MDMA for Couples and Relationship Satisfaction

Introduction

This research paper will be exploring the whether MDMA use increases relationship satisfaction when used together by couples in either a recreational or clinical setting. Currently, the substance MDMA (3,4-methylenedioxymethamphetamine) is considered a breakthrough treatment by the Food and Drug Administration (FDA) in the United States for the management of PTSD. However, MDMA is still listed as a Schedule 1 controlled substance, making it illegal for recreational or personal use, although it remains in the top four most used recreational substances in the US. In the early days of MDMA’s use, before its prohibition, MDMA had been used as a tool for facilitating couples’ therapy, and the purpose of this proposed research study is to revisit its potential as a powerful psychotherapeutic medicine—not only for severe cases of PTSD, but for couples who want to increase satisfaction in their intimate relationships.

MDMA has been popular in nightclubs since the 1980s, and continues to be a commonly used substance at underground dance parties (raves) among young people to this day. For just as long, people have also been aware of the psycho-spiritual effects of MDMA, and researchers are now beginning to revisit the potential positive effects an MDMA experience can have on mental health.  Many who use MDMA report feelings of increased connection to others, and deeper understanding and appreciation toward those they love. In this essay, we will take a closer look at how undergoing these experiences with a partner may translate into a more fulfilling relationship overall, regardless of whether the MDMA was taken in intentionally with a therapist, or in a recreational setting.

I have decided to include “recreational” experiences of MDMA in this research study, because due to its Schedule 1 status, not everyone has access to pursuing legal avenues of MDMA treatment. For the purpose of this essay, “recreational” experiences will be defined as couples that take MDMA independently outside of a clinical or research setting. It is projected that MDMA, when taken with a partner, will increase relationship satisfaction due to its anecdotally reported effects of increased feelings of empathy, closeness, and compassion.

To deepen my understanding of whether couples in my community were benefiting from using MDMA together, I compiled a survey asking participants who had taken MDMA with their partner, with or without a guide or facilitator, asking them to rate their relationship satisfaction in multiple areas both before and after the experience. Following a brief literature review of research that is in alignment with the topic of MDMA and couples’ therapy, I will refer to this survey in more detail in the Methods and Results sections of the paper.

Literature Review

Research Question:

Can MDMA Use Within Couples Increase Relationship Satisfaction?

            MDMA was first synthesized in 1912, and was tested for various purposes until the 1950s. As stated in the introduction, MDMA has had known uses as a facilitation tool for couples’ therapy as early as 1977 when it was resynthesized by Alexander Shulgin. Recognizing its potential for couples’ therapy facilitation after ingesting the substance with his wife, Ann, he began recording his and his wife’s experiences on MDMA and other chemical compounds, sharing the substance with other chemists and psychotherapists. (Shulgin & Shulgin, 1991)

 While being relatively benign and non-hallucinatory, MDMA could induce powerful emotional breakthroughs and experiences of closeness within couples. These early sessions that occurred in the United States between 1977 and 1985 laid the groundwork for the individual and group therapy protocols that are currently being used in research studies on MDMA and PTSD, which is its first new frontier since being reconsidered for therapeutic use in the 2010s. (Passie, 2018) Psychotherapists working with MDMA in the early years of its synthesis advocated for keeping it within the clinical research community, but eventually its use spread to the public, becoming widely known as “Ecstasy” or “Molly”. (Sessa, 2019)

            While recreational use of MDMA proliferated at nightclubs, by the mid-1980s, America’s War on Drugs was already being waged in full force. The idea that the human desire to alter one’s consciousness via psychoactive substances was morally wrong was strongly reinforced by the government in the years succeeding the first wave of the psychedelic revolution in the 1960s and 70s, and the number of arrests for drug-related offenses, including low-level possession charges, increased significantly during the following decade. Although stigma and persecution against psychoactive substances and the people who use them is still alive and well in America, thousands of people have continued to explore their curiosity about non-ordinary states of consciousness through psychedelics and entactogens such as MDMA since its prohibition.

Legal MDMA Therapy in Clinical Mental Health Research—

Past, Present, and Future

            We have these brave individuals to thank for the inspiration to pursue the scientific research of MDMA despite its current Schedule 1 status that deems it “dangerous and with no potential for medical use.” As early as 1986, the non profit organization Multidisciplinary Association for Psychedelic Studies (MAPS) was formed in response to the DEA’s increase in persecution of possession of psychedelic substances in an attempt to advocate for the continuation of scientific research of MDMA, psychedelics, and marijuana for the purpose of assessing their potential for mental health and medical treatment. In 2012, MAPS conducted its first controlled clinical study on MDMA for adults with PTSD, which concluded in over 50 percent of participants no longer meeting the criteria for PTSD. (Silwosky, 2020)

            In recent years, there has been a resurgence of interest in some psychological and scientific communities regarding the use of psychedelics and MDMA, not only for severe cases of PTSD, but for adults with autism, depression, end-of-life anxiety, and other mental health issues. It is estimated that MAPS’ years of work in psychedelic research will culminate in MDMA being decriminalized for the purpose of medical and mental health treatment in controlled, clinical settings as soon as 2023.

 When MDMA is once again fully recognized as a medicine, and for the first time, acknowledged by the mainstream mental health community as a breakthrough therapy, avenues for its use as a catalyst for deeper understanding and connection in intimate relationships will reopen. MAPS and other advocates for cognitive liberty hope that by beginning with proving that PTSD and other severe psychological ailments can be helped by MDMA, stigma against its use will be reduced, and using MDMA with a trained therapist will someday soon be an accessible option for couples wanting to explore their relationships.

How Might MDMA Work Neurologically to Support Relationship Growth?

MDMA is theorized to be so effective at dissolving psychological and emotional blockages in cases of both PTSD treatment and within intimate relationships due to the multiple receptors, neurotransmitters, and intermediary processes that account for MDMA’s effects. When ingested, MDMA releases both serotonin and noradrenaline, along with dopamine to a lesser extent. MDMA’s activity on the serotonin system mitigates anxiety and depression, reduces the amygdala’s fear response, (Greer, 1986) increasing levels of self-confidence, compassion, and empathy for oneself and others. (Van Wel, et. al., 2012)

MDMA has also been observed to induce the release of oxytocin, the hormone released during early bonding between infant and caregiver. Oxytocin, sometimes referred to as “the cuddle hormone”, produces feelings of closeness and empathy between couples that take MDMA together. MDMA-assisted therapy has been noted for its success with patients with psychological trauma, which is theorized as a result of its ability to facilitate the verbal processing of painful memories. Acting as a buffer between oneself and their emotions, MDMA allows patients to recall their trauma without re-experiencing the emotional pain that normally comes with being in contact with the traumatic experience(s). (Sessa, 2017)

MDMA is also being explored clinically for the treatment of alcohol use disorder, social anxiety, and mood disorders. A common factor in these and other frequently diagnosed mental disorders is developmental or emotional trauma. (Stewart, 1996) Although it may not always involve a mental health diagnosis, pathological patterns within couples or high-conflict relationships are often rooted in the individuals’ relational trauma being triggered by the current relationship dynamic. Since MDMA acts so powerfully on the serotonin system and produces the release of oxytocin, which mimics the feelings of those early developmental attachment bonds, it can be suggested that MDMA-assisted couples therapy contains potential for addressing the early developmental attachment wounding that may lie at the root of high-conflict relationship patterns.

Phenomenological and Experiential Research Supporting MDMA as a Beneficial Medicine for Couples

            In 2018, Dr. Robert Colbert, LMFT and PhD graduate from California Institute of Integral Studies, conducted a series of interviews with couples that recreationally used MDMA together semi-regularly. The interviews explored eight couples’ experiences of emotional and psycho-spiritual phenomena that occurred during and after their MDMA experiences. These interview sessions were recorded, transcribed, and analyzed for major themes, which included “[the medicine facilitating] a different reason to relate to each other, serving me in so many ways, [the MDMA experiences] added depth to [our] relationship,” (Colbert, p. 5, 2018) and helped couples to reconnect during challenging moments by drawing on memories of their transformational experiences on MDMA. Couples interviewed in this study used MDMA without a therapist, instead relying on each other to hold space for their emotions. The study concluded that the majority of the couples interviewed experienced a tendency to encourage their partner to access sensitive emotional material, and cited their experiences as a catalyst for overall change in their lives. (Colbert, 2018)

            In a 2017 study by Katie Anderson of London South Bank University, Anderson notes the limited amount of research that has been conducted to date on potential psychological benefits of MDMA use specifically within romantic relationships. Anderson piloted a heuristic study, in which ten couples were interviewed using visual methods and individual written diaries, in order to explore how the shifting of internal and external boundaries that occur while under the influence of MDMA with a partner, and meaning that the partners may make of these shifts. (Anderson, 2017) Anderson’s research generated results that supported the existence of a metaphorical “bubble” that forms around couples during their experience, “producing a distinct affective atmosphere of muted fear, worry, and shame, and heightened feelings of safety and love, which mediates emotional and discursive ‘practices’ of intimacy.” (Anderson, p. 3, 2017) Through this process, couples are more easily able to forgive, empathize, and move past challenging issues.

            In a 2019 article by K. Almond and R. Allen published in The Family Journal, MDMA was explored as a potential adjunct to the empirically proven relationship counseling method of Emotionally Focused Therapy, or EFT. Specifically, each couple participating in this study was comprised of at least one individual who had undergone severe trauma in their lives, or had a diagnosis of PTSD. Drawing on the incredibly promising results of the studies on MDMA for PTSD treatment, and the systemic, evidence-based approach of EFT, suggesting that MDMA’s “breakthrough” abilities for PTSD will translate into couple’s therapy session, healing trauma within the context of relationships as well as for individuals. (Almond, 2019)

            One of the obvious limitations on the existing literature and research on MDMA’s potential therapeutic effects on couples and relationships is its Schedule 1 status, making it difficult to obtain access to research it for anything other than severe mental health issues such as PTSD at this point. Although there is a wealth of knowledge from Alexander and Ann Shulgin’s work, since prohibition, much of the energy and money being spent on MDMA legalization is focused on treating issues that are most likely to clear its legal status with the federal government: severe PTSD, which affects populations such as military and law enforcement. It has been argued that focusing on these populations first leaves more marginalized demographics behind, since there have yet to be large-scale MDMA-assisted therapy studies on gender-based or racial trauma.

            Although they are rare, the three MDMA studies I cited that took place in the specific context of couples’ therapy or relationships provided significant insight into the common phenomena that arise when couples take MDMA together, and the positive effects it appears to have on relationships. However, all three of these studies were strictly collecting data from populations that either worked with a therapist or guide, or couples who took MDMA recreationally with their partners in a private setting. None of these studies aimed to include diverse experiences of couples that took MDMA in both clinical and non-clinical settings, limiting their research to more homogenous demographics.

My research study aims to fill this gap by taking into account the experiences of both couples that choose to have their experience with a therapist, and those who choose to take MDMA with a partner. Both options have risks for different populations; some may feel safer with an experienced guide, and others may fear the legal implications of taking MDMA with an underground setting, or not have access to a therapist or the cost of therapy. I hope to take a variety of experiences into account, so voices of diverse backgrounds can be considered in this research.

Methods

For this research study, I will chose to create a survey in which participants who have ever taken MDMA with a partner, whether it took place as part of a research study, in the presence of a trained therapist or guide, or privately in a recreational setting. I asked a series of questions about different areas of relationship satisfaction, and asked each participant to rate their level of satisfaction in each area on a scale of 1-10. I also left space for and encouraged participants to elaborate on their experience in each area.

Before asking participants about their MDMA experiences, I asked a few questions about their identities and backgrounds to get a better picture of the demographics I was surveying and representing in my study. I predicted that I would be able to get a diverse sample of people of different races and gender identities, however, I assumed that most of the people I had access to surveying were in the same age demographic; around age 25-35. I asked them to identify, if comfortable sharing, the type of relationship they were in when they took MDMA, (monogamous or polyamorous), their sexual orientation, if they had a significant age difference between them, their race and gender identity, and if they had a religious or spiritual orientation.

 Categories I asked participants to rate their satisfaction in the relationship in on a scale of 1-10 both before and after taking MDMA included general satisfaction, communication and mutual understanding, openness, trust, and vulnerability, appreciation, reverence, and connection, romance, physical intimacy, and sexuality, and spiritual connection and/or shared life purpose. I chose to have participants rate experiences on a scale of 1-10 to get a clear picture of increase, decrease, or stagnation in relationship satisfaction. In an effort to acknowledge that a number cannot define human experiences in relationships, I asked them to elaborate in more detail if they felt comfortable sharing to get a better sense of the phenomena they experienced occurring in their relationship after taking MDMA together. Next, I asked participants to share if they had been attending traditional couples’ therapy before, during, or after their MDMA experience with their partner, and if a guide or therapist facilitated their MDMA experience.

Finally, I asked participants to share whether they would define their MDMA experience(s) with their partner as “intentional” (for the purpose of increasing relationship satisfaction, spiritual inquiry, exploration, connection, or working through interpersonal issues) or “recreational” (for the purpose of enjoyment)? For those who had shared that they were attending traditional couples’ therapy in conjunction to experimenting with MDMA together as a couple, I asked them to share if they experienced any changes in the therapeutic process in their therapy sessions following taking MDMA. Lastly, I invited all participants to share any other relevant details regarding their MDMA experience with their partner.

A major ethical consideration that came to mind when asking people in my community if they would like to participate in my study is that MDMA is still illegal to possess and consume, and that having information about their past, current, or future MDMA use could potentially pose a threat to their safety and security. For this reason, I gave participants the option of responding via an encrypted texting app, to protect information they might feel sensitive about sending through email. I anticipated that since many people in my community have positive associations with psychedelics, my research question would attract people who are excited to share about positive experiences they may have had with MDMA, causing the data to be biased in favor of my hypothesis that MDMA can indeed improve relationship satisfaction when taken with a partner.

Although there are numbers involved in my research survey, the numbers serve as a tool to more simply describe and communicate subjective, experiential shifts and occurrences in relationships. Especially when taking into account participants’ elaborations on different aspects of satisfaction in their relationships, it is clear that this study is qualitative by nature. Since we are taking into account peoples’ internal experiences of relational healing and transformation in a non-ordinary state of consciousness, it can also be understood that this study falls under the category of phenomenological research. In inviting individuals to share personal anecdotes of their experiences taking MDMA with their partners, the study also invokes aspects of narrative research.

Although I did create the survey and send it out to several volunteers, I did not receive enough responses to gather comprehensive data. If I were to do this research study in the future, I would send the survey out to 8-10 participants. To ensure reliability in this qualitative phenomenological study, I would want to ensure to gather data from participants from a variety of backgrounds: mixed-race couples, queer and straight relationships, transgender relationships, polyamorous and monogamous couples, and couples comprised of individuals living with different levels of trauma.

It would also provide more reliable data to conduct multiple surveys with the same couples as they take MDMA at different times throughout their relationship in order to analyze if the data can be measured over time. At the same time, it is important to keep data samples small and in-depth when working with qualitative data, so no more than ten participants would be surveyed. To confirm validity, it would be necessary to make sure that the couples that had taken MDMA had actually taken MDMA—not a placebo, or in the case of recreational users, another drug or filler chemical being sold as MDMA.

Results

Limitations/Delimitations

Limitations that may influence the results of this study are potential participants feeling reluctant to share data because of the risk inherent in claiming to have experience with an illegal substance. This may limit responses from certain demographics that are more likely to be targeted by law enforcement, skewing data in favor of more privileged voices. Another limitation is that participants are mostly limited to friends and friends of friends, most of whom who may want to take the survey and share their experiences have had positive associations with psychedelics. My own bias acts as a limitation as well by steering my research toward the results I want to see; data that matches up with my own experience of MDMA and psychedelics being powerful agents for healing in relationship to others.

A delimitation to this study is that I chose to survey participants that were in my age demographic (age 25-35.) Although it may be limiting to exclude certain age groups in the study, it is beneficial to narrow down the study to a specific neurodevelopmental stage. During this time, the brain has finished developing in most cases, and a healthy person in this age demographic is statistically the safest to use MDMA. Another delimitation I set on this study was that we would look at data only from participants who used pure MDMA—a few potential participants asked if they could share data from experience with the similar substance MDA, but I elected to keep the study focused on only MDMA for the sake of clarity and simplicity.

Conclusion

10 participants were sent surveys comprised of varying subjective categories related to relationship satisfaction, asked to rate their satisfaction in these categories on a scale of 1-10, elaborating with more detail if desired. Keeping an MDMA experience they had with a partner, they answered these questions from the perspective of themselves before having taken MDMA, and then again from how they felt about the same aspects their relationship after their MDMA experience. To analyze the data, I calculated the average difference in relationship satisfaction in each category on the survey.

It was concluded that participants who took the survey, whether their experience took place in a recreational or clinical setting, reported their satisfaction increasing at least some amount in the majority of the described categories of relationship satisfaction after taking MDMA with their partner. I also analyzed the subjective data found in the details the participants elected to share when prompted. In the reflection sections where I invited participants to elaborate on phenomena that felt relevant, recurring themes included increased empathy and understanding, physical touch as a catalyst for healing, new levels of emotional vulnerability, and an ability to hold challenging memories more lightly together.

References

Almond, K., & Allan, R. (2019). Incorporating MDMA as an Adjunct in Emotionally Focused Couples Therapy With Clients Impacted by Trauma or PTSD. The Family Journal, 27, 293 – 299.

Anderson, K. (2017). Navigating Intimacy with Ecstasy: The Emotional, Spatial and Boundaried Dynamics of Couples’ MDMA Experiences. United Kingdom: London South Bank University.

Colbert, R. N. (2018). Evenings with Molly: A Grounded Theory Discovery with Adult Couples Who Use MDMA Recreationally. California Institute of Integral Studies.

Katie Anderson, Paula Reavey, Zoë Boden, (2019) ‘Never drop without your significant other, cause that way lies ruin’: The boundary work of couples who use MDMA together, International Journal of Drug Policy, Volume 71, 2019, Pages 10-18, ISSN 0955-3959, https://doi.org/10.1016/j.drugpo.2019.05.004.

Greer G.R., Tolbert R. (1990) The Therapeutic Use of MDMA. In: Peroutka S.J. (eds) Ecstasy: The Clinical, Pharmacological and Neurotoxicological Effects of the Drug MDMA. Topics in the Neurosciences, vol 9. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1485-1_2

Passie, T. (2018). The early use of MDMA (‘Ecstasy’) in psychotherapy (1977–1985). Drug Science, Policy and Lawhttps://doi.org/10.1177/2050324518767442

Sessa, B., Higbed, L., & Nutt, D. (2019). A Review of 3,4-methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy. Frontiers in psychiatry10, 138. https://doi.org/10.3389/fpsyt.2019.00138

Shulgin, A. T., & Shulgin, A. (1991). Pihkal: A chemical love story. Berkeley, CA: Transform Press.

Sliwoski, V. (2020, October 26). Here Comes the First Approved MDMA (Ecstasy) Drug – Canna Law Blog™. Retrieved December 04, 2020, from https://harrisbricken.com/cannalawblog/here-comes-the-first-approved-mdma-ecstasy-drug/

van Wel, J. H., Kuypers, K. P., Theunissen, E. L., Bosker, W. M., Bakker, K., & Ramaekers, J. G. (2012). Effects of acute MDMA intoxication on mood and impulsivity: role of the 5-HT2 and 5-HT1 receptors. PloS one7(7), e40187. https://doi.org/10.1371/journal.pone.0040187

Published by maiashmuelipsychotherapy

I am a graduate student, therapist and researcher interested in how altered states of consciousness and spiritual/mystical experiences can be transformative for clients’ mental health. I work with clients of all backgrounds, and provide trauma-informed, harm-reduction oriented care.

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