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KEY TAKEAWAYS

Ecstasy (MDMA) rehab helps overcome addiction by:

Managing withdrawal symptoms with medication (e.g. Aspirin for jaw pain)
Aiming to address social anxiety, eating disorders, and low self-esteem with CBT and mindfulness
Liaising with GPs and community resources to provide ongoing support during recovery

When Is Ecstasy Rehab Necessary?

Psychological Dependency

Psychological dependency means ecstasy rehab is necessary because intense psychological cravings occur daily, starting around noon, peaking between 9 pm – 12 am each night, and persisting for up to 6 months without rehab treatment [1]:

Weekly CBT and mindfulness exercises address cravings with cognitive restructuring, coping skills training, breathing exercises, and metaphorical storytelling
10-minute role plays encourage patients to act out drug-refusals and non-drug-related behavioural activities (e.g. journalling) to manage external (dance music) and internal (low mood) triggers for ecstasy use [2]

Ecstasy rehab is necessary for up to 55% of users who are reliant on ecstasy to cope with social anxiety due to an 82% increased risk of unintentional overdose in comparison to users with no anxiety disorder [3] [4]:

The avoidance of ‘high-risk’ situations (e.g. taking 4+ pills in one night to gain social confidence) is discussed during therapy sessions and replaced with ‘low-risk' activities (e.g. taking Propranolol)
SSRIs (e.g. citalopram) and Omega-3 supplements are provided to stimulate serotonin, following a 46% reduction in serotonergic activity after daily drug-taking, exacerbating anxiety in up to 33% of users [5] [6]

Polydrug Addiction

Polydrug addiction means ecstasy rehab is necessary because:

30.1% of ecstasy users also use heroin and require 8 - 32mg buprenorphine for up to 7 – 14 days, followed by psychotherapy to address the needs of both addictions (e.g. social anxiety and overdose-related trauma) [6] [7]
93.6% of ecstasy users consume alcohol simultaneously, requiring 15 – 40mg Chlordiazepoxide for 5 – 10 days and 100mg Thiamine 3 times daily to manage dehydration and prevent delirium tremens whilst addressing overlapping cue-induced cravings (e.g. parties, social anxiety) and focusing on relapse prevention [6] [8]
56.8% of ecstasy users have co-occurring benzodiazepine addictions, requiring a 5 – 10% taper every 1 – 2 weeks alongside propranolol, zopiclone or SSRIs to manage anxiety, insomnia, and depression [6] [9]
The overdose risk increases by 3-fold and psychosis by 271%; specialist addiction staff conduct daily mental status examinations to identify any signs of psychosis (e.g. hallucinations, mood swings) and implement harm-reduction strategies into weekly counselling sessions [4] [10]

Onset Of Medical Conditions

Experiencing the onset of dehydration means ecstasy rehab is necessary because temperature, blood pressure, and pulse rates are checked regularly, electrolyte replacements (e.g. sodium chloride) are given, and 2 – 3L of fluid is encouraged daily to mitigate [11]:

The 20% increased risk of developing rhabdomyolysis within 24 - 48 hours of cessation, due to dehydration and hyperthermia (>38◦C) in 85 - 90% of users whilst intoxicated [12] [13]
Profuse sweating and hot/cold flushes in 18 – 26% during ecstasy detox, after experiencing a 2500 mL/h sweat rate and an average 1.6 ◦C increase in body temperature for up to 6 hours whilst intoxicated [6] [14] [15]
The exacerbation of muscle aches in 57.6% and joint pain/stiffness in 33.4% caused by a 20 - 30% loss of sodium, lasting up to 2 days after use [6] [16]

Some rehabs use cooling blankets, fanning, and ice baths alongside isotonic intravenous or oral liquids like normal saline (0.9% NaCl) or coconut water to aid rehydration and lower body temperature by 3 – 4 ◦C within 1 hour [15].

Ecstasy Rehab Process

Detox

Detox occurs during an ecstasy rehab programme by removing ecstasy from the body and managing symptoms of withdrawal (e.g. bruxism, dysphoria) with medication (e.g. NSAIDs, SSRIs, beta-blockers) and nutritional supplements (Omega-3, Sodium Chloride).

Therapy

Therapy sessions in ecstasy rehab address emotional reliance for social confidence with:

Rapport Building (Around 5 minutes): The therapist asks prompting questions (e.g. “To what extent has ecstasy affected your social life?) to engage the patient and understand intentions for drug use
Psychoeducation (10 minutes): Collaborative discussions using Handouts (e.g. Ecstasy Good vs Bad worksheet: Good = Easier to talk to strangers vs Bad = Increases social anxiety after use)
Motivational Interviewing and Feedback (30 minutes): Reframing techniques, e.g. Patient: “Dancing in front of others is less daunting and more fun” vs Therapist: “Are the friendships you make in clubs something you value? “What makes the situation fun?” [17]

Self-esteem scores increased by 54.2% within 5 months of receiving 2-weekly group counselling sessions focused on building self-esteem and acceptance through the expression of feelings and development of social cohesion:

Group members collaboratively discussed positive (achievements, values) and negative (self-criticism, desire to please) indicators of self-esteem and drug use
Therapists provided personalised feedback and focused on enhancing competence and autonomy to replace negative self-attributions [18]

CBT And Mindfulness

CBT and Mindfulness techniques in ecstasy rehab address emotional dysregulation caused by a 46% reduction in serotonin by incorporating breathing techniques, cognitive reappraisal, and problem-solving strategies [5]:

60-minute CBT sessions are divided into 3 20-minute sub-sessions to assess patients' mental functioning and develop/practice cognitive skills related to the current emotional state (e.g. catastrophising vs acceptance) [2]
4-7-8 Breathing requires patients to close their eyes and inhale through the nose for 4 seconds, hold for 7 seconds, and exhale through the mouth for 8 seconds, repeating the cycle 4 times
Box Breathing encourages patients to sit with a straight back, inhale through the nose, hold, exhale through the mouth, and hold, each for 4 seconds whilst repeating the cycle for 5 – 10 minutes [19]

Anhedonic depression in ecstasy users decreases by 24%, and catastrophising decreases by 37% after 10 weeks of CBT incorporated with motivational interviewing, mindfulness, and harm reduction [20].

Depression and anxiety in stimulant misusers decrease by up to 68% after practising mindfulness for an average of 145.3 minutes during 8 weeks of treatment [21].

Aftercare Planning

Aftercare planning in ecstasy addiction treatment addresses social or recreational triggers with:

4 - 6 months of family counselling sessions to strengthen existing relationships and social networks, improve communication, and promote engagement in drug-free family activities (e.g. daily walks) to aid recovery [22]
Weekly continuing care group meetings for up to 12 months with flexible timings (e.g. 1 pm or 6 pm) whilst providing information about 24-hour hotlines for those motivated to use during daytime boredom or late nights [23]
45 – 90-minute individual counselling sessions with psychoeducation about how to identify/manage cue-induced cravings during recovery (e.g. hearing dance music in a nightclub) [23]
Linkage to community resources, GPs, and specialist mental health services for ongoing monitoring and treatment (e.g. citalopram, propranolol) to manage social anxiety
Encouragement to attend ongoing peer support groups to share experiences, practice drug-refusal skills (e.g. saying 'no immediately', changing topic), and discuss breaking contact with drug dealers/ecstasy-using friends/family

Ecstasy Rehab Vs Other Drugs

	Detox	Withdrawal Symptoms Timeline
Ecstasy	7 - 14 days	12 - 24 hours: Exhaustion, Dysphoria 1 - 3 days: Increased Appetite, Anxiety 7+ days: Episodic cravings, anhedonia, fatigue
Heroin	7 - 10 days or up to 12 months with MM	12 - 48 hours: Runny nose, watery eyes, panic attacks 3 - 5 days: Appetite Loss, Diarrhoea, Vomiting, Goosebumps 7+ days: Anxiety, mild nausea
Alcohol	5 - 10 days	12 - 48 hours: Headaches, Hallucinations, Seizures 48 - 72 hours: Delirium Tremens, Hypertension 5 - 7 days: Symptoms begin to subside
Cocaine	Around 7 days	6 - 12 hours: Anxiety, Paranoia 1 - 3 days: Mood Swings, Aches and Pains, Chills 7+ days: Suicide ideation, Insomnia
Cannabis	Around 14 days	24 - 48 hours: Excessive sweating, Irritability, Insomnia 3 - 7 days: Tremors, abdominal pains 7 - 14 days: Mood disturbances persist

	Therapy Focus	MAT Used?
Ecstasy	Developing coping skills Building self-esteem Emotion regulation	No
Heroin	Grief and Overdose-related trauma Harm reduction Craving management	Yes
Alcohol	Stress-management Strengthening social and coping skills Cognitive restructuring	Yes
Cocaine	Managing triggers and cravings Sleep hygiene and relaxation	No
Cannabis	Mindfulness Building sober support networks Managing pain, stress and insomnia	No

Ecstasy Rehab Vs Other Treatment Approaches

	Ecstasy Rehab	Neuroplasticity Training
Full Treatment Programme?	Yes	No
Purpose Of Treatment	Detox Regulate emotions + restore chemical imbalances Build self-esteem, coping, and social skills	Improve cognitive functions (e.g. memory, attention) by: Strengthening existing neural pathways Developing new skills (e.g learning a language)
Detox?	Yes	No
Structure And Routine	7 - 10 day detox with symptom management Individual and Group Therapy Aftercare	Repetitive practice of skills/activities, such as: Video games Physical exercise Learning to play an instrument
Relapse Management?	Yes	No
Duration	28 days	Ongoing
Public Or Private Treatment?	Both	Public

	Sensory Integration Therapy	CBT
Full Treatment Programme?	No	No
Purpose Of Treatment	Improve processing of sensory inputs (e.g. sound) Develop adaptive responses to everyday stimuli	Identify and modify harmful thoughts + behaviours (e.g low mood = drug use Vs low mood = journaling)
Detox?	No	No
Structure And Routine	Personalised treatment plan Engage in play-based activities (e.g. using weighted blankets, or sitting on a ball)	Develop treatment plan/goals Problem-solving, behavioural activation, cognitive restructuring Maintaining Behaviour Change
Relapse Management?	No	Yes
Duration	Weekly 1 hour sessions for 5 - 6 months	60-minute sessions for 6 - 12 weeks
Public Or Private Treatment?	Public	Public

How Do Co-Occurring Eating Disorders Change Ecstasy Rehab?

Co-occurring eating disorders (ED) change ecstasy addiction treatment because 15% use ecstasy for weight-control purposes and 43% experience weight loss within 6 months due to self-induced vomiting and laxative misuse alongside drug taking, leading to [6] [24]:

An additional 2 months in treatment (e.g. 90 vs 30 days) as patients with extremely low BMI <15 kg/m2 need more time to readjust from a state of caloric deprivation, severe fatigue, and weakened immune system [25]
4 – 16 hours of onsite or arranged contact per week with a psychiatrist and nutritionist to develop a weight-restoration/stabilisation meal plan that considers cravings for binge foods (e.g. chocolate) and ecstasy during treatment [26]
30 – 60-minute individual therapy sessions rather than 3-hour group sessions (due to fatigue, overwhelm etc.) to discuss resisting weight-based oppressions, body acceptance, and preparing healthy meals [25] [26]
Ongoing monitoring from addiction staff with eating disorder training to observe patients during/between mealtimes for ED behaviour (e.g. food refusal) and set/review weight range goals with the patient
ED assessments and BMI measurements at intake and intermittently throughout treatment (e.g. as part of weekly counselling) to evaluate and adjust the level of supervision accordingly [26]

MDMA Rehab arranges hospital care for patients with co-occurring Anorexia or Bulimia Nervosa who are unable to reach a stable weight (BMI ≥ 17 kg/m2) or physically/cognitively participate and benefit from therapy provided [26].

Ecstasy Rehab Outcomes

The success rate of ecstasy rehab is 84.2% 12 months after attending a 30 – 60-day treatment programme with a 1 – 2-week detox, daily individual and group therapy sessions, followed by individualised post-treatment care [27].

Being employed after ecstasy rehabilitation increases the likelihood of continued abstinence by 37.3%, having family support reduces the risk of relapse by 48%, and for each additional therapy session attended, the risk of relapse reduces by 18% [28][29].

Ecstasy addiction rehab increases patients' self-confidence by up to 70.2% because therapy sessions are adapted to focus on building self-esteem, efficacy, and acceptance, leading to [30]:

A 16% increase in social functioning scores and a 26.3% reduction in self-reported anxiety symptoms from baseline to 6 months after treatment
A 16.3% reduction in emotion-orientated and avoidance-orientated coping behaviour (e.g. self-blame, escapism) after 44 weeks
A 14% reduction in dysfunctional attitudes and negative automatic thoughts (e.g. desire to gain others' approval, impression management) after receiving 10 60-minute CBT sessions during rehab [20]

Ecstasy Rehab At Abbeycare

Ecstasy rehab at Abbeycare is a 28-day programme that begins with a 7-10 day detox, followed by weekly CBT, mindfulness exercises, and individualised post-treatment support to:

A symptom managed detox (7-10 days) administering propranolol, NSAID's or SSRI's as directed by our medical team
Therapy uncovering underlying causes of ecstasy use e.g using ecstasy for social confidence
Personalised aftercare planning focusing on ecstasy's social or recreational triggers, including signposting to external services as appropriate

References

[1] Hopper, James W., et al. “Incidence and Patterns of Polydrug Use and Craving for Ecstasy in Regular Ecstasy Users: An Ecological Momentary Assessment Study.” Drug and Alcohol Dependence, vol. 85, no. 3, Dec. 2006, pp. 221–35. Accessed 21 Feb. 2025. “There tended to be daily troughs in craving around noon time and peaks around 9:00 p.m. or midnight, (each “day” spans 9:00 a.m.–8:59 a.m. the next morning).”
[2] United Nations Office on Drugs and Crime. Cognitive Behavioural & Relapse & Relapse Prevention Strategies. 18 Sept. 2007. Accessed 21 Feb. 2025.“Practise the play for 10 minutes, ... identify high risk situations and determine reinforcers.”
[3] Elmer, Timon, et al. “Subjective Long-Term Emotional and Social Effects of Recreational MDMA Use: The Role of Setting and Intentions.” Scientific Reports, vol. 14, no. 1, Nature Portfolio, Feb. 2024. Accessed 21 Feb. 2025.“Table S3.”
[4] Yule, Amy M., et al. “Risk Factors for Overdose in Treatment-Seeking Youth with Substance Use Disorders.” The Journal of Clinical Psychiatry, vol. 79, no. 3, June 2018. Accessed 21 Feb. 2025.“Table 3.”
[5] Reneman, Liesbeth, et al. “Investigating the Potential Neurotoxicity of Ecstasy (MDMA): An Imaging Approach.” Human Psychopharmacology: Clinical and Experimental, vol. 16, no. 8, 2001, pp. 579–88. Accessed 21 Feb. 2025.“5-HIAA depletions paralleled those of 5-HT in all brain regions studied (on average -46% ) of rats with a 6 h survival period.”
[6] Topp, Libby, et al. “Ecstasy Use in Australia: Patterns of Use and Associated Harm.” Drug and Alcohol Dependence, vol. 55, no. 1-2, June 1999, pp. 105–15. Accessed 21 Feb. 2025.“Table 3.”
[7] Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. 2004. Accessed 21 Feb. 2025. “Detoxified over a 10- to 14-day (or longer) period by gradually decreasing the initial stabilization dose of buprenorphine (usually 8–16 mg per day) by 2 mg every 2–3 days.”
[8] NHS. IN-PATIENT ALCOHOL DETOXIFICATION GUIDELINES. July 2021. Accessed 21 Feb.2025.“Appendix 4.”
[9] National Institute for Health and Care Excellence. Scenario: Benzodiazepine and Z-Drug Withdrawal. May 2024. Accessed 21 Feb.2025.“From diazepam 40 mg daily or less: reduce by 2–4 mg every 1–2 weeks until dose is 20 mg daily.”
[10] Shevlin, Mark, et al. “Cannabis and Psychosis: The Impact of Polydrug Use.” Drugs and Alcohol Today, vol. 17, no. 3, Sept. 2017, pp. 186–94. Accessed 21 Feb. 2025.“Table 2.”
[11] NSW Health. “Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.” NSW Health, Aug. 2022. Accessed 21 Feb. 2025.“Recommend that patients try to maintain small regular light meals over the course of the withdrawal episode, and to maintain hydration (at least 2-3L of liquids daily.”
[12] Amanollahi, Alireza, et al. “Incidence of Rhabdomyolysis Occurrence in Psychoactive Substances Intoxication: A Systematic Review and Meta-Analysis.” Scientific Reports, vol. 13, no. 1, Oct. 2023, p. 17693, Accessed 21 Feb. 2025..“Incidence of rhabdomyolysis was low for intoxication with ethanol (3.0 [95% CI 0.3–5.7]), ... ecstasy was 19.9 (95% CI 3.3–36.5).”
[13] DAVISON, D., and A. C. PARROTT. “Ecstasy (MDMA) in Recreational Users: Self-Reported Psychological and Physiological Effects.” Human Psychopharmacology: Clinical and Experimental, vol. 12, no. 3, May 1997, pp. 221–26. Accessed 21 Feb. 2025. “Table 1.”
[14] van Amsterdam, Jan, et al. “Hard Boiled: Alcohol Use as a Risk Factor for MDMA-Induced Hyperthermia: A Systematic Review.” Neurotoxicity Research, vol. 39, no. 6, Sept. 2021, pp. 2120–33. Accessed 21 Feb. 2025.“In a hot environment, the sweat rate can exceed 2500 mL/h, ... alcohol consumption results in a net loss of 900 mL water within 2h.”
[15] Parrott, A. C. “MDMA and Temperature: A Review of the Thermal Effects of ‘Ecstasy’ in Humans.” Drug and Alcohol Dependence, vol. 121, no. 1-2, Feb. 2012, pp. 1–9. Accessed 21 Feb. 2025.“Body temperature decreased by 0.2 ◦C in the abstinence weekend (p < 0.05), ... Group mean body temperature (tympanic membrane) peaked at 1.6 ◦C after 6 h on-MDMA.”
[16] Bergeron, Michael F. “Muscle Cramps during Exercise-Is It Fatigue or Electrolyte Deficit?” Current Sports Medicine Reports, vol. 7, no. Suppl. 1, July 2008, pp. S50–55. Accessed 21 Feb. 2025.“An estimated sweat-induced loss of 20% - 30% of the exchangeable Na + pool has been noted with severe muscle cramping.”
[17] Norberg, Melissa M., et al. “Brief Interventions to Reduce Ecstasy Use: A Multi-Site Randomized Controlled Trial.” Behavior Therapy, vol. 45, no. 6, Nov. 2014, pp. 745–59. Accessed 24 Feb. 2025. “Appendix A.”
[18] Fernández-Alarcón, Santiago Manuel, et al. Psychological Improvement of People with Substance Addiction through a Self-Esteem Workshop. no. 4, Sept. 2024, pp. 786–95. Accessed 24 Feb. 2025. Self-esteem pre-treatment was 13.43 (SD = 5.55) and rose statistically significantly at post-treatment to 20.78 (SD = 3.22).”
[19] JBHD. Guide to Breathing Exercises for Emotional Dysregulation and Anxiety in Individuals with ADHD. 2025. Accessed 24 Feb. 2025.“4-7-8 Breathing. Purpose: To calm the mind and body, helping to reduce anxiety and promote sleep. Instructions, ... Close your eyes and inhale quietly through your nose for a count of 4. Hold your breath for a count of 7.”
[20] Hides, Leanne, et al. “Outcomes of an Integrated Cognitive Behaviour Therapy (CBT) Treatment Program for Co-Occurring Depression and Substance Misuse in Young People.” Journal of Affective Disorders, vol. 121, no. 1-2, Feb. 2010, pp. 169–74. Accessed 24 Feb. 2025.“Table 2.”
[21] Glasner, Suzette, et al. “Mindfulness-Based Relapse Prevention for Stimulant Dependent Adults: A Pilot Randomized Clinical Trial.” Mindfulness, vol. 8, no. 1, Aug. 2016, pp. 126–35. Accessed 24 Feb. 2025.“Table 3.”
[22] SAMHSA. “Chapter 3—Family Counseling Approaches.” Substance Abuse and Mental Health Services Administration (US), 2020. Accessed 25 Feb. 2025. “Clients with SUDs and their partners attend 12 to 20 weekly sessions, ... over 4 to 6 months, depending on the target population and individual needs.”
[23] SAMHSA. Treatment for Stimulant Use Disorders TREATMENT IMPROVEMENT PROTOCOL TIP 33. 2021. Accessed 25 Feb. 2025.“Treatment is provided during hours and days that are convenient for patients (i.e., not just during traditional 9 a.m. to 5 p.m. business hours), ... helpful for patients who do not work and find boredom and lack of daytime activities significant contributors to substance use.”
[24] Bruening, Amanda B., et al. “Exploring Weight Control as Motivation for Illicit Stimulant Use.” Eating Behaviors, vol. 30, Aug. 2018, pp. 72–75. Accessed 26 Feb. 2025.“There were 15.3% of women who reported drug use for weight-control purposes, ... women who reported drug use for weight control predominantly used illicit stimulants (70%), such as cocaine, amphetamine, methamphetamine, and ecstasy.”
[25] Harrop, Erin N. “Typical-Atypical Interactions: One Patient’s Experience of Weight Bias in an Inpatient Eating Disorder Treatment Setting.” Women & Therapy, vol. 42, no. 1-2, Dec. 2018, pp. 45–58. Accessed 26 Feb. 2025. “My body continued in a state of caloric deprivation for two additional months during the inpatient process, which necessitated refeeding on an outpatient basis.”
[26] SAMHSA. Substance Use Disorder Treatment for People with Co-Occurring Disorders UPDATED 2020 TREATMENT IMPROVEMENT PROTOCOL TIP 42. 2020. Accessed 26 Feb. 2025. “Hire a psychiatrist part-time, even 4 to 16 hours per week, and that a significant number of clients can be seen that way.”
[27] Mohammad, Akikur, et al. “Addiction Treatment Aftercare Outcome Study.” Open Journal of Psychiatry, vol. 07, no. 01, 2017, pp. 51–60. Accessed 26 Feb. 2025. “Among the 19 patients that participated in a treatment program lasting more than 30 days, 16 patients (84.2%) experienced a successful 12-month treatment outcome.”
[28] Wang, Liang-Jen, et al. “Difference in Long-Term Relapse Rates between Youths with Ketamine Use and Those with Stimulants Use.” Substance Abuse Treatment, Prevention, and Policy, vol. 13, no. 1, Dec. 2018. Accessed 26 Feb. 2025. “Table 3.”
[29] Moeeni, Maryam, et al. “Predictors of Time to Relapse in Amphetamine-Type Substance Users in the Matrix Treatment Program in Iran: A Cox Proportional Hazard Model Application.” BMC Psychiatry, vol. 16, no. 1, July 2016. Accessed 26 Feb. 2025. “Estimated hazard ratios (HRs) suggest that, on average, the rate of relapse into the drug reduced by 18 per each additional session of consultation and training attended (HR = .82, p = 0.000).”
[30] Habibi, Rahim, et al. “The Effects of Family-Centered Problem-Solving Education on Relapse Rate, Self Efficacy and Self Esteem among Substance Abusers.” International Journal of High Risk Behaviors and Addiction, vol. 5, no. 1, Mar. 2016. Accessed 27 Feb. 2025. “Table 2.”

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: July 20, 2025