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The effect of the ecstasy 'come-down' on the diagnosis of ecstasy dependence


McKetin, R and Copeland, J and Norberg, MM and Bruno, R and Hides, L and Khawar, L, The effect of the ecstasy 'come-down' on the diagnosis of ecstasy dependence, Drug and Alcohol Dependence, 139 pp. 26-32. ISSN 0376-8716 (2014) [Refereed Article]

Copyright Statement

Copyright 2014 Elsevier B.V.

DOI: doi:10.1016/j.drugalcdep.2014.02.697


Background: The existence of an ecstasy-dependence syndrome is controversial. We examined whether the acute after-effects of ecstasy use (i.e. the 'come-down') falsely lead to the identification of ecstasy withdrawal and the subsequent diagnosis of ecstasy dependence.

Methods: The Structured Clinical Interview for DSM-IV-TR Disorders: Research Version (SCID-RV) was administered to 214 Australian ecstasy users. Ecstasy withdrawal was operationalised in three contrasting ways: (i) as per DSM-IV criteria; (ii) as the expected after-effects of ecstasy (a regular come-down); or (iii) as a substantially greater or longer come-down than on first use (intense come-down). These definitions were validated against frequency of ecstasy use, readiness to change and ability to resist the urge to use ecstasy. Confirmatory factor analyses were used to see how they aligned with the overall dependence syndrome.

Results: Come-down symptoms increased the prevalence of withdrawal from 1% (DSM-IV criterion) to 11% (intense come-downs) and 75% (regular come-downs). Past year ecstasy dependence remained at 31% when including the DSM-IV withdrawal criteria and was 32% with intense come-downs, but increased to 45% with regular come-downs. Intense come-downs were associated with lower ability to resist ecstasy use and loaded positively on the dependence syndrome. Regular come-downs did not load positively on the ecstasy-dependence syndrome and were not related to other indices of dependence.

Conclusion: The acute after-effects of ecstasy should be excluded when assessing ecstasy withdrawal as they can lead to a false diagnosis of ecstasy dependence. Worsening of the ecstasy come-down may be a marker for dependence.

Item Details

Item Type:Refereed Article
Keywords:dependence, diagnosis, ecstasy, 3,4-methylenedioxyNmethylamphetamine, prevalence, withdrawal, substance use disorder, substance dependence
Research Division:Psychology
Research Group:Biological psychology
Research Field:Behavioural neuroscience
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Bruno, R (Associate Professor Raimondo Bruno)
ID Code:89666
Year Published:2014
Web of Science® Times Cited:14
Deposited By:Psychology
Deposited On:2014-03-11
Last Modified:2017-11-06

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