Ecstasy
Experts Want Realistic Messages
Brian Vastag,
©
Journal of the American Medical Association
August 15, 2001
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Ecstasy Experts Want Realistic
Messages
Brian Vastag
Bethesda As
the popularity of the drug ecstasy (MDMA) continues to climb11%
of high school seniors have tried it, according to a National Institute on
Drug Abuse (NIDA) surveybehavioral
researchers are recommending control strategies that may seem antithetical
to ever-expanding law enforcement efforts. Instead of focusing on
eradication and punishment, these social scientists take another tack:
they encourage harm reduction that acknowledges the realities of ecstasy.
At a recent NIDA conference, a half-dozen speakers advocated this
immediate action approach. Providing plenty of water at rave parties to
prevent dehydration (a common adverse effect), offering purity testing to
help users avoid ubiquitous adulterants, and developing peer-led programs
will go a long way toward reducing dangers, they said.
Ecstasy pills sold in the United States generally contain 100 mg or
less of MDMA. According to the social scientists, typical users take no
more than one pill at a time during a "session" and most limit
their use to once or twice per week.
Social
science researchers say that blunt prevention messages like this
one fail to reduce ecstasy use. They advocate less extreme
campaigns that users can identify with. (Photo credit: National
Institute on Drug Abuse) |
"Ecstasy is seen as relatively benign," said Robert Carlson,
PhD, an addiction researcher at Wright State University of Medicine in
Dayton, Ohio. "[Prevention] messages are not getting across, and
something needs to be done."
Skepticism about government studies, perception that ecstasy is safer
than other drugs (including alcohol and tobacco), and willingness to take
calculated risks all factor into the ecstasy equation, said Patricia Case,
ScD, director of the program in urban health at Harvard University.
"A lot of [ecstasy users] make clear decisions, despite the known or
unknown risks, that the benefits outweigh those risks," she said.
With considerations like these, Carlson and his colleagues are emphatic
that one-size-fits-all campaigns hyping the dangers of ecstasy fail to
sway users. Instead, they want messages that reflect reality: the effects
of ecstasy feel good, different groups use it for various reasons in a
range of settings, and evidence of addiction remains scant.
Claire Sterk, PhD, professor of behavioral sciences at Emory
University's Rollins School of Public Health, Atlanta, Ga, would drive
proponents of "Just Say No"–style campaigns crazy. "We'll
be better off having a campaign [poster] that says, 'Ecstasy can . . .
make you feel really good. It increases your sensory awareness, it makes
you feel music.' It's okay to acknowledge that," she said. "And
then have a big comma and say, 'But there are consequences.'"
In contrast, NIDA's prevention campaign uses scare tactics. The
oft-seen image of a brain before and after ecstasy provides a prime
example. Split in half, a brain scan displays a lurid orange hemisphere on
the leftthe
"plain brain." On the "brain after ecstasy" side,
muted tones and a missing chunk of cortex offer vivid testimony of the
drug's propensity for destroying serotonin neurons, according to NIDA,
which has distributed thousands of postcards and handouts displaying the
graphic.
What the materials don't say is that the "after" scan comes
from someone who abused multiple drugs and took several hundred doses of
ecstasy, a huge amount the average user will never approach (Lancet.
1998;352:1433-1437). "We need to stop exaggerating the negative
consequences and stop using extreme cases," said Sterk. "I'm not
saying there aren't consequences, I'm saying we don't know what they
are."
Sterk and colleagues say that effective campaigns will take shape only
after researchers come to grips with why people take ecstasy. This
application of ethnography teaches that understanding springs from getting
to know users. It's a social, not clinical, approach.
Case and her team spent hundreds of hours in New York City bars and
clubs, gauging drug habits in the gay community. Carlson explored the
lives of young adults who took ecstasy in Ohio. And Jean Schensul, PhD,
executive director of the Institute for Community Research in Hartford,
Conn, tracked networks of ecstasy-involved urban teenagers.
Their conclusion: each group is driven by unique motivations. Whereas
older New York City gay men may use ecstasy "as part of a
posttraumatic stress response" to having "lived through the
'death years' of AIDS," midwestern youth may simply be rebelling, and
Hartford's poor teens may be yearning for an escape. Targeting all of them
with the same message doesn't make sense. "We know people will
continue to use," said Sterk. "What we can do right away is come
up with appropriate, targeted messages to reduce the risk."
Richard Glen Boire's
Letter to the Editor
Dear JAMA,
Bravo to those Ecstasy researchers
who are bravely challenging the effectiveness of NIDA’s anti-Ecstasy
scare campaign. As pointed out by the researchers quoted in the article,
Ecstasy is a complex drug, and the reasons various people use it are
equally complex.
Portraying Ecstasy as nothing but a
brain deadener, is not only inaccurate, it is ineffective and dangerous
social policy. With millions of young adults saying “yes” to Ecstasy
it’s NIDA’s duty to provide them with complete and accurate
information about the drug. The fact that NIDA still doesn’t do so, is
an artifact of the national “War” policy with respect to some drugs.
In the midst of war, all government pronouncements become propaganda.
--Richard Glen Boire, J.D.
Center for Cognitive Liberty &
Ethics
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