The effect of the ecstasy 'come-down' on the diagnosis of ecstasy dependence

McKetin, Rebecca, Copeland, Jan, Norberg, Melissa M., Bruno, Raimondo, Hides, Leanne, & Khawar, Laila (2014) The effect of the ecstasy 'come-down' on the diagnosis of ecstasy dependence. Drug and Alcohol Dependence, 139, pp. 26-32.

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Background: The existence of an ecstasy dependence syndrome is controversial. We examined whether the acute after-effects of ecstasy use (i.e., the “come-down”) falsely lead to the identification of ecstasy withdrawal and the subsequent diagnosis of ecstasy dependence.

Methods: The Structured Clinical Interview for DSM-IV-TR Disorders: Research Version (SCID-RV) was administered to 214 Australian ecstasy users. Ecstasy withdrawal was operationalized in three contrasting ways: (i) as per DSM-IV criteria; (ii) as the expected after effects of ecstasy (a regular come-down); or (iii) as a substantially greater or longer come-down than on first use (intense come-down). These definitions were validated against frequency of ecstasy use, readiness to change and ability to resist the urge to use ecstasy. Confirmatory factor analyses were used to see how they aligned with the overall dependence syndrome.

Results: Come-down symptoms increased the prevalence of withdrawal from 1% (DSM-IV criterion) to 11% (intense come-downs) and 75% (regular come-downs). Past year ecstasy dependence remained at 31% when including the DSM-IV withdrawal criteria and was 32% with intense come-downs, but increased to 45% with regular come-downs. Intense come-downs were associated with lower ability to resist ecstasy use and loaded positively on the dependence syndrome. Regular come-downs did not load positively on the ecstasy dependence syndrome and were not related to other indices of dependence.

Conclusion: The acute after-effects of ecstasy should be excluded when assessing ecstasy withdrawal as they can lead to a false diagnosis of ecstasy dependence. Worsening of the ecstasy come-down may be a marker for dependence.

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5 citations in Scopus
5 citations in Web of Science®
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ID Code: 80042
Item Type: Journal Article
Refereed: Yes
Keywords: dependence, diagnosis, ecstasy, 3-methylenedioxy-N-methylamphetamine, 4-methylenedioxy-N-methylamphetamine, prevalence, withdrawal
DOI: 10.1016/j.drugalcdep.2014.02.697
ISSN: 0376-8716
Subjects: Australian and New Zealand Standard Research Classification > PSYCHOLOGY AND COGNITIVE SCIENCES (170000) > PSYCHOLOGY (170100) > Biological Psychology (Neuropsychology Psychopharmacology Physiological Psychology) (170101)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2014 Elsevier Ireland Ltd.
Copyright Statement: NOTICE: this is the author’s version of a work that was accepted for publication in Drug and Alcohol Dependence. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Drug and Alcohol Dependence, Volume 139, 1 June 2014, DOI: 10.1016/j.drugalcdep.2014.02.697
Deposited On: 04 Feb 2015 00:34
Last Modified: 22 Jun 2017 14:48

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