It appears to be a very low risk, according to the data so far. MDMA has a very low addiction potential. We know this from both pre-clinical (animal) studies and also from epidemiological data (watching how the drug is used in large populations). Drugs services have never been burdened by MDMA addictions problems - despite the massive widespread use of ecstasy. Ecstasy users very rarely display typical drug-seeking behavior (i.e. robbing people to buy ecstasy). And in 20 years of clinical MDMA use - with over 2000 administrations of the drug in a clinical setting - there have been absolute zero cases of people developing MDMA addiction after taking the drug clinically.

MDMA is a synthetic molecule that has both stimulation and relaxation effects. It provides a very clear, safe, warm, loving, empathic and reflective mental state that allows the user to connect with themselves that greatly enhances trauma-focused psychotherapy. It allows difficult memories of the past - that one would usually avoid - to be addressed. Many addictions are caused by trauma and are maintained by rigid thinking and avoidance of past painful traumatic memories. Under MDMA the user can 'go there' to those usually avoided memories and not feel overwhelmed. This allows them to work through the issues with their therapist and start tacking the underlying issues behind the addiction.

In many ways all the psychedelic therapies / states have a lot on common, whether they are LSD, psilocybin, MDMA, DMT, ketamine etc. They all induce an altered state of consciousness that one can harness clinically to facilitate personal growth and development, which, when combined with a course of psychotherapy, can be used to address underlying emotional issues (especially those associated with trauma that are usually avoided). But of course all those drugs produce different mental states. In general, MDMA is more gentle and more easily tolerated than the other 'classic' psychedelics. But they all have their uses in different patients and different conditions.

When we use psilocybin clinically we wean people off their antidepressants and mood stabilizers because the antidepressants and mood stabilizers reduce the effects of the psilocybin. We want to get the best clinical effect we can. But you should not reduce those prescribed drugs yourself without medical advice and support.

Other psychedelics, including LSD, can be very effective agets for treating addictions; and much if the work in the 1950s and 1960s with LSD psychotherapy was for addictions - especially alcohol addiction. MDMA appears to be effective at treating PTSD and addictions because so many addictions have a long-standing trauma component, which MDMA-assisted psychotherapy is well suited to tackle. The open-hearted, warm, empathic and containing mental state induced by MDMA allows the user to address repressed emotional memories of past traumas that they would usually avoid. This aloows the user to reflect upon and resolve long-standing issues.

Both are often associated with painful emotional memories of past traumatic episodes - espeicallythose arising in childhood - that the sufferer finds overwhelming. Most cases of addictions I have worked with I have considered to be 'PTSD + Substance'. The addict uses the drug to suppress the feelings of PTSD. So they are closely linked. MDMA-assisted psychotherapy allows the user to address these memories in a state of reflective empathy, which means they can work through the issues without being overwhelmed.

That it is dangerous physically. It is in fact very safe physically; we know this from 25years of heavy recreational use of ecstasy with very low rates of morbidity and mortality. It is not 100% safe (what therapeutic intervention is?) but when used clinically risks can be reduced to an absolute minimum. The media representation of ecstasy as a dangerous drug is often over-inflated.

Yes. It will likely be available only to adults 18-65 years old initially, until further research is done in older people and children.

I think of MDMA as a non-specific adjunct to psychotherapy. So in theory it could be applied to any condition that we currently treat with psychotherapy - which is all mental disorders! It appears to be particularly good for tackling long-standing trauma-based disorders. Most research to date has been in PTSD, but addictions and other anxiety-based disorders could also respond to MDMA therapy. We need to do more research with a broader range of psychiatric conditions.

Good question. The simple answer is: It is it's own type of psychotherapy! It is not CBT, or psychodynmaic, or psychoanalytical, or MET, or EMDR, or CAT, or IPT or anything else. It is a unique form of psychotherapy that is designed specifically for use with the drug. Of course, there are elements of all those different psychological models in MDMA therapy, but no previous model is rigidly stuck to. We are in the process of writing formal manuals for MDMA therapy for a variety of conditions. The manual for MDMA-PTSD therapy is available on the MAPS website.

To date, most studies with MDMA have been done on PTSD - and there are no published studies using MDMA-assisted psychotherapy to treat depression. There is one study (Danforth) using MDMA to treat social anxiety disorder in adults with autism. The results were good. Many cases of anxiety and depression are caused by trauma, which leads to a stuck-ness and rigidity. Psychedelic-assisted psychotherapy can help shift the rigid thinking and allow new possibilities of thinking to emerge that can aid healing. Psychedelics act as non-specific adjuncts to psychotherapy. That is, they can deepen and strengthen the effects of psychotherapy. So, in theory, any psychiatric disorder that responds to psychotherapy (which is all of them), can, in theory be enhanced by psychedelic-assisted psychotherapy.

So far, most research with MDMA-assisted psychotherapy has been done only on PTSD. The protocols are available on the MAPS website (www.maps.org). There have, to date as far as I know, been only two studies on other conditions: Alicia Danforth's study on social anxiety disorder in people with autism and our own Bristol study on alcoholism. I think Alicia's protocol is on the MAPS website. Our Bristol protocol is not in the public domain yet. There have not been any studies on depression, so I have not seen a protocol for that condition yet.

As part of their Phase 3 drug development of MDMA-assisted psychotherapy for the treatment of PTSD, the Multidisciplinary Association for Psychedelic Studies (MAPS) is working not only with the US medicines regulatory body (FDA), but also with the European body (EMA). FDA approval is likely to be a bit quicker - hopefully by the end of 2022. But EMA approval will come soon after that.

Good question. Personally I think that people who want to work with complex cases of mental disorder - especially those involving severe trauma - ought to have some form of formal (non-psychedelic) clinical training first. This means they could train as a medical doctor, a nurse, a counselor, a psychotherapist, a social worker, a physiotherapist, an occupational therapist or some other allied medical profession. Psychedelic training should - in my opinion - then come later, once they have gained experience working with normal patients in a variety of settings.

Psychedelics act as non-specific adjuncts to psychotherapy. That is, they can deepen and strengthen the effects of psychotherapy. So, in theory, any psychiatric disorder that responds to psychotherapy (which is all of them), can, in theory be enhanced by psychedelic-assisted psychotherapy. Many cases of anxiety and depression are caused by trauma, which leads to a stuck-ness and rigidity. Psychedelic-assisted psychotherapy can help shift the rigid thinking and allow new possibilities of thinking to emerge that can aid healing.

Hi. I'm not totally up to speed with developments in Australia. But I am speaking at a conference in Melbourne this later year on psychedelics and MDMA. (www.mindmedicineaustralia.org) There is also a group called Prism in Australia that organize research. Look them up.