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Federal government websites often end in. The site is secure. 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. 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. Author manuscript; available in PMC Apr Parrott , PhD, 2 Christopher L. Blazer , MD, PhD 1. Andy C. Christopher L. Dan G. Address correspondence to Dr. PMC Copyright notice. Abstract This study investigates the potential heterogeneity of ecstasy or MDMA 3,4-methylenedioxy-N-methylamphetamine users. Ecstasy Users versus Non-Ecstasy Users Regardless of ecstasy use, drug users were likely to be white and to have attended college than non-drug users Table 1. Open in a separate window. CI: confidence intervals. Prevalence of Hallucinogen Use Disorders Among all participants, 1. Latent Class Analysis 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. 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. Implications The presence of different subgroups of lifetime ecstasy users has important implications for prevention efforts. Study Limitations and Strengths These findings should be interpreted with the following limitations in mind. CONCLUSIONS 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. We thank Ms. Amanda McMillan for her editorial assistance. Footnotes The opinions expressed in this paper are solely those of the authors, and not of any sponsoring agency. Declaration of interest The authors report no conflict of interest. Parrott AC. Drug-related harm: a complex and difficult concept to scale. Hum Psychopharmacol. Harv Rev Psychiatry. Cowan RL. Neuroimaging research in human MDMA users: a review. J Psychopharmacol. Gouzoulis-Mayfrank E, Daumann J. Anxiety, depression, and behavioral symptoms of executive dysfunction in ecstasy users: contributions of polydrug use. Drug Alcohol Depend. MDMA in humans: factors which affect the neuropsychobiological profiles of recreational ecstasy users, the integrative role of bioenergetic stress. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Pediatr Clin North Am. Maxwell JC. Party drugs: properties, prevalence, patterns, and problems. Subst Use Misuse. Acad Emerg Med. Club drugs, update. Overall, illicit drug use by American teens continues gradual decline in Various stimulant drugs show continuing gradual declines among teens in , most illicit drugs hold steady. Human psychopharmacology of ecstasy MDMA ,a review of 15 years of empirical research. Human Psychopharmacol. Increasing MDMA use among college students: results of a national survey. J Adolesc Health. Drugs and the dance music scene: a survey of current drug use patterns among a sample of dance music enthusiasts in the UK. Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcohol Clin Exp Res. Prevalence, correlates, and disability of personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. Grant BF. The impact of a family history of alcoholism on the relationship between age at onset of alcohol use and DSM-IV alcohol dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. Alcohol Health Res World. Drug treatment careers: a conceptual framework and existing research findings. J Subst Abuse Treat. Past month and lifetime comorbidity and polydrug use of ecstasy users among young adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Hallucinogen use disorders among adult users of MDMA and other hallucinogens. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatr. Substance use disorders among inhalant users: results from the National Epidemiologic Survey on alcohol and related conditions. Addict Behav. Research Triangle Institute. Mplus: Statistical analysis with latent variables version 4. Celeux G, Soromenho G. An entropy criterion for assessing the number of clusters in a mixture model. J Classif. Deciding on the number of classes in latent class analysis and growth mixture modeling. A Monte Carlo simulation study. Struct Equ Model. Understanding reasons for drug use amongst young people: a functional perspective. Health Educ Res. Chronic tolerance to recreational MDMA 3,4— methylenedioxymethamphetamine or ecstasy. Understanding drugs and behaviour. Chichester: Wiley; The neurobiology of addiction. Elsevier, MA: Academic Press; Psychiatric disorders in ecstasy MDMA users: a literature review focusing on personal predisposition and drug history. Mental disorders in current and former heavy ecstasy MDMA users. Jessor R. New perspectives on adolescent risk behavior. In: Jessor R, editor. The association of early adolescent problem behavior with adult psychopathology. Am J Psychiatry. Multiple protective and risk factors for drug use and abuse: cross-sectional and prospective findings. J Pers Soc Psychol. Investigating the neurocognitive deficits associated with chronic drug misuse. Curr Opin Neurobiol. A family study of the high-risk children of opioid- and alcohol-dependent parents. Ecstasy use in Australia: patterns of use and associated harm. Brick J. Handbook of the medical consequences of alcohol and drug abuse. New York: The Haworth Press; J Neural Transm. Mood, cognition and serotonin transporter availability in current and former ecstasy MDMA users: the longitudinal perspective. Ethanol increases the distribution of MDMA to the rat brain: possible implications in the ethanol-induced potentiation of the psychostimulant effects of MDMA. Int J Neuropsychopharmacol. Psychopharmacology Berl ; — The high prevalence of substance use disorders among recent MDMA users compared with other drug users: Implications for intervention. Copy Download. Personal history of using substance abuse treatment services.
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