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May 1, 2002
Vol. 59
No. 8

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.

Steven C. Schlozman has contributed to Educational Leadership.

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