What Is Ecstasy Addiction

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Ecstasy (MDMA) addiction is defined as compulsive-drug seeking behaviour, regardless of negative consequences such as:

Depression caused by a 46% reduction in serotonergic activity in the cerebral cortex after consuming ecstasy for 3 months [1]
Mouth ulcers and occlusal tooth wear caused by excessive chewing and teeth grinding for up to 48 hours after use of ecstasy

Physical Consequences Of Ecstasy Addiction

Teeth Grinding And Jaw Clenching

Teeth grinding and jaw clenching are physical consequences of ecstasy addiction due to an 8-fold increase of serotonergic activity within 40 minutes of consuming 3mg/kg ecstasy [2].

Serotonin (5-HT) levels remain 3 times higher for up to 2 hours after taking ecstasy and stay elevated by 20% in the occipital-parietal and temporal brain regions for up to 90 days, leading to [3] [4]:

Jaw clenching and teeth grinding in 89% of users, typically lasting until the morning after drug-taking [5]
Bruxism, hypersensitive teeth, and mouth ulcers from excessive chewing in 44%, lasting up to 48 hours after taking ecstasy [6]
Occlusal tooth wear in 60% and enamel loss exposing dentine and pulp 2 - 4 mm under the surface [5] [7]

Blurred Vision And Eye Twitching

Blurred vision and eye twitching are physical consequences of ecstasy addiction due to a 5-fold increase in dopamine and an 8-fold increase in serotonin in the brain [2] [8].

Ecstasy-induced damage to the serotonergic and dopaminergic neurons causes blurred vision and eye twitching for around 1 hour after drug-taking in 69% of chronic users (mean use duration = 3.6 years) [6]:

In a case study, a 17-year-old man experienced diplopia (double vision) for 5 days after taking 80 – 160mg ecstasy tablets at least once a week for up 2 months [9]
In a case study, a 31-year-old man experienced acute vision loss (visual field index = 0) triggered by a 10-second flickering sensation after using ecstasy sporadically [10]

Rhabdomyolysis

Rhabdomyolysis is a physical effect of ecstasy addiction caused by dehydration and hyperthermia (>38.0 °C) in up to 85% of ecstasy misusers [11].

In a case study, a 20-year-old man experienced rhabdomyolysis within 38 hours of consuming ecstasy during a music event after consuming ecstasy once every 1 – 2 months for over 2 years:

The man experienced hyperpyrexia immediately (41.4°C) and became stiff and unresponsive; after 24 hours, he experienced hyperthermia (38.6°C) that lasted for 5 days
Bilateral 5–7 cm posterior arm bruises and swelling developed within 24 hours, and platelet count dropped to 22,000 platelets/μL (normal value = 150,000 - 450, 000 μL)
Plasma creatine kinase (CK) increased to 409,440 U/L (normal value = 40–320 U/L) and took 10 days to return to baseline levels [12]

Ecstasy misuse increases the likelihood of developing rhabdomyolysis by 19.9% in comparison to 3.0% for alcohol, as up to 2500 mL/h water is lost from sweating compared to 900ml for every 2 hours of drinking alcohol [13] [14].

Muscle Cramps

Muscle cramps are a physical consequence of addiction to ecstasy because of Hyponatremia (sodium < 130 mmol/L) in 38.8% and dehydration in 85% of users [11] [15].

A 20 – 30% sweat-induced loss of sodium leads to muscle cramping and is likely to be exacerbated after misusing ecstasy due to [16]:

Profuse sweating in up to 85% of ecstasy addicts whilst intoxicated, for up to 3 hours after consumption [6] [11]
Up to 1500mg of sodium is lost per litre of sweat, and ecstasy takers have an average sweat rate of 2500 mL/hr whilst in a hot environment (e.g. rave/nightclub) [13] [17]

57.6% of ecstasy addicts experience muscle aches, and 33.4% experience joint pain/stiffness during a ‘come down’, lasting up 3 days after intoxication [6].

Psychological Consequences Of Ecstasy Addiction

Loneliness

Loneliness in 51.5% of ecstasy misusers is a psychological consequence of ecstasy abuse caused by disruptions in serotonergic neurotransmission and oxytocin release, leading to [18]:

Enhanced feelings of compassion and deep emotional connection in 69% for around 3 hours, as oxytocin increases by up to 150 pg/ml within 120 minutes of drug-taking [19] [20]
Low mood and depression in 55.6% caused by a 90% depletion of 5-HT in the frontal cortex after chronic ecstasy use, increasing the likelihood of loneliness by up to 51% [3] [6] [21]
Ecstasy-induced emotional dysregulation results in 80 - 100% feeling happy, warm, friendly, and talkative whilst intoxicated, whereas 55 – 90% feel depressed, irritable, and lethargic after using [11]

Feelings of loneliness during ecstasy dependence are likely to be exacerbated by a lack of social support in 82.4% and damaged relationships with friends/family in over 40% caused by drug-induced arguments, anxiety, or mistrust [6].

Socialising Addiction

A co-occurring behavioural addiction to socialising occurs during ecstasy dependence because a 5-fold increase in dopamine (DA) leads to long-term potentiation and habit formation based on motivational arousal [8].

54.8% of ecstasy addicts use the drug for sociability as over 40% believe that ecstasy improves social confidence and friendship quality [20]:

Ecstasy addicts are more likely to consume ecstasy with friends in a club, rave, or festival setting compared to at home in private (54.4 vs 4.97%) [20]
Exposure to ecstasy-related cues (e.g. electronic dance music) exacerbates drug cravings in over 50% of chronic users (>30 uses during lifetime) [22]
DA release reinforces addictive behaviour by strengthening the association between an action (using ecstasy for sociability) and positive experiences (gaining social confidence)

Ecstasy-Induced Psychosis

Ecstasy-induced psychosis occurs as a result of ecstasy misuse because serotonergic and dopaminergic neurotransmission is increased by up to 501% and remains disrupted for up to 7 years [8]:

Chronic ecstasy users (used an average of 371 times) are more likely to experience paranoia (9.0 vs 7.4), hostility (9.7 vs 6.4) and psychoticism (12.7 vs 9.0) in comparison to occasional users (used an average of 7 times) [23]
Ecstasy-induced psychosis increases aggression and violence by 47.2%, resulting in hospitalisation for up to 3 weeks in some cases [24]

In a case study, a 28-year-old man experienced psychosis and had obsessive delusions about partner infidelity for around 7 months, following an increase in ecstasy use (2 to 10 tablets a night) after taking the drug weekly for 18 months [25].

One study found that 100% of ecstasy addicts used cannabis simultaneously, and were 271% more likely to develop drug-induced psychosis [23] [26].

Amotivational Syndrome

Amotivational syndrome occurs during MDMA addiction because prolonged hyperstimulation of the serotonergic and dopaminergic system replaces the hedonistic-euphoric state with anhedonia and hypophoria [27]:

65% experience a lack of energy and feel unmotivated after taking MDMA, resulting in 11 - 25% taking sick leave, quitting or being dismissed from a job within 6 months of drug-taking [6]
Up to 80% experience low mood and impaired concentration between drug-taking sessions due to serotonergic neurotoxicity in the brain caused by taking MDMA 2 – 3 times monthly for up to 12 years [28]

A qualitative study found that up to 17% of MDMA users (>6 months of use) felt that the drug dampened aesthetic experiences, feelings of positivity and worsened friendship quality:

“MDMA has dulled my ability to appreciate listening to music or being in nature, even when I am not on the drug”
“MDMA has caused me to have more blunted and shallower emotional experiences in my daily life, even when not on the drug” [20]

How MDMA Addiction Develops

Stage	Indicators Of This Stage
Initial Recreational Use	Around 4 days of use within 90 days [29] Used on weekends, holidays or special occasions (e.g. birthdays) to relax and connect with others No withdrawals, cravings or negative effects on health/social status (e.g. remains in full-time employment)
Habitual Use	Taken at least once monthly; user believes drug use is controlled and still used for recreational purposes [29] Goal-directed and self-medicating (e.g. using after a miscarriage and continuing when feeling low due to positive effects)
Dependence	Attending social events more frequently, as ecstasy is mostly used (85%) with friends at raves, parties or clubs [33] Compulsive drug seeking regardless of negative consequences (e.g. job loss) + heavier use e.g. >4 tablets in 1 night [6]
Addiction	Reliant on ecstasy to function; daily use for at least 90 days, typically alongside other drugs (e.g. heroin, cocaine) Solitary use and inability to maintain daily activities or function in society [29]
Withdrawal	Depression, anxiety, fatigue, intense ecstasy cravings, and insomnia within 24 - 72 hours of last use

Who Is Most At Risk Of Developing An MDMA Addiction?

Who Is Most At Risk?	Why?
18 - 25 Year Olds	25% more impulsive than over 65s due to an undeveloped prefrontal cortex; impulsiveness is positively correlated with heavy ecstasy use (>20 times) (rs = 0.29, n = 46,P = 0.049) [30][31] Ecstasy is mostly used at clubs, raves or parties (85.1%) and 70.4% of frequent clubbers are under 30 [32][33]
Social Anxiety	55% use ecstasy for sociability, fitting in and coping and 47% feel more socially confident whilst intoxicated [20]
Trauma Sufferers	123% more likely to use ecstasy to cope with sexual abuse or domestic violence, for more days per month (4 vs 1) compared to those with no trauma history [34]
Polydrug Users	Using marijuana, opioids or cocaine increases the risk of ecstasy use by 23% within 30 days [35] Cravings for multiple drugs increase by up to 60% on ‘non-using’ days, requiring higher/more frequent doses due to tolerance (>4 vs 1-2 pills daily) [36]
Chronic Stress Sufferers	Used by up to 80% to cope with chronic stress, and less than 25% feel in control of their drug-taking [37] Habitual use is reinforced as ecstasy increases cortisol levels by up to 800%, remaining elevated for up to 3 months after using [38]

MDMA Addiction Risks And Dangers

Contaminated Ecstasy

Contaminated ecstasy causes hepatic, cardiovascular, cerebral, and hyperpyrexic toxicity due to blood levels (0.5mg/L - 10mg/L) up to 40 times higher than the typical recreational range [39]:

Different batches of ecstasy pills vary 70-fold or more, as some contain mixtures of para-methoxyamphetamine (PMMA), 3,4-methylenedioxy-phenyl-N-methylbutanamine, and ephedrine [39]
Ecstasy mixed with PMMA causes hyperthermia (39.4° C), and serotonin syndrome in up to 94%, requiring hospitalisation for neuromuscular paralysis, orotracheal intubation, and rapid cooling [40]
PMMA in ecstasy has contributed to 50 deaths, as users are typically unaware of the contamination and take an average of 6 hours to seek medical care after exposure [40]

In a case study, 12 users overdosed after unintentionally consuming MDMA pills containing 18% xenobiotics (e.g. pesticides) or double the standard MDMA dose (270mg):

58% experienced severe hyperthermia (40.9-43° C) for around 3 hours, 50% experienced hypotension (90/60mmHg) and 67% required emergent endotracheal intubation
2 patients died, and 4 users had permanent neurologic, musculoskeletal and renal sequelae after experiencing hyperkalemia, acute kidney injury, and rhabdomyolysis [41]

Overdose

Ecstasy overdose risks are exacerbated in addicts because addicts are more likely to:

Have depression (65% vs 33%) and higher levels of impulsivity (32% vs 18%) in comparison to casual users, increasing the risk of intentional overdose by 260% [42] [43]
Have anxiety disorders (60% vs 32%) caused by disruptions in serotonergic activity and use MDMA to gain social confidence, increasing the chances of unintentional overdose by 82% [42] [43]
Take up to 10 pills on one occasion compared to a maximum of 3 for occasional users due to a higher tolerance; only 19% of pills contain pure ecstasy and ingesting unknown substances causes 25% of overdoses [42] [43] [44]
Use multiple drugs like cocaine (75% vs 56%), LSD (83% vs 69%) and benzodiazepines (33% vs 12%) in comparison to casual users; increasing the overdose risk by 3-fold [23] [43]

(Read about rehab for LSD here.)

In a case study, 35% reported increasing their MDMA dose to achieve the desired effect after developing a drug tolerance:

A 30-year-old man took around 10 pills every weekend for 8 years and started to 'cook down' and inject 250mg of powder up to 4 times daily; intravenous drug use heightens the risk of unintentional overdose by 185% [42] [43]
“My tolerance has increased, so I now take 3 or 4 at once and if I can’t get that much, then I’ll snort one and a half, chop them up and do them both at once, I’ve eaten up to 8 at once.” - an 18-year-old girl who had taken MDMA over 50 times [42]

How Do Different Forms Change MDMA Addiction?

	Pills	Powder
Description	Resemble colourful sweets stamped with logos (e.g. butterfly)	Off-white/ light yellow finely crushed crystalline, bitter taste
Route Of Administration	Oral ingestion (97%)	Snorting (76%) or rubbed into gums by some users
Cost	Around £10, some are under £5	Around £14 per 0.1g
Average Use Per Session	4 pills	1 gram or 4 lines
Risks	Only 19% contain pure ecstasy [44] Addicts take 500+ pills during lifetime; 1 in 340 pills cause an overdose [42][45]	Mixed with other white highly-potent drugs e.g. fentanyl Rapid onset vs 30 - 45 minutes for pills
How Does This Form Change Addiction?	Easily accessible as 40% of addicts are unemployed [47]	Long-term nasal damage e.g, loss of smell, nasal septum destruction

	Capsules	Crystal
Description	Clear capsule shells coated with gelatine, filled with 100mg powder or crystal	White or grey crystals, resembling rough quartz crystal
Route Of Administration	Oral ingestion (95%)	Oral ingestion (85%) or smoked (9%)
Cost	Around £12 per capsule	Up to £100 per gram
Average Use Per Session	3 capsules	0.8g
Risks	Only 34% contain pure ecstasy 30% take capsules with unknown contents [44]	Increases overdose risk by 47%, although some believe crystals are “safer or purer” than powder [46]
How Does This Form Change Addiction?	Used at a younger age (18 vs 20) compared to pure crystal [44]	Contributes to financial problems in 38% of addicts [6]

How Does Taking SSRIs Change MDMA Addiction?

Taking SSRIs (e.g. citalopram, sertraline) alongside MDMA changes MDMA addiction because the risk of mortality is increased by 182% due to [48]:

Serotonin syndrome (SS) in up to 16% is caused by an 8-fold increase in serotonergic activity within 40 minutes of consuming 3mg/kg ecstasy and a 2-4-fold increase within 6 hours of taking SSRIs [2] [49]
Simultaneous fluoxetine use in 16% of ecstasy addicts increases the metabolisation of ecstasy by up to 30% and may lead to SS within 24 hours of initiation with symptoms such as myoclonus and delirium [44] [50]
Early signs of SS (e.g. sweating, agitation) develop within 6 hours of drug-taking and are often perceived by ecstasy addicts to be ‘normal’ drug reactions, therefore medical care is unlikely to be initiated

References

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About the author

Mischa Ezekpo

Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: November 12, 2025