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When MDMA (ecstasy) was developed initially, doctors used it in controlled medical settings to help couples who were undergoing counselling and as a diet aid. However like many other mood-altering substances, abuse of MDMA increased and as a result, it was declared illegal in 1985. The drug was especially popular among young Caucasian partygoers for the effects it produced. Ecstasy abuse has remained high, with more users in other ethnic groups taking up the habit.
Ecstasy works by interfering with serotonin transmission in the brain. Serotonin is a chemical produced in the brain that plays an important role in regulating mood, sleep, sensitivity to pain, memory and learning. MDMA binds to serotonin transmitters in the brain and prolongs serotonin transmission thereby increasing the production of serotonin. It also stimulates the production of dopamine on a smaller scale.
Increased serotonin and dopamine levels produce pleasant, euphoric feelings that last about three-four hours, emotional warmth, distorted perception of time and increased energy. Users also report feeling empathic and emotionally relaxed.
The short and long term effects of ecstasy however are anything but pleasant. On the short term, an user may feel depressed after the effects of the drug wear off. This is caused by depletion of the normal levels of serotonin in the brain.
Some of the physiological effects of ecstasy include raised body temperature and heart rate. With the increased energy levels, users in high temperatures party settings dance for prolonged hours, which often lead to excessive sweating, dehydration and heat stroke (hyperthermia). When ecstasy is used together with alcohol, the risk of dehydration becomes higher.
Dangerously high temperatures and dehydration can cause kidney and liver failure. Ecstasy causes the release of norepinephrine, which raises the heart rate, a potential danger for people with cardiovascular disease. Some users of the drug experience negative reactions to the drug, including confusion, sleep problems, severe anxiety and depression, paranoia and hallucinations.
Users of ecstasy are often exposed to harmful substances. The drug, which is normally swallowed in 60-120 mg pills, is sold through the black market. The components of these pills are not always known. Sometimes the pills are laced with dangerous substances such as rat poison, cocaine and heroine, atropine and toxic substances such as dextromethorphan (DXM), a cough suppressant, ketamine (an anesthetic that is normally used by vets on animals) and PMA (paramethoxyamphetamine). Identifying these substances is difficult because the drug is produced in unregulated and illegal laboratories. The tablets are normally marked with underground brand names and symbols to identify them such as smiley faces and clover leaves among others.
The effects produced by ecstasy mean that users' judgement is distorted it makes them less cautious. Engaging in risky behaviour such as having multiple sexual partners, binge drinking, cigarette smoking and other forms of reckless behavior is therefore common in people who use ecstasy. Users are often at a high risk of contracting HIV and other sexually transmitted infections and unwanted pregnancies.
Studies show that ecstasy impairs the serotonin production mechanism in the brain, causing the serotonin levels to drop significantly with prolonged use. This affects the brain's functions of information retention, learning and mood regulation. People who use ecstasy especially in combination with other drugs over a long period tend to perform poorly on cognitive tasks such as learning and memory. Even though users recover with treatment and abstinence from the drug, some of the effects of these drugs can last a long time even after the person stops using the drug. In one study conducted on primates, the subjects' nerve terminals that are responsible for serotonin production showed signs of damage up to seven years after ecstasy was administered for only four days.
Other studies have shown that women are more vulnerable to the effects of ecstasy on their serotonin receptors. In addition, people who have never used ecstasy have normal functioning serotonin mechanisms when compared to those who have used the drug.
Ecstasy is addictive and can result in tolerance. After using it over a long period, the user's body adjusts itself to the drug and the person needs higher doses to experience similar effects. Common signs of addiction are an increase in use, needing higher doses and obsession with getting more supplies as well as difficulty in functioning normally without the drug. Stopping usage can cause withdrawal symptoms such as nausea, involuntary clenching of teeth, blurred vision, chills and sweating, muscle tension and feeling faint.
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