Why MDMA therapy for alcohol use disorder? And why now?

Introduction

The paper opens by describing alcohol use disorder (AUD) as a major clinical, social and economic problem. Although many people drink without harm, a substantial minority drink in harmful ways (about 24% of adults in England are reported to consume alcohol harmfully) and several percent meet diagnostic criteria for AUD. The disorder commonly co-occurs with depression, anxiety and a history of psychological trauma, and imposes large costs on families and society. Current pharmacological and psychotherapeutic treatments are characterised as unsatisfactory, with high relapse rates after detoxification. Against this background, the author argues that renewed interest in psychedelic-assisted psychotherapy provides a rationale to consider 3,4-methylenedioxymethamphetamine (MDMA) as a potential adjunct for treating AUD. The paper situates the idea historically—classical psychedelics such as LSD were trialled in the 1950s–60s for alcoholism with mixed but sometimes promising results—and notes contemporary research revisiting psychedelic therapies for substance use disorders. MDMA has been used in clinical research for PTSD but, according to the extracted text, has not been formally explored as a treatment for any substance use disorder. The paper therefore sets out a rationale for MDMA-assisted psychotherapy in AUD and describes a planned safety and feasibility study (the Bristol-Imperial MDMA-for-Alcoholism, BIMA, study). An underlying premise is that MDMA's psychopharmacological profile may make it particularly suitable for enabling patients to process traumatic memories without being overwhelmed by negative affect, which is relevant because trauma is common in people with AUD.