The Shrink In The Classroom

ECSTASY: INTIMACY ABRIDGED

Last month, we discussed adolescent substance abuse and dependence,
identifying their complex causes and the need for multifaceted approaches
to prevention and cure. Along with biological and psychological causes,
substance problems are strongly influenced by culture. Because the
pressures of peer culture can be very strong in schools, and students are
often more likely to confide first in teachers rather than parents,
educators should be well informed about the most current risks and effects
of substance abuse, especially because information about specific drugs
frequently changes.

During the past decade, Ecstasy and other "club drugs" have become
increasingly popular among young people in Europe and the United States.
Because of their developmental needs, students who might otherwise avoid
drug use and abuse find Ecstasy attractive, so educators should be aware of
its effects and how to discuss it in the classroom and with individual
students.

What Is Ecstasy?

Ecstasy is the popular name for a series of amphetamine-like substances
with similar chemical formulations. The most common of these agents is
3,4-methylenedioxymethamphetamine, from which MDMA, another popular name
for Ecstasy, is derived. Merck, a pharmaceutical company, may have
synthesized the drug as early as 1912 but did not receive an official
patent until 1941, possibly intending to market it as an appetite
suppressant. In the 1950s, the U.S. Army briefly investigated using Ecstasy
for psychological warfare. The drug did not receive much attention until
the 1970s, when experimental psychotherapists began to use it to increase
patients' empathic feelings. Despite reports of Ecstasy abuse in the early
1980s, the drug remained legal in the United States until 1985. The
Oregon-based cult led by the Bhagwan Rajneesh used Ecstasy as a means of
achieving "enlightenment"; after the Bhagwan's death, his followers
dispersed throughout the world and helped introduce Ecstasy to mainstream
culture. Ecstasy did not gain substantial popularity, however, until the
birth of the Rave movement in the late 1980s.

Raves are large-often open-air-gatherings of young adults and adolescents
who frequently combine music with the ingestion of club drugs, such as
Ecstasy and related compounds, or other drugs, such as d-Lysergic Acid
Diethylamide (LSD) and Ketamine. The loud, repetitive rhythms of
techno-music reportedly enhance the pleasurable sensations of the
amphetamine-like rush that accompanies Ecstasy intoxication. Raves and
similar gatherings also provide convenient and relatively safe venues to
distribute and procure Ecstasy and other illegal substances.

The effects of Ecstasy vary, but they generally include an intense feeling
of empathy and trust. Users feel more relaxed and comfortable with others,
experiencing increased feelings of intimacy and emotional warmth. The drug
also has amphetamine properties, with possible effects of increased blood
pressure and heart rate, profuse sweating, dehydration, muscle aches, and
irregular heart rhythms. The purity of the Ecstasy compound varies
enormously, with many containing substantially more amphetamine than MDMA,
which may account for the great variety of drug effects.

An odd piece of Ecstasy paraphernalia is the baby pacifier, which many
regular Ecstasy users suck on to soothe the dry mouth and sore, clenched
jaws that they develop because of the drug's amphetamine properties.

The extent to which Ecstasy is dangerous is controversial. Proponents,
though they are certainly not in the mainstream, maintain that Ecstasy, by
itself and with proper supervision, is helpful for treating trauma and
enhancing emotional closeness. Any Internet search of information regarding
Ecstasy will, as with most illicit substances, yield many organizations and
people who believe that this particular drug is unfairly maligned.
Understanding whether this agent has therapeutic utility requires more
study, but researchers know that a number of very dangerous effects
accompany the use of Ecstasy on the street.

Deaths and serious complications have resulted from heat stroke, heart
attacks, and liver damage. At least some of these effects appear related to
the combination of intense physical activity, crowding, and ingestion of
Ecstasy that characterizes many Rave gatherings. Following initial reports
of these deaths, Rave participants were cautioned to drink plenty of water,
but what followed was a series of complications involving water
intoxication. Because Ecstasy appears to promote rhythmic movement, users
often methodically swig water without realizing how much they are
consuming. Both death and serious medical problems have resulted from
intense consumption of water in this setting.

From a psychiatric standpoint, some users report depression, anxiety and
panic attacks, and hallucinations and paranoia. In addition, many people
respond to Ecstasy with all the signs of addiction, including withdrawal,
craving, and decreased social function. Whether Ecstasy can lead to the
permanent experience of these psychiatric problems is not known, but
long-term effects have persisted in some individuals.

Many Ecstasy users report intense feelings of depression or thoughts of
suicide in the days between use, and these feelings and thoughts sometimes
persist for long periods. Although researchers do not fully understand the
mechanisms of these effects, they do know that Ecstasy affects the
neurotransmitter serotonin. Laboratory evidence with mice and primates
suggests substantial serotonergic neuron damage with Ecstasy exposure. The
amount of Ecstasy that will lead to such deleterious effects is unclear,
but case reports indicate that both frequent and infrequent users can
experience profound difficulties.

Why Ecstasy?

Ecstasy is clearly a major player in the current drug scene among young
people. Its properties are reminiscent of more familiar agents, such as
LSD, but Ecstasy's enhancement of feelings of intimacy increases its appeal
to some young people as they make their way into adulthood. The
developmental ladder first described by Erik Erikson suggests that
adolescents search for identity, whereas young adults search for intimacy
and closeness. In other words, adolescents must first understand who they
are before they understand how to get close to others. This task is
enormously important and difficult, filled with subtleties and nuance.
During this potentially confusing time, it is no wonder that young people
might embrace any substance that makes attaining intimacy easier.

In this light, taking Ecstasy to promote intimacy is like reading Cliffs
Notes without realizing that there is substantially more to the story.
Young people miss out on the subtleties of emotional closeness without any
awareness of what they have left behind. Ecstasy use is as much a threat to
young people's emotional development as it is to their physical health and
psychosocial functioning.

In the Classroom

Given the extent to which teenagers value and are confused by intimacy,
arguments about the medical dangers of using a drug will pale in comparison
to what teenagers perceive as the short-term benefits of using it.

Teachers are particularly suited to address these concerns. Students need
to seek out ways to be emotionally close to others, and, in a maladaptive
way, they are attempting to do so with this particular kind of substance
abuse. But they can also learn from positive modeling by teachers. On both
conscious and unconscious levels, they look to teachers for guidance in
understanding such issues as empathy and identity.

To this end, teachers should engage students in honest discussions about
the challenges and difficulties of growing up. Discussing specific movies
or books can be helpful. Scenes from movies-such as The Basketball Diaries,
in which a middle-class student finds himself hooked on heroin-can provide
opportunities for discussion. Such movies must be carefully edited and are
probably only appropriate for older students, but teenagers often feel more
comfortable discussing these issues in the virtual arena that fiction and
movies afford.

Occasionally, teachers will suspect individual students of substance abuse.
In these instances, teachers should not try to help the student by
themselves but instead seek outside assistance. Any substance abuse is
potentially serious, and teachers who don't refer these issues for outside
help risk missing the opportunity to benefit students whom they suspect of
having a problem. The teacher should discuss with the student the most
appropriate adult to alert to the problem. Many students will not want
their parents initially involved but will be willing to talk with a
guidance counselor, therapist, psychiatrist, or pediatrician. If students
insist on not telling any other adult, teachers should make clear that such
a course is not acceptable. Ethical, educational, and legal principles
dictate that students need treatment that addresses both the substance
abuse and its psychosocial ramifications.

Teachers need not engage in daily discussions of drug use and abuse to
affect how their students deal with illicit substances. Issues such as
self-esteem and self-image figure prominently in the use of drugs by young
people. To the extent that the classroom affords a setting to enhance
confidence and to create a sense of positive identity, teenagers will find
themselves less drawn to the quick fix that all drugs provide. Indeed, the
most successful drug intervention and prevention programs involve direct
work with teachers and schools. Educators remain on the front line in this
crucial endeavor.