments are costly, requires significant time to take effect, and often come with debilitating side effects, resulting in decreased treatment retention and outcomes. Here, the aim of this manuscript is to explore the intricate mechanisms keeping concurrent PTSD and substance use in place and how traditional treatment methods are ineffective in treating the root cause of these conditions. The link between PTSD and substance use as a coping strategy is explored through the Self-Medication Hypothesis in combination with the prevalence of Adverse Childhood Events. The use of 3, 4 Methylenedioxymethamphetamine (MDMA)-assisted therapy is explored as a new and promising integrated treatment focusing on the safety, internal process, trust, and therapeutic rapport of the client and clinician. MDMA-assisted therapy consists of only a couple doses of a psychoactive substance administered in a controlled environment and under strict supervision. MDMA-assisted psychotherapy is more cost-effective than traditional treatments with virtually no adverse effects when compared to psychotropic medications. MDMA-assisted psychotherapy is shorter in length and more effective than traditional therapy with positive outcomes achieved within weeks, and lasting multiple years. Suggestions for future research include involving individuals who use substances and greater diversity and number in study samples. In addition, this manuscript contains recommendations for clinical practice for therapist training, an integrative treatment approach, and affordable access to MDMA-assisted treatment for PTSD and concurrent disorders. Finally, recommendations are made for the rescheduling of MDMA to allow for more significant research and clinical practice opportunities.

Published in	Psychology and Behavioral Sciences (Volume 10, Issue 6)
DOI	10.11648/j.pbs.20211006.17
Page(s)	231-240
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Trauma, Substance Use, Adverse Childhood Experiences, MDMA-Assisted Psychotherapy, Psychedelic-Assisted Therapy, Concurrent Disorders

References

[1]	Oehen, P., Traber, R., Widmer, V., Schnyder, U. (2013). A randomized, controlled pilot study of MDMA (3, 4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD). Journal of Psychopharmacology, 27 (1), 40-52.
[2]	Feinstein, R., Heiman, N., & Yager, J. (2015). Common factors affecting psychotherapy outcomes: Some implications for teaching psychotherapy. Journal of Psychiatric Practice, 21 (3), 180-189.
[3]	Hutchison, C. A. & Bressi, S. K. (2020). MDMA-assisted psychotherapy for posttraumatic stress disorder: Implications for social work practice and research. Clinical Social Work Journal, 48, 421-430.
[4]	Maria-Rios, C. E., & Morrow, J. D. (2020). Mechanisms of shared vulnerability to post-traumatic stress disorder and substance use disorder. Frontiers in Behavioral Neuroscience 14 (6), 1-21.
[5]	Canadian Centre on Substance Abuse. (2009). Substance abuse in Canada: Concurrent disorders. www.ccsa.ca
[6]	Belleau, E. L., Chin, E. G., Wanklyn, S. G., Zambrano-Vazquez, L., Schumacher, J. A., & Coffey, S. F. (2017). Pre-treatment predictors of dropout from prolonged exposure therapy in patients with chronic posttraumatic stress disorder and comorbid substance use disorders. Behaviour Research and Therapy, 91, 43-50.
[7]	Mithoefer, M. C., Grob, C. S., & Brewerton, T. D. (2016). Novel psychopharmacological therapies for psychiatric disorders: Psilocybin and MDMA. Personal View.
[8]	Karsberg, S., Hesse, M., Mulbjerg Pederson, M., Charak, R., & Uffe Pedersen, M. (2021). The impact of poly-traumatization on treatment outcomes in young people with substance use disorders. BMC Psychiatry, 21 (140), 1-14.
[9]	Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders. https://store.samhsa.gov
[10]	Alexander, A. C., & Ward, K. D. (2018). Understanding postdisaster substance use and psychological distress using concepts from the self-medication hypothesis and social cognitive theory. Journal of Psychoactive Drugs, 50 (2), 177-186.
[11]	American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders (5^th ed.).
[12]	Canadian Centre on Substance Abuse. (2013). When mental health and substance abuse problems collide. https://www.ccsa.ca
[13]	Centre for Addiction and Mental Health. (2021). Mental illness and addiction: Facts and statistics. https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics
[14]	Hakobyan, S., Vizirian, S., Lee-Cheong, S., Krausz, M., Honer, W. G., & Schultz, C. G. (2020). Concurrent disorder management guidelines. Systematic review. Journal of Clinical Medicine, 9 (2406).
[15]	Khan, S. (2017). Concurrent mental and substance use disorders in Canada. https://www150.statcan.gc.ca/n1/pub/82-003-x/2017008/article/54853-eng.htm
[16]	Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and childhood dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14 (4), 245-258.
[17]	Rhee, T. G., Barry, L. C., Kuchel, G. A., Steffens, D. C., & Wilkinson, S. T. (2019). Associations of adverse childhood experiences with past-year DSM-5 psychiatric and substance use disorders in older adults. The American Geriatrics Society, 67, 2085-2093.
[18]	Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259-1264. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.463.3843&rep=rep1&type=pdf accessed June 22, 2021.
[19]	Barone, W., Beck, J., Mitsunaga-Whitten, M., & Perl, P. (2019). Perceived benefits of MDMA-assisted psychotherapy beyond symptom reduction: Qualitative follow-up study of a clinical trial for individuals with treatment-resistant PTSD. Journal of Psychoactive Drugs, 51 (2), 199-208.
[20]	dos Santos, G. R., Bouso, J. C., Mendes Rocha, J., Novak Rossi, G., & Hallak, J. E. (2021). The use of classic hallucinogens/psychedelics in a therapeutic context: Healthcare policy opportunities and challenges. Risk Management and Healthcare Policy, 14, 901-910.
[21]	Jerome, L., Schuster, S., & Yazar-Klosinski, B. B. (2013). Can MDMA play a role in the treatment of substance abuse? Current Drug Abuse Reviews, 6 (1).
[22]	Schuckher, F., Sellin, T., Engstrom, I., & Berglund, K. (2019). History of childhood abuse is associated with less positive treatment outcomes in socially stable women with alcohol use disorder. BMC Women’s Health, 19 (159).
[23]	Kowatch, K. R., Schmidt, F., & Mushquash, C. J. (2019). Review of culturally-adapted cognitive behavioral therapy interventions for North American Indigenous children and youth. Journal of Concurrent Disorders, 1 (3), 5-22. https://www.concurrentdisorders.ca/wp-content/uploads/2019/09/review-of-culturally-adapted-cognitive-behavioral-therapy-interventions-for-north-american-indigenous-children-and-youth.pdf
[24]	Norman, S. B., Myers, U. S., Wilkins, K. C., Goldsmith, A. A., Hristova, V., Huang, Z., McCullough, K. C., & Robinson, S. K. (2012). Review of biological mechanisms and pharmacological treatments of comorbid PTSD and substance use disorder. Neuropharmacology, 62 (2), 542-551.
[25]	Feduccia, A. A., & Mithoefer, M. C. (2018). MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? Progress in Neuropsychopharmacology & Biological Psychiatry, 84, 221-228.
[26]	Meichenbaum, D. (2017). The therapeutic relationship as a common factor: Implications for trauma therapy. In The Evolution of Cognitive Behavior Therapy (pp. 195-206). Routledge.
[27]	Morefield, K. M., Keane, M., Felgate, P., White, J. M., & Irvine, R. J. (2011). Pill content, dose and resulting plasma concentrations of 3, 4-methylenedioxymethamphetamine (MDMA) in recreational ‘Ecstasy’ users. Addiction, 106.
[28]	Sessa, B., Higbed, L., & Nutt, D. (2019). A review of 3, 4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. Frontiers in Psychiatry, 10 (138).
[29]	Thrul, J., & Garcia-Romeu, A. (2021). Whitewashing psychedelics: Racial equity in the emerging field of psychedelic-assisted mental health research and treatment. Drugs: Education, Prevention and Policy, 28 (3), 211-214.
[30]	Varker, T., Watson, L., Gibson, K., Forbes, D., & O’Donnel, M. L. (2021). Efficacy of psychoactive drugs for the treatment of posttraumatic stress disorder: A systematic review of MDMA, Ketamine, LSD, and Psilocybin. Journal of Psychoactive Drugs, 53 (1), 85-95.
[31]	Feduccia, A. A., Jerome, L., Yazar-Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R. (2019). Breakthrough for trauma treatment: Safety and efficacy of MDMA-assisted psychotherapy compared to paroxetine and sertraline. Frontiers in Psychiatry, 10 (650).
[32]	Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Fraguada Narloch, V. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18 (40).
[33]	Sessa, B. (2017). Why MDMA therapy for alcohol use disorder? And why now? Neuropharmacology.
[34]	Mithoefer, M. C. (2017). A manual for MDMA-assisted psychotherapy in the treatment of posttraumatic stress disorder. Multidisciplinary Association for Psychedelic Studies Inc. Santa Cruz, CA. https://s3-us-west-1.amazonaws.com/mapscontent/research-archive/mdma/TreatmentManual_MDMAAssistedPsychotherapyVersion+8.1_22+Aug2017.pdf
[35]	Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., Ot’alora, M. G., Garas, W., Paleos, C., Gorman, I., Nicholas, C., Mithoefer, M., Carlin, S., Poulter, B., Mithoefer, A., Quevedo, S., Wells, G., Klaire, S. S., van der Kolk, B.,... Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: A randomized, double-blind, placebo controlled phase 3 study. Nature Medicine, 27, 1025-1033.
[36]	Canada. (2019). Controlled drugs and substances act. https://laws-lois.justice.gc.ca/PDF/C-38.8.pdf
[37]	Government of Canada. (n.d.). Health Canada’s special access program: request a drug. https://www.canada.ca/en/health-canada/services/drugs-health-products/special-access/drugs.html
[38]	Canadian Psychology Association. (2017). Canadian code of ethics for psychologists. https://cpa.ca/docs/File/Ethics/CPA_Code_2017_4thED.pdf
[39]	Marseille, E., Kahn, J. G., Yazar-Kloskinski, B., & Doblin, R. (2020). The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD. Plos One.

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APA Style

Brenda Tichler. (2021). Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use. Psychology and Behavioral Sciences, 10(6), 231-240. https://doi.org/10.11648/j.pbs.20211006.17

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ACS Style

Brenda Tichler. Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use. Psychol. Behav. Sci. 2021, 10(6), 231-240. doi: 10.11648/j.pbs.20211006.17

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AMA Style

Brenda Tichler. Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use. Psychol Behav Sci. 2021;10(6):231-240. doi: 10.11648/j.pbs.20211006.17

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@article{10.11648/j.pbs.20211006.17,
  author = {Brenda Tichler},
  title = {Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use},
  journal = {Psychology and Behavioral Sciences},
  volume = {10},
  number = {6},
  pages = {231-240},
  doi = {10.11648/j.pbs.20211006.17},
  url = {https://doi.org/10.11648/j.pbs.20211006.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.pbs.20211006.17},
  abstract = {The importance of treating concurrent Post-Traumatic Stress Disorder (PTSD) and substance use with psychedelics is a controversial topic, hampered in part by a lack of empirical evidence and rigidity of substance scheduling. Traditional treatments for concurrent PTSD and substance use concerns are compartmentalized, with clinicians focusing on one condition over the other. In addition, traditional medication treatments are costly, requires significant time to take effect, and often come with debilitating side effects, resulting in decreased treatment retention and outcomes. Here, the aim of this manuscript is to explore the intricate mechanisms keeping concurrent PTSD and substance use in place and how traditional treatment methods are ineffective in treating the root cause of these conditions. The link between PTSD and substance use as a coping strategy is explored through the Self-Medication Hypothesis in combination with the prevalence of Adverse Childhood Events. The use of 3, 4 Methylenedioxymethamphetamine (MDMA)-assisted therapy is explored as a new and promising integrated treatment focusing on the safety, internal process, trust, and therapeutic rapport of the client and clinician. MDMA-assisted therapy consists of only a couple doses of a psychoactive substance administered in a controlled environment and under strict supervision. MDMA-assisted psychotherapy is more cost-effective than traditional treatments with virtually no adverse effects when compared to psychotropic medications. MDMA-assisted psychotherapy is shorter in length and more effective than traditional therapy with positive outcomes achieved within weeks, and lasting multiple years. Suggestions for future research include involving individuals who use substances and greater diversity and number in study samples. In addition, this manuscript contains recommendations for clinical practice for therapist training, an integrative treatment approach, and affordable access to MDMA-assisted treatment for PTSD and concurrent disorders. Finally, recommendations are made for the rescheduling of MDMA to allow for more significant research and clinical practice opportunities.},
 year = {2021}
}

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TY  - JOUR
T1  - Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use
AU  - Brenda Tichler
Y1  - 2021/12/02
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N1  - https://doi.org/10.11648/j.pbs.20211006.17
DO  - 10.11648/j.pbs.20211006.17
T2  - Psychology and Behavioral Sciences
JF  - Psychology and Behavioral Sciences
JO  - Psychology and Behavioral Sciences
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PB  - Science Publishing Group
SN  - 2328-7845
UR  - https://doi.org/10.11648/j.pbs.20211006.17
AB  - The importance of treating concurrent Post-Traumatic Stress Disorder (PTSD) and substance use with psychedelics is a controversial topic, hampered in part by a lack of empirical evidence and rigidity of substance scheduling. Traditional treatments for concurrent PTSD and substance use concerns are compartmentalized, with clinicians focusing on one condition over the other. In addition, traditional medication treatments are costly, requires significant time to take effect, and often come with debilitating side effects, resulting in decreased treatment retention and outcomes. Here, the aim of this manuscript is to explore the intricate mechanisms keeping concurrent PTSD and substance use in place and how traditional treatment methods are ineffective in treating the root cause of these conditions. The link between PTSD and substance use as a coping strategy is explored through the Self-Medication Hypothesis in combination with the prevalence of Adverse Childhood Events. The use of 3, 4 Methylenedioxymethamphetamine (MDMA)-assisted therapy is explored as a new and promising integrated treatment focusing on the safety, internal process, trust, and therapeutic rapport of the client and clinician. MDMA-assisted therapy consists of only a couple doses of a psychoactive substance administered in a controlled environment and under strict supervision. MDMA-assisted psychotherapy is more cost-effective than traditional treatments with virtually no adverse effects when compared to psychotropic medications. MDMA-assisted psychotherapy is shorter in length and more effective than traditional therapy with positive outcomes achieved within weeks, and lasting multiple years. Suggestions for future research include involving individuals who use substances and greater diversity and number in study samples. In addition, this manuscript contains recommendations for clinical practice for therapist training, an integrative treatment approach, and affordable access to MDMA-assisted treatment for PTSD and concurrent disorders. Finally, recommendations are made for the rescheduling of MDMA to allow for more significant research and clinical practice opportunities.
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Author Information

Brenda Tichler

Counselling and Applied Psychology, Faculty of Health Disciplines, Athabasca University, Athabasca, Canada

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Brenda Tichler. (2021). Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use. Psychology and Behavioral Sciences, 10(6), 231-240. https://doi.org/10.11648/j.pbs.20211006.17

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ACS Style

Brenda Tichler. Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use. Psychol. Behav. Sci. 2021, 10(6), 231-240. doi: 10.11648/j.pbs.20211006.17

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AMA Style

Brenda Tichler. Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use. Psychol Behav Sci. 2021;10(6):231-240. doi: 10.11648/j.pbs.20211006.17

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@article{10.11648/j.pbs.20211006.17,
  author = {Brenda Tichler},
  title = {Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use},
  journal = {Psychology and Behavioral Sciences},
  volume = {10},
  number = {6},
  pages = {231-240},
  doi = {10.11648/j.pbs.20211006.17},
  url = {https://doi.org/10.11648/j.pbs.20211006.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.pbs.20211006.17},
  abstract = {The importance of treating concurrent Post-Traumatic Stress Disorder (PTSD) and substance use with psychedelics is a controversial topic, hampered in part by a lack of empirical evidence and rigidity of substance scheduling. Traditional treatments for concurrent PTSD and substance use concerns are compartmentalized, with clinicians focusing on one condition over the other. In addition, traditional medication treatments are costly, requires significant time to take effect, and often come with debilitating side effects, resulting in decreased treatment retention and outcomes. Here, the aim of this manuscript is to explore the intricate mechanisms keeping concurrent PTSD and substance use in place and how traditional treatment methods are ineffective in treating the root cause of these conditions. The link between PTSD and substance use as a coping strategy is explored through the Self-Medication Hypothesis in combination with the prevalence of Adverse Childhood Events. The use of 3, 4 Methylenedioxymethamphetamine (MDMA)-assisted therapy is explored as a new and promising integrated treatment focusing on the safety, internal process, trust, and therapeutic rapport of the client and clinician. MDMA-assisted therapy consists of only a couple doses of a psychoactive substance administered in a controlled environment and under strict supervision. MDMA-assisted psychotherapy is more cost-effective than traditional treatments with virtually no adverse effects when compared to psychotropic medications. MDMA-assisted psychotherapy is shorter in length and more effective than traditional therapy with positive outcomes achieved within weeks, and lasting multiple years. Suggestions for future research include involving individuals who use substances and greater diversity and number in study samples. In addition, this manuscript contains recommendations for clinical practice for therapist training, an integrative treatment approach, and affordable access to MDMA-assisted treatment for PTSD and concurrent disorders. Finally, recommendations are made for the rescheduling of MDMA to allow for more significant research and clinical practice opportunities.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Using Drugs to Treat Drug Dependence: Exploring the Use of MDMA-Assisted Psychotherapy for Individuals with PTSD and Concurrent Substance Use
AU  - Brenda Tichler
Y1  - 2021/12/02
PY  - 2021
N1  - https://doi.org/10.11648/j.pbs.20211006.17
DO  - 10.11648/j.pbs.20211006.17
T2  - Psychology and Behavioral Sciences
JF  - Psychology and Behavioral Sciences
JO  - Psychology and Behavioral Sciences
SP  - 231
EP  - 240
PB  - Science Publishing Group
SN  - 2328-7845
UR  - https://doi.org/10.11648/j.pbs.20211006.17
AB  - The importance of treating concurrent Post-Traumatic Stress Disorder (PTSD) and substance use with psychedelics is a controversial topic, hampered in part by a lack of empirical evidence and rigidity of substance scheduling. Traditional treatments for concurrent PTSD and substance use concerns are compartmentalized, with clinicians focusing on one condition over the other. In addition, traditional medication treatments are costly, requires significant time to take effect, and often come with debilitating side effects, resulting in decreased treatment retention and outcomes. Here, the aim of this manuscript is to explore the intricate mechanisms keeping concurrent PTSD and substance use in place and how traditional treatment methods are ineffective in treating the root cause of these conditions. The link between PTSD and substance use as a coping strategy is explored through the Self-Medication Hypothesis in combination with the prevalence of Adverse Childhood Events. The use of 3, 4 Methylenedioxymethamphetamine (MDMA)-assisted therapy is explored as a new and promising integrated treatment focusing on the safety, internal process, trust, and therapeutic rapport of the client and clinician. MDMA-assisted therapy consists of only a couple doses of a psychoactive substance administered in a controlled environment and under strict supervision. MDMA-assisted psychotherapy is more cost-effective than traditional treatments with virtually no adverse effects when compared to psychotropic medications. MDMA-assisted psychotherapy is shorter in length and more effective than traditional therapy with positive outcomes achieved within weeks, and lasting multiple years. Suggestions for future research include involving individuals who use substances and greater diversity and number in study samples. In addition, this manuscript contains recommendations for clinical practice for therapist training, an integrative treatment approach, and affordable access to MDMA-assisted treatment for PTSD and concurrent disorders. Finally, recommendations are made for the rescheduling of MDMA to allow for more significant research and clinical practice opportunities.
VL  - 10
IS  - 6
ER  -

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