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Official websites use. Share sensitive information only on official, secure websites. Address correspondence to Dr. This study investigates the potential heterogeneity of ecstasy or MDMA 3,4-methylenedioxy-N-methylamphetamine users. Latent class analysis LCA and multinomial logistic regression procedures were used to identify subtypes of ecstasy users. Approximately 1. LCA identified three subtypes of ecstasy users. Subtypes were distinguished by family income, history of substance abuse treatment, and familial substance abuse. The recent resurgence in ecstasy use among adults underscores the need to monitor trends in its use. The use of ecstasy or MDMA 3,4—methylenedioxymethamphetamine constitutes an important public health concern. An understanding of the nature of these different subtypes is critical to etiological and prevention research. Ecstasy comprises properties of both stimulants and hallucinogens and is classified as a hallucinogen. Nationally, the estimated number of new past-year ecstasy users decreased from 1. Several studies have found that many ecstasy users also use alcohol, marijuana, and other stimulants such as cocaine and amphetamines. As of now, there is limited information available concerning what particular subgroups may be at high risk for exhibiting substance use disorders SUDs and that should thus receive tailored or intense interventions. Little is also known about the extent to which ecstasy users are characterized by a severe pattern of psychiatric disorders, and whether early case finding and intervention within this population is warranted. Given the recent increase in ecstasy use among adults, 14 we need to characterize better various types of users who constitute this population in order to identify vulnerable subgroups for tailored interventions. Latent class analysis LCA is a particularly suitable method for investigating whether distinct subtypes or classes of drug users exist within a diverse sample of study participants. LCA thus can help elucidate whether there are discrete sets of ecstasy users by classifying them empirically into a few subgroups according to their reported use patterns of a variety of drugs. In this study, we apply LCA to investigate the existence of subtypes of ecstasy users. Recently, Keyes et al. They found that both past-year and former ecstasy users as compared to non-drug users had increased odds of exhibiting alcohol use disorders, panic disorder, dysthymia, and antisocial personality disorder in their lifetime. Additionally, a history of bipolar and social phobia was associated with former ecstasy use, while a history of specific phobia was associated with past-year ecstasy use. Similarly, non-ecstasy drug users had greater odds of exhibiting all these lifetime disorders than non-drug users. Direct comparisons in psychiatric disorders between ecstasy users and non-drug users, however, are not reported by Keyes et al. Two main questions are examined: 1 Are there subtypes of ecstasy users that are distinguished by their patterns of drug use? Eligible participants consisted of persons living in households, military personnel living off base, and residents of group quarters ie, boarding houses, rooming houses, non-transient hotels and motels, shelters, facilities for housing workers, college quarters, and group homes. Study participants were selected using a multistage cluster sampling design. Professional lay interviewers from the Bureau of the Census administered the face-to-face personal interviews using computer assisted personal interviewing for the survey. Of the 43, participants, 18, were male and 24, were female. Details of the survey designs are reported elsewhere. Participants who responded affirmative to the latter question were considered lifetime ecstasy users. Lifetime use of alcohol, tobacco, and each specific drug class was dichotomized. We evaluated the fit of models between two and six latent classes. Bayesian Information Criterion BIC , entropy, and parsimony were all considered in selecting the final model. Entropy ranges from 0 to 1, with higher values indicating a clearer delineation of classes. Finally, prevalence rates of specific psychiatric disorders by LCA-defined subtype were determined. For reference purposes, we also report rates of specific psychiatric disorders among drug users who had never used ecstasy. All results presented are weighted estimates except for sample sizes. A comparatively high prevalence of ecstasy use was found among young adults aged 18—29 years 4. Regardless of ecstasy use, drug users were likely to be white and to have attended college than non-drug users Table 1. Among all participants, 1. Results of LCA suggested a three-class model as the best fit based on the consideration of parsimony, clearer delineation of classes, and statistical power ie, adequate sample size in each class. This model yielded the highest entropy value 0. Class 1: Ecstasy—polydrug users. Class 2: Ecstasy—marijuana—stimulant users. Class 3: Ecstasy—marijuana users. Finally, compared with ecstasy—marijuana users, a personal history of substance abuse treatment was associated greater odds of being classified as ecstasy—marijuana—stimulant users. The multinomial logistic model included all variables listed in the first column. A comparison with non-ecstasy drug users clearly showed that ecstasy—polydrug users had significantly higher rates of all SUDs, whereas ecstasy—marijuana—stimulant users had higher rates of disorders related to the use of alcohol, marijuana, cocaine, amphetamines, and heroin. Further, ecstasy—marijuana users had a higher rate of marijuana use disorders as compared to non-ecstasy drug users. Overall, ecstasy—polydrug users had a highest mean number of SUDs 5. Comparisons with non-ecstasy drug users showed that ecstasy—polydrug users had higher rates of mania, histrionic personality disorder, and antisocial personality disorder. This study reports new findings concerning the heterogeneity of ecstasy users in a large nationally representative sample of American adults. This study extends previously unaddressed questions 26 by elucidating specific SUD affecting ecstasy users and by applying LCA to identify three subtypes of ecstasy users: ecstasy—polydrug users, ecstasy—marijuana—stimulant users, and ecstasy—marijuana users. Ecstasy—polydrug users exhibited the highest prevalence of disorders related to the use of tobacco, marijuana, amphetamines, opioids, sedatives, and tranquilizers; they also had a higher rate of dysthymia and antisocial personality disorder than did ecstasy—marijuana users. These findings provide impressive evidence that ecstasy users are not homogeneous in nature and that a large proportion of such users are likely to be relatively poor and affected by multiple psychiatric disorders. The high prevalence of psychiatric disorders among ecstasy users is likely, in turn, to result in significantly curtailed occupational, interpersonal, and other life opportunities. Of this most compromised group, the majority met criteria for disorders related to use of tobacco, alcohol, and marijuana. Approximately one half had disorders related to the use of cocaine and hallucinogens; more than one third exhibited disorders related to the use of four prescription drug classes; and close to one third met criteria for an antisocial personality disorder. Polysubstance abuse by members of this group may be due to their use of multiple substances to intensify or modulate the effects of drug use, attenuate the discomfort or negative affect associated with the after-effects of ecstasy or other drug use, or to self-medicate health problems resulting from polysubstance abuse. Studies, nonetheless, have suggested a dose—response relationship between the quantity of lifetime ecstasy use and current psychiatric and cognitive difficulties. The majority of them also met criteria for disorders related to the use of tobacco, alcohol, and marijuana; close to one half exhibited a cocaine use disorder; and about one third reported a hallucinogen use disorder. Because their rates of SUDs were lower than those of ecstasy—polydrug users, this group can be viewed as comprising moderately problematic drug users who on average met criteria for 3. Their profile is also consistent with their lower odds of low-income and history of substance abuse treatment and familial substance abuse as compared to ecstasy—polydrug users. However, this group still manifested much higher rates of alcohol, marijuana, cocaine, and amphetamine use disorders than did non-ecstasy drug users, suggesting that their drug use might be more advanced than non-ecstasy drug users in general. The majority met criteria for nicotine and alcohol use disorders, and close to one half exhibited a marijuana use disorder. Compared with the first two ecstasy groups, this group on average had fewer SUDs, was less likely to have a personal history of substance abuse treatment, and had a lower prevalence of dysthymia. Members of this group resembled non-ecstasy drug users in having an average of two SUDs. The results suggest that cocaine-using ecstasy users are more advanced in their substance abuse than non-cocaine-using ecstasy users. A next step would be to compare the role of cocaine and ecstasy use, alone or in combination, in the risk for SUDs. The presence of different subgroups of lifetime ecstasy users has important implications for prevention efforts. The variations in their patterns of substance use behaviors suggest that the three groups may be located on a continuum of drug use, ranging from less extensive users of mainly marijuana and ecstasy to the middle group, which uses stimulants in addition, and then to the high group, which uses multiple drugs. The generally high rate of substance use among ecstasy users suggests that prevention programs that primarily seek to reduce ecstasy use may be ineffective if they do not also address other substance use eg, marijuana and cocaine use. Additionally, substance abuse is associated with a long list of medical illnesses involving multiple organs and cognitive impairment, and medical problems are likely to persist even after the abuse itself is terminated. It would be of clinical relevance to test whether adding ecstasy use to a routine assessment of substance use in clinical settings would be more helpful in detecting patients in need of medical interventions than a routine assessment of alcohol or cigarette use alone. This practice may be of particular value to the majority of ecstasy users with multiple comorbid disorders who are at risk for adverse effects of drug abuse. In addition, the finding that pure ecstasy users are rare has several implications for research. These findings should be interpreted with the following limitations in mind. The cross-sectional design of the NESARC survey precludes making inferences of causal relationships from our findings. A very small proportion of the institutionalized population eg, homeless, hospitalized, or incarcerated individuals was not included in the survey. Individuals who suffered severe consequences from their substance abuse may be less likely to have been sampled by the household survey, or may otherwise have been unable to participate. Because the very large sample represents the domiciled U. Perhaps the most important characteristic of the data source is its inclusion of the most comprehensive assessments of psychiatric disorders available, which supports the comparison of specific psychiatric disorders among subtypes of ecstasy and other drug users. This first national investigation of the variety of ecstasy users adds new evidence to the field by identifying at least three subtypes of ecstasy users, who are differentiated by patterns of psychiatric disorders, family income, and history of familial substance abuse. Ecstasy—polydrug users are more likely than other groups to live in a low-income family and to manifest antisocial behaviors. The recent resurgence in ecstasy use and high rates of SUDs among ecstasy users underscores the need to monitor trends in ecstasy use and to investigate further how focused prevention and early case finding and intervention efforts may help reduce substance abuse among ecstasy users. The opinions expressed in this paper are solely those of the authors, and not of any sponsoring agency. As a library, NLM provides access to scientific literature. Am J Addict. Published in final edited form as: Am J Addict. Find articles by Li-Tzy Wu. Find articles by Andy C Parrott. Find articles by Christopher L Ringwalt. Find articles by Chongming Yang. Find articles by Dan G Blazer. The publisher's version of this article is available at Am J Addict. Open in a new tab. C3 ecstasy—polydrug users vs. C3 ecstasy— marijuana—stimulant users vs. C2 ecstasy—polydrug users vs. NS Hallucinogen dependence 9. NS Hallucinogen use disorders NS Nicotine dependence CI: confidence interval. Declaration of interest The authors report no conflict of interest. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Personal history of using substance abuse treatment services.

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Many people travel to the tropical island of Gili Trawangan in search of white beaches, turquoise oceans and ultimate tranquillity. Others visit Gili Trawangan for more nefarious desires: bustling nightlife, bikini-ladened boat parties and more importantly, drugs… a lot of it. Much like Amsterdam is to Europe, Gili T is a strange grey area where recreational drug use is given a blind eye in an otherwise immensely strict country. Naturally growing plants such as weed and magic mushrooms are in abundant supply, while even heavier Class A gear is also readily available. As such this chemically enhanced paradise rivals every other party island across the world. So in that case, this article will explore the darker side of Gili Trawangan that Lonely Planet leaves out. This article may contain affiliate links , which I may receive compensation for at no extra cost to you dear readers! Gili Trawangan is one of the many thousands of islands that make up Indonesia, a highly religious nation. Other than Bali, the country is predominantly Muslim , so even drinking alcohol is frowned upon in most places! A measly 5 grams of a heavy substance is enough to earn yourself a death sentence. Since , 18 drug traffickers have been executed, 15 of which were foreigners from countries including Australia, the Netherlands and Brazil! As they are a short ferry ride away from Bali the favourite amongst travellers , the Gilis have become a popular spot for tourists to experience a few days of island life. Gili T is easily the most popular of the three despite it being an island of enormous contradictions. On the one hand, Gili T is a serene tropical paradise surrounded by turquoise oceans and turtle-filled reefs. Gili Trawangan stands out for one simple reason, drugs. Do you really think club-goers in Ibiza are just high on life? What makes this island really unique is how drugs seem to be tolerated. You can get them anywhere, from the young men working behind bars to the staff at BnBs and hostels. Not 2 minutes after I arrived on the island I found myself sitting at a bar with an Indonesian Lil Wayne lookalike offering me everything from your basic weed to ecstasy, acid and even crystal meth. However, these are on the extreme side of the spectrum. The island is better known for a more naturally occurring psychedelic drug, magic mushrooms. This is the drug of Gili T, the entire reason that an enormous proportion of people come to the island in the first place! And unlike the harder stuff, which is talked about under hushed tones, magic mushrooms are sold openly and are even advertised on the streets! Here in Asia, they have their own unique technique — making Shroom Shakes. A popular method in South-East Asia is to blend psychedelic mushrooms with different fruit juices or maybe even some coke Cola I mean. Relax yourself, Tony Montana. The popular choice is blending them with orange juice, as the acetic acids help break down the psychoactive ingredient psilocybin shoutout Joe Rogan which brings on the effects much faster and hits a hell of a lot stronger, handing you your one-way ticket to tripping balls in the best of ways. Imagine a mushroom-flavoured , gritty protein shake. Good tip, you can usually tell the strength of the shake by its colour. The lighter it is, the weaker it is. Bars literally advertise their shakes openly with some beautifully eye-catching signs. The fact that mushrooms are shamelessly advertised shows how liberal the island is. There just seems to be an unspoken agreement about drug use. Each to their own and all that. So there must be on the island, right? Yes and no. There are no official policemen on the island. I nstead, the island is patrolled by a security force formed by local residents. Though they are governed by authorities on the mainland, this is effectively their island to run as they please and enforce their own form of justice. Everyone dreams of living in a utopia where everyone can hold hands and sing Kumbaya. Sadly, the reality is a little more depressing, and there are always people out to ruin it for everyone. Gili T is no different. Laws are still occasionally broken on Gili Trawangan, and surprisingly, not many are related to drugs. Rather than putting the culprit in jail, the locals of Gili T have a more biblical punishment. No, not that bow-legged walk home in your cum-stained dress and smudged mascara, this is an even more embarrassing affair. For Indonesians, losing face is the ultimate embarrassment. Thus to punish thieves, they are paraded around the entire island by the local security force with signs hanging from their necks labelling them as a thief, so everyone knows of their low-life activities. On the flip side, if you really are enough of a DICKHEAD to steal and get caught red-handed, then a stroll around the island under disapproving looks is a fuck tonne more preferable than being in an Indonesian prison, even if that is what you deserve. Check out these other helpful articles! Your email address will not be published. Notify me of follow-up comments by email. Notify me of new posts by email. This site uses Akismet to reduce spam. Learn how your comment data is processed. Travelling Welshman. Instagram tompj. Home Destinations. Which Drugs Are Available? How Strong Are They? Where Can You Find Them? What About the Cops? What Are the Punishments? Ethical or Not? Thank You for Reading! Game over before it began. Sun, sea and countless bad decisions. Relaxing with somebody enhancers. Photo by Artem Beliaikin on Flickr. Eye-catching and mouth-watering sign. Some freshly picked magic mushrooms. Photo by Cannabis Pictures on Flickr. The main street that surrounds the island. Photo by Ivetta Inaray on Flickr. The perfect place to travel to a new dimension. The local security on Gili Trawangan. Thieves busted and paraded around the island. Eugne Du plooy at am Reply. TravellingWelshman at am Reply. Leave a Reply Cancel reply Your email address will not be published.

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