Heavy “Ecstasy” Use Is Associated With Increased Impulsivity:

Neuroendocrine and subjective responses to pharmacological challenge with citalopram: a controlled study in male and female ecstasy/MDMA users

Despite evidence that +/-3,4-methylenedioxymethamphetamine (MDMA; 'ecstasy') causes persistent alterations to the serotonergic system of animals, evidence for long-term neurological effects of ecstasy/MDMA in humans remains equivocal. The current study assessed serotonin functioning of nine male and 11 female recreational ecstasy polydrug users by measuring neuroendocrine (prolactin, cortisol) responses to pharmacological challenge with the selective serotonin reuptake inhibitor citalopram, compared with nine male and five female cannabis polydrug users and 11 male and 11 female non-drug using controls. A single-blind, randomised, placebo-controlled design was used. Subjective responses, other substance use, mood, personality traits and demographic variables were measured to control for potentially confounding variables. There were no significant differences between ecstasy polydrug users, cannabis polydrug users and non-drug using controls in neuroendocrine or subjective responses to serotonergic challenge, and there were no sex by drug group interactions. There was no relationship between extent of ecstasy use and neuroendocrine functioning, alone or in combination with potential confounding variables. Subjective responses to the pharmacological challenge (nausea, tremor, dry mouth), novelty seeking and lifetime dose of alcohol were the only variables that contributed to one or more of the neuroendocrine outcome variables. These data do not support the premise that recreational ecstasy/MDMA use results in measurable impairment of serotonergic control of endocrine activity.

Impulsivity and borderline personality as risk factors for suicide attempts among opioid-dependent individuals

The study aimed to examine the association of impulsivity and screening positively for borderline personality disorder (BPD+) as risk factors for suicide attempts among opioid-dependent individuals. The study used a case-control design with 775 opioid-dependent cases and 306 non-opioid-dependent controls. Cases were more likely than controls to screen BPD+ and to be classed as highly impulsive. Significant risk for lifetime suicide attempt was associated with screening BPD+ and also with high impulsivity. A number of risk factors were identified for suicide attempts among those with either high impulsivity or among those who screened BPD+: being female, a diagnosis of an anxiety disorder and a diagnosis of illicit drug dependence (other than opioid dependence). Opioid dependence was not a unique risk factor for suicide attempts among either the BPD+ group or the high impulsivity group. Although opioid dependence was not a unique risk factor for suicide attempts among those who screened BPD+, cases presented with multiple risk factors at substantially higher rates than controls. This research also highlights the importance of assessing impulsivity, in both clinical settings and research, particularly among those with a history of suicidal behaviour.

A structured review of reasons for ecstasy use and related behaviours: pointers for future research

BACKGROUND

While the health risks of using ecstasy warrant intervention development, a recent meta-analysis of determinants of ecstasy use identified a number of lacunae in the literature. Specifically, no studies were included that address behaviours other than 'using ecstasy' (e.g. 'trying out ecstasy' or 'ceasing ecstasy use'). However, because meta-analyses aim to integrate study results quantitatively, the resulting rigid exclusion criteria cause many studies to be discarded on the basis of their qualitative methodology. Such qualitative studies may nonetheless provide valuable insights to guide future research. To provide an overview of these insights regarding ecstasy use, the current study summarizes and combines what is known from qualitative and exploratory quantitative literature on ecstasy use.

METHODS

The databases PsycINFO and MedLine were searched for publications reporting reasons for ecstasy use and related behaviour, and the results were structured and discussed per behaviour and compared over behaviours.

RESULTS

Two main categories of reasons were found. The first category comprised reasons to start using ecstasy, use ecstasy, use ecstasy more often, and refrain from ceasing ecstasy use. The second category comprised reasons to refrain from starting to use ecstasy, use less ecstasy, and cease using ecstasy. Reasons for related behaviours within each of these two categories appear to differ, but not as substantially as between the two categories. A large number of reasons that were not yet explored in quantitative research emerged.

CONCLUSION

The current summary and combination of exploratory studies yields useful lists of reasons for each behaviour. Before these lists can inform interventions, however, they beg quantitative verification. Also, similarity of determinant configurations of different behaviours can be assessed by addressing determinants of several behaviours in one study. Another important finding is that meta-analytical integration of the literature may overlook important findings and implications. Thus, qualitative reviews remain useful instruments in setting the research agenda.

Distinctions in Behavioral Impulsivity: Implications for Substance Abuse Research

OBJECTIVES: Researchers have clearly implicated impulsivity as having a key role in substance use disorders, and comparisons of self-report measures suggest there are measurably different components of impulsive behavior. However comparatively little research has been devoted to understanding the multidimensional nature of this construct using laboratory measures of impulsivity that may be more sensitive to tracking changes across time. Many studies have measured impulsivity, but this construct has been measured using methodologically different types of laboratory impulsivity paradigms that are often used in isolation. As a result, it is important to determine whether some of the most frequently used types of behavioral measures of impulsivity account for unique variance. METHODS: Here, we used factor analytical techniques in two studies to evaluate the independence of three of the most commonly used behavioral impulsivity paradigms. First, a factor analysis was conducted using previously collected data (n = 204), and second, data was gathered specifically to replicate and extend the results of our original analysis (n = 198). RESULTS: Both studies revealed three distinct factors, confirming our hypothesis of at least three components of impulsive behavior that can be measured by these methodological approaches. CONCLUSIONS: These findings suggest that researchers should carefully consider their selection of laboratory-behavioral impulsivity measures, and that the measure(s) selected should be related to the particular underlying processes relevant to substance use disorders and treatment success.

Recreational ecstasy use and the neurotoxic potential of MDMA: current status of the controversy and methodological issues

The controversy over possible MDMA-induced serotonergic neurotoxicity in human recreational ecstasy users is examined critically in light of recent research findings. Although the designs of such studies have improved considerably since the 1990s, the evidence to date remains equivocal for a number of reasons, including (1) inconsistent findings on the existence and reversibility of persistent ecstasy-related serotonergic and cognitive deficits; (2) lack of clear association between changes in brain imaging measures and functional deficits attributed to MDMA-induced neurotoxicity; (3) the contribution of concomitant cannabis or other drug use to both brain imaging abnormalities and cognitive deficits; (4) methodological shortcomings such as failure to adequately match samples of ecstasy users and controls; (5) the questionable relevance of animal models of MDMA-induced neurotoxicity to typical human patterns of ecstasy use; and (6) the potential role of inherent pre-drug deficits in serotonergic systems, impulse control and executive cognitive function that may predispose to excessive use of drugs including ecstasy. Given the retrospective nature of nearly all studies of ecstasy users to date, the controversy over whether MDMA has ever caused neurotoxicity or cognitive deficit in human ecstasy users is likely to continue for some time without resolution.

Disrupted 'reflection' impulsivity in cannabis users but not current or former ecstasy users

Evidence for serotonin involvement in impulsivity has generated interest in the measurement of impulsivity in regular ecstasy users, who are thought to display serotonergic dysfunction. However, current findings are inconsistent. Here, we used a recently developed Information Sampling Test to measure 'reflection' impulsivity in 46 current ecstasy users, 14 subjects who used ecstasy in the past, 15 current cannabis users and 19 drug-naïve controls. Despite elevated scores on the Impulsivity subscale of the Eysenck Impulsiveness-Venturesomeness-Empathy questionnaire, the current and previous ecstasy users did not differ significantly from the drug-naive controls on the Information Sampling Test. In contrast, the cannabis users sampled significantly less information on the task, and tolerated a lower level of certainty in their decision-making, in comparison to the drug-naive controls. The effect in cannabis users extends our earlier observations in amphetamine- and opiate-dependent individuals (Clark, et al., 2006, Biological Psychiatry 60: 515-522), and suggests that reduced reflection may be a common cognitive style across regular users of a variety of substances. However, the lack of effects in the two ecstasy groups suggests that the relationship between serotonin function, ecstasy use and impulsivity is more complex.

Adolescent Suicidal Behavior and Substance Use: Developmental Mechanisms

Adolescent suicidal behaviors and substance use are disturbingly common. Research suggests overlap of some of the etiological mechanisms for both adolescent suicidal behavior and substance use, yet clear understanding of the complex relations between these behaviors and their causal underpinnings is lacking. A growing body of evidence and a diathesis model (Mann et al. 1999; Mann, 2003) highlight the importance of impulse control as a proximal risk factor for adolescent suicidal and substance use behaviors. This literature review extends current theory on the relationships between adolescent suicidal behavior and substance use by: (1) examining how, when, and to what extent adolescent development is affected by poor impulse control, stressful life events, substance use behavior, and biological factors; (2) presenting proposed causal mechanisms by which these risk factors interact to increase risk for suicidal behaviors and substance use; and (3) proposing specific new hypotheses to extend the diathesis model to adolescents at risk for suicide and substance use. More specifically, new hypotheses are presented that predict bidirectional relationships between stressful life events and genetic markers of 5-HT dysregulation; substance use behavior and impulsivity; and substance use behavior and suicide attempts. The importance of distinguishing between different developmental trajectories of suicidal and substance use behaviors, and the effects of specific risk and protective mechanisms are discussed. Use of new statistical approaches that provide for the comparison of latent growth curves and latent class models is recommended to identify differences in developmental trajectories of suicidal behavior and substance use. Knowledge gained from these prospective longitudinal methods should lead to greater understanding on the timing, duration, and extent to which specific risk and protective factors influence the outcomes of suicidal behavior and substance use. In turn, findings from these studies should inform researchers who conduct future treatment and prevention studies.

Behavioral measures of impulsivity and the law

The General Theory of Crime proposes that crime is explained by the combination of situational opportunity and lack of self-control. Impulsivity is one of the important components of self-control. Because behavioral measures of impulsivity are becoming more commonly utilized to assess forensic populations, this manuscript provides an overview of three current behavioral measures. In doing so, an example of their application is provided using a group of individuals likely to come into contact with the legal system: adolescents with Conduct Disorder. Earlier age of onset of Conduct Disorder symptoms has been shown to be an important predictor of the persistence of poor outcomes into adulthood, including participation in criminal activities. This study found differential behavioral profiles across distinct measures of impulsivity by those with childhood- versus adolescent-onset Conduct Disorder. Legal implications for defining behavioral deficits using behavioral measures of impulsivity and their current limitations are discussed.

Hug drug or thug drug? Ecstasy use and aggressive behavior

While clinical studies have established a link between aggression and ecstasy (3,4-methylenedioxymeth-amphetamine [MDMA]), no research has attempted to explore how this link manifests itself in behavioral outcomes. In this research we examine the effects of ecstasy on aggressive and violent behavior in a sample of active users. Data were collected from 260 ecstasy users in Atlanta, Georgia. Data analysis included ordered logit regression to examine the likelihood of engaging in aggressive behavior, controlling for key predictors of aggression independent of ecstasy use. Our results indicate that those with a higher prevalence of lifetime ecstasy use exhibit higher levels of aggressive and violent behavior. However, the effect of lifetime ecstasy use differs by levels of low self-control as a measure of propensity for aggression. Those who exhibit low self-control are more affected by ecstasy use than those who do not in terms of aggression. Our findings add an important dimension to our current knowledge about the relationship between aggression and ecstasy.

Effect of nicotine on negative affect among more impulsive smokers

In the present study, the authors tested the hypothesis that nicotine would provide greater relief from negative affect for more impulsive smokers than for less impulsive smokers. Euthymic adult smokers (N=70) participated in 2 laboratory sessions, during which they underwent a negative mood induction (music + autobiographical memory), then smoked either a nicotinized or de-nicotinized cigarette. Mixed-effects regression yielded a significant Impulsivity x Condition (nicotinized vs. de-nicotinized) x Time interaction. Simple effects analyses showed that heightened impulsivity predicted greater negative affect relief after smoking a nicotinized cigarette but not after smoking a de-nicotinized cigarette. These data suggest that nicotine may be a disproportionately powerful negative reinforcer for highly impulsive smokers, promoting higher levels of nicotine dependence and inhibiting smoking cessation.

Acute effects of 3,4-methylenedioxymethamphetamine (MDMA) on behavioral measures of impulsivity: alone and in combination with alcohol

The use of 3,4-methylenedioxymethamphetamine (MDMA) has frequently been associated with increased levels of impulsivity during abstinence. The effects of MDMA on measures of impulsivity, however, have not yet been studied during intoxication. The present study was designed to assess the acute effects of MDMA and alcohol, alone and in combination, on behavioral measures of impulsivity and risk-taking behavior. A total of 18 recreational users of MDMA entered a double-blind placebo-controlled six-way crossover study. The treatments consisted of MDMA 0, 75, and 100 mg with and without alcohol. Alcohol dosing was designed to achieve a peak blood alcohol concentration (BAC) of about 0.06 g/dl during laboratory testing. Laboratory tests of impulsivity were conducted between 1.5 and 2 h post-MDMA and included a stop-signal task, a go/no-go task, and the Iowa gambling task. MDMA decreased stop reaction time in the stop-signal task indicating increased impulse control. Alcohol increased the proportion of commission errors in the stop-signal task and the go/no-go task. Signal detection analyses of alcohol-induced commission errors indicated that this effect may reflect impairment of perceptual or attentive processing rather than an increase of motor impulsivity per se. Performance in the Iowa gambling task was not affected by MDMA and alcohol, but there was a nonsignificant tendency towards improvement following alcohol intake. None of the behavioral measures of impulsivity showed a MDMA x alcohol interaction effect. The lack of interaction indicated that the CNS stimulant effects of MDMA were never sufficient to overcome alcohol-induced impairment of impulse control or risk-taking behavior.

Suicidal behaviors and drug abuse: impulsivity and its assessment

Impulsivity appears to play an important role in suicidal behaviors and drug abuse, which are two psychiatric problems that may interact with one another. Interpretation of the literature on impulsivity in these behaviors may be complicated by the variety of measurement techniques for the assessment of impulsivity. There are three general types of impulsivity assessment: self-report, biological, and laboratory behavioral. Because laboratory behavioral measures both meet an operational definition of impulsivity and are sensitive to state-dependent changes in impulsivity, this paper presents data that focuses on laboratory behavioral performance among samples emitting suicidal behaviors or substance abuse. To better account for influence of impulsivity in these psychiatric disturbances, no single source of measurement should be used without the consideration of other types of instruments.

Functional MRI study of working memory in MDMA users

RATIONALE

Methylene-dioxymethamphetamine (MDMA) is known to cause degeneration of serotonin nerve terminals after acute doses in animals. Similarly, behavioral studies in human MDMA users regularly find abnormalities in memory, mood, and impulse control. However, studies of brain function using brain imaging in MDMA users have been less consistent.

OBJECTIVES

The purpose of this study was to determine, using functional magnetic resonance imaging (fMRI), whether individuals with a self-reported history of MDMA use would differ from non-MDMA using controls on activation while performing a working memory task.

METHODS

Fifteen MDMA using subjects and 19 non-MDMA using controls underwent fMRI scanning while performing the immediate and delayed memory task (IMT/DMT). The study was based on a block design in which the delayed memory task (DMT) alternated with the immediate memory task (IMT), which served as a control condition. FMRI scans were acquired on a 1.5 T scanner, using a gradient echo echoplanar pulse sequence.

RESULTS

Random effects SPM99 analysis showed significantly greater activation (whole volume corrected cluster P<0.05) during the DMT relative to the IMT in the MDMA subjects compared with the control subjects in the medial superior frontal gyrus, in the thalamus extending into putamen, and in the hippocampus.

CONCLUSIONS

Although these effects could be due to other drugs used by MDMA users, these results are consistent with behavioral problems that are associated with MDMA use, and with animal studies on the effects of MDMA on brain function.