stargurl

Journal of the American Medical Association
August 17, 2001
Brian Vastag

Bethesda - As the popularity of the drug ecstasy ( MDMA ) continues to climb - -- 11% of high school seniors have tried it, according to a National Institute on Drug Abuse ( NIDA ) survey -- behavioral researchers are recommending control strategies that may seem antithetical to ever-expanding law enforcement efforts. Instead of focusing on eradication and punishment, these social scientists take another tack: they encourage harm reduction that acknowledges the realities of ecstasy.

At a recent NIDA conference, a half-dozen speakers advocated this immediate action approach. Providing plenty of water at rave parties to prevent dehydration ( a common adverse effect ), offering purity testing to help users avoid ubiquitous adulterants, and developing peer-led programs will go a long way toward reducing dangers, they said.

Ecstasy pills sold in the United States generally contain 100 mg or less of MDMA. According to the social scientists, typical users take no more than one pill at a time during a "session" and most limit their use to once or twice per week.

Social science researchers say that blunt prevention messages like this one fail to reduce ecstasy use. They advocate less extreme campaigns that users can identify with.

"Ecstasy is seen as relatively benign," said Robert Carlson, PhD, an addiction researcher at Wright State University of Medicine in Dayton, Ohio. "[Prevention] messages are not getting across, and something needs to be done."

Skepticism about government studies, perception that ecstasy is safer than other drugs ( including alcohol and tobacco ), and willingness to take calculated risks all factor into the ecstasy equation, said Patricia Case, ScD, director of the program in urban health at Harvard University. "A lot of [ecstasy users] make clear decisions, despite the known or unknown risks, that the benefits outweigh those risks," she said.

With considerations like these, Carlson and his colleagues are emphatic that one-size-fits-all campaigns hyping the dangers of ecstasy fail to sway users. Instead, they want messages that reflect reality: the effects of ecstasy feel good, different groups use it for various reasons in a range of settings, and evidence of addiction remains scant.

Claire Sterk, PhD, professor of behavioral sciences at Emory University's Rollins School of Public Health, Atlanta, Ga, would drive proponents of "Just Say No"style campaigns crazy. "We'll be better off having a campaign [poster] that says, 'Ecstasy can . . . make you feel really good. It increases your sensory awareness, it makes you feel music.' It's okay to acknowledge that," she said. "And then have a big comma and say, 'But there are consequences.'"

In contrast, NIDA's prevention campaign uses scare tactics. The oft-seen image of a brain before and after ecstasy provides a prime example. Split in half, a brain scan displays a lurid orange hemisphere on the left -- the "plain brain." On the "brain after ecstasy" side, muted tones and a missing chunk of cortex offer vivid testimony of the drug's propensity for destroying serotonin neurons, according to NIDA, which has distributed thousands of postcards and handouts displaying the graphic.

What the materials don't say is that the "after" scan comes from someone who abused multiple drugs and took several hundred doses of ecstasy, a huge amount the average user will never approach ( Lancet. 1998;352:1433_1437 ). "We need to stop exaggerating the negative consequences and stop using extreme cases," said Sterk. "I'm not saying there aren't consequences, I'm saying we don't know what they are."

Sterk and colleagues say that effective campaigns will take shape only after researchers come to grips with why people take ecstasy. This application of ethnography teaches that understanding springs from getting to know users. It's a social, not clinical, approach.

Case and her team spent hundreds of hours in New York City bars and clubs, gauging drug habits in the gay community. Carlson explored the lives of young adults who took ecstasy in Ohio. And Jean Schensul, PhD, executive director of the Institute for Community Research in Hartford, Conn, tracked networks of ecstasy-involved urban teenagers.

Their conclusion: each group is driven by unique motivations. Whereas older New York City gay men may use ecstasy "as part of a posttraumatic stress response" to having "lived through the 'death years' of AIDS," midwestern youth may simply be rebelling, and Hartford's poor teens may be yearning for an escape. Targeting all of them with the same message doesn't make sense. "We know people will continue to use," said Sterk. "What we can do right away is come up with appropriate, targeted messages to reduce the risk."