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Journal of Psychoactive Drugs

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Subjective Reports of the Effects of MDMA in a

Clinical Setting
a a
George Greer & Requa Tolbert
a
3 Azul Drive, Santa Fe , New Mexico , 87505
Published online: 20 Jan 2012.

To cite this article: George Greer & Requa Tolbert (1986) Subjective Reports of the Effects of MDMA in a Clinical Setting,
Journal of Psychoactive Drugs, 18:4, 319-327, DOI: 10.1080/02791072.1986.10472364

To link to this article: http://dx.doi.org/10.1080/02791072.1986.10472364

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 Subjective Reports
of the Effects of MDMA
in a Clinical Setting
Downloaded by [University of Sydney] at 22:42 04 May 2015
GEORGE GREER , M.D .* & R EQUA TOLBERT , R.N. , M.S.N. *
Th e psychological effect s of M[)MA were first re-
ported in lLJ 7X by Shulgin and Nichols. Because it had
originally been pat ented in German y in ILJ 14 a nd was no
lo nge r pate ntable . no pharmac eutical manufact urer could
be found who was interes ted in spon sorin g an Investiga-
tional New Drug application with the Food and Drug
Administration or in supporting resear ch (Shulgin 1980 l.
In lLJXO. it was learned that. in Califor nia at least. dru gs
that were not yet available commerc ially cou ld be used
within a physicia n' s practic e if they were manufactured by
the physician or by a pharm acist <Younger 1978). T he
state mcd icul board recomm ended that there be peer re-
view . in fo rmed co nsent and supporting scientific litera -
turc when co nducting e xperimenta l work (Ca lifornia
Board of Medical Quality Assuranc e llJ80). This article is
a summary rep ort of data ga thered from the first 29 people
administe red MDMA in a clinic al setting .
Bec au se the primary purpose of the project was to
assisl the subjects in achieving their part icu lar and varied
goals for havin g the sessions . the data available for ana ly-
sis is limited . Onl y phenomenologi ca l descripti ons were
o bta ine d of the the rapi st s observations and of the sub-
jec ts' ex perie nce s before , during and after the se ss io ns .
Psychologica l evaluation s by independent observers with
tt:sting before and utter sessions. placebo control group
data with doub le-b lind asse ssment . and laboratory ex ami-
nations of organ and metabolic functions were not co n-
ducted .
METHO D
The MDMA used in this study was synthesized in the
Journal o{ Psychoactive [)1"lI~S
laboratory of Alexande r Shul gin, Ph .D . . who had co l-
lah orat ed in writ ing the onl y pub lished pape rs on its
synthes is (Braun . Shulgin & Braun 1980) . Dr. Shulgi n
was prese nt during the entire procedure for consu ltation
and assista nce . Identity was verified prima rily by infrared
spectrophotometry .
The sessions were conducted in San Francisco and in
Santa Fe. New Mexico . from 1980 to 1983. All subjects
were referred by psychotherapists or friends specifically
for the purpose of having an MDMA session , and none
were referred from the author's (Greer) pri vate psychiat-
ric practice . A questionnaire designed for screening and
preparing the subjects for MDMA sessions was filled out,
and lengthy informed consent information was explained
both verba lly and in writing . (Informatio n regardin g " In-
formed Con sent for MDMA Session " is available from
the authors.) Parentheti call y, five subjects (we ll-know n
by the authors) filled out the questionnaire retrospe cti vely
at the time of follow-up .
In this preparatory proces s. the poss ible side e ffects
that could occ ur (resulting primaril y from MDM A's sy m-
pathomimetic effects ) were described in detail. Subje cts
were also told that they should not take MDMA unless
they wert: ce rtain that they were willing to dea l with any
disturbi ng experie nce they might have . incl udi ng (but not
limited to) prev ious psychological diffi cu lties .
The following medical cond ition s were criteria for
exclu sio n from the stud y: hypertension . heart disease .
hyperthyroidism. diabetes me llitus . hypo glycemi a. sei-
zure disorder. glaucoma. d iminished liver functio n and
actua l or possib le pregnanc y . Subjects wit h a history of a
socially or vocationally disab ling psycho logical cond i-
3 19 Vo!' 18(4) Oct-Dec. 1986
 GRE ER & TOLBERT
tion. oth er than that caused by alcohol or other dru g
intoxication . wer e a lso excl ude d. Subject No . !9 wa s an
e xce ptio n be cau se the di sability wa s not known until after
the session .
Th e foll ow ing ag ree me nts wer e mad e before the
sess io n to ensure an atmos phe re of sec urity durin g the
sess ion: ( I ) Eve ryo ne ag reed to remain o n the premi se s
until it was mutuall y ag ree d th at the session was ove r and
that it was safe to leave : (2 ) Th e subje cts ag ree d to re fra in
from an y de structi ve ac tiv ity to se lf. othe rs or propert y :
(3) All ag ree d th at ther e would be no sex ua l acti vit y
bet ween the therapi st s and the subjec ts: and (4 ) Th e sub-
j ect s agree d to foll ow an y instructi on s g ive n by a th er api st
when ex plic itly sta ted as part o f the stru cture o f the ses-
s ion .
Downloaded by [University of Sydney] at 22:42 04 May 2015
Mo st of th e sess io ns were held in th e s ubjects'
homes . A s ix-hour fast was instituted to ens ure rapid
absorptio n of th e MDM A and to pre vent nau sea . Be for e
th e dos e w as admin iste red there was tim e to reesta blis h
co ntact w ith the th e rapi sts and answer qu estions . An oral
do se o f 75- 150 mg of MDM A was th en give n . (Su bjec t
No . 7 rece ived high e r do se s . whi ch arc d iscu ssed bcl ow . )
Low er do ses wer e used in inte rpe rso na l sess ions and
h igh er do ses wer e g ive n to hea vier peopl e . During ind i-
v id ua l sess io ns . th e su bjec t list en ed to in strument al
mu sic- w ith or wi tho ut headpho nes and/or eyeshades-
to faci lita te an internal ex pe rie nce . During interperson al
sess io ns . mu sic was usu all y pl ayed in the back ground .
Th e th er ap ists were atte ntive and available to re sp ond to
requ e sts o r need s . to recei ve a nd record co mm unica tions.
and to inter act with subj ects as wa s deemed appropriate.
Wh en subjects noti ced th at th e effect o f MDM A w as
beginning to subs ide - us ua lly before two hours-they
we re o ffe red a second dose of 50 mg or. rarel y. 75 m g .
Th e purpose o f the second dos e was to pro lo ng the session
a nd to pro vide a more grad ua l return to th eir usu al sta te o f
co nsc io us ness . Some su bjects we re o ffere d propranolol
(20-40 mg. ev ery three and a half to fou r hours ) or a s ing le
five m illi gr am dose o f di azep am to reduce unwant ed
sy m pa t ho m im et ic s id e e ffec ts . Oth ers re c e i vc d 1-
trypt ophan (500 mg ) to reduce di scomforts occurr ing late
in the sess io n .
Wh en th e sess ions we re ov er . th e subje cts ' ab ility to
dri ve was assessed before they wer e all owed to drive a
car. Th e usu al durati on of sessions was five to eight hours .
dep ending on the dos age and se ll ing. Fo llo w- up wa s
co nd uc ted both ve rb all y (so o n a fte r the sessio n) and mu ch
lat er by written qu e sti onnaire .
RESULTS
T he da ta ga thered from th e qu e stionnaires a rc pre-
se nted her e in nar rati ve for m . (T hese d at a arc avail abl e
Journal of Psvchouctivc Drugs
SUBJ ECTI V E REPORTS
from the autho rs in tabul ar fonn .) Th e find ings are pre -
se nted in the ca tegories o f the qu est ion s as ke d . Mu ch
in form ati on wa s guthercd on the pre se ssion question-
nai res . but most was for sc ree ni ng purpose s o r for co m-
pari son with the follow -up qu est ionnaire s. Th e o n ly item s
from that qu esti onnaire menti oned her e arc pree xi sting
ph ysical or psychol ogi cal problem s and the subjec ts ' pur-
poses for havin g the sess ion .
Fo urtee n ( 14) o f the 29 su bjects rep ort ed psych ol ogi -
cal problems . non e o f whi ch was o f a seve re nature . Si x
ind ividual s reported a di ssat is faction w ith them sel ve s.
suc h as fear o f rejectio n . per fect ion ism or lac k of self-
confiden ce . Mild depression was report ed by four sub-
ject s. anxie ty by two . hate or sad ness at be ing a lo ne by
two . normal ex iste ntia l despair or an gst by t wo and diffi -
c ulty mak ing major life c ho ices by o ne . (S ubjects with
di agn osabl e psychi atr ic di sord e rs are di scu ssed bcl ow . )
Add itio na lly . two subjects had s igni ficant he alth prob-
lems : s ub jec t No .4 ha d esse ntia l hyp ert en sio n th at was
well co ntro lled w ith medi cation. and sub jec t No . 7 had
c hro nic mac ula ede ma in o ne ey e wit h an oc u lar impl an t.
Fo llow-up questi onnaire s we re co m p lete d by 2X o f
the 29 subjects fro m tw o month s to tw o yea rs a fte r the last
session. and most were aro und nin e month s . Th e o the r
sub ject (No . 22) respo nde d wi th a lett er ove r tw o yea rs
lat er instead of fillin g o ut the qu esti onn a ire .
Benefits During Sessions
E ve ry s u bjec t ex per ie nce d some be ne f it fro m
MDM A durin g his /her ses sio n . Twe nty -se ve n (27) sub-
j ect s felt c loser and mor e intimate wi th a nyo ne pre sen t.
<The other tw o had so lo sess io ns .) A 11 21 subje cts wh o had
ses sions in co uples o r gro ups ex pe rie nce d mor e c lose ness
a nd/or e nha nce d co m m u nicatio n . a nd two found it eas ier
to recei ve co mp lime nts and critic ism.
A ll 29 subjects rep orted pos itive cha nges in th eir
attitudes or feelings . S ixtee n ( 16) felt warmer . fre sh er.
mor e a live . e upho ric or lo vin g fee lings. Ten ( 10) subjec ts
mentioned g reate r se lf-co n fide nce o r sel f-acceptan ce. and
10 fe lt that their defen ses we re low e red . Two of the se and
five othe rs rep ort ed und ergoi ng a th er ap euti c e motio na l
pro cess . Five subj ect s sa id th ey had a tran scendent c xpcri-
cncc . Fi ve noti ced havin g fewer negative tho ug ht s or
feelings. Three lclt more se lf-a ware o r se lf-gro unded. and
two repo rte d feeling b lessed o r at peace.
T went y-t wo (22) sub jec ts rep ort ed so me cogn itive
benefit : an e xp and ed ment al per sp ecti ve . insight int o per -
so na l patt erns or probl ems. im proved se lf-exa m ina tio n or
"int rap sychi c co m m un icatio n " sk ills . or " issue rcsolu -
tion . ·· Five subjects used a lo w do se (5 0 rng ) to fac ilitate
their cr eati ve w riting abilities -four in a gro up sess io n
and o ne a lo ne . A ll found it quite use fu l. Five sub jects
320 V o!' I X(4 ) Oc t- Dec. 1')X6
 GREER & TOLBERT
reported clear cognition or enhanced presence of mind .
One subject reported an enhanced sense of touch .
Another subject felt pleasantly warm, which was unusual
for her .
Undesirable Effects
All subjects reported some undesirable experience
during or after their sessions. The longest that any of these
symptoms persisted was one week, except in two sub-
jects . Subject No. 14 experienced a week of increased
appetite and a 15 pound weight gain over a few weeks . He
enjoyed eating more for a few months and then lost 10
pounds . No other subjects reported increased appetite .
Subject No . 19 had difficulty coping with work , friends
and relatives a few weeks later. He then had anxiety
attacks that caused him to miss seven days of work . Work
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had been a major life stress both before and after the
session, and had led to similar episodes of disabling
anxiety in the past. He was "not receptive to the sensa-
tion" of MDMA and "strcssl ed] that the session itself
was not the anxiety-inducing catalyst. Rather, I think it
served to open up some tightly controlled emotions that
spilled out in a frightening way ." He entered long-term,
semiweekly psychotherapy for the first time . A year later
he said , " It probably was a good thing. It speeded up
processes that needed to happen ."
Every subject reported some undesirable physical
symptom and one subject (No .7) had many more physical
symptoms than any other. She was by far the oldest (74
years) , though in good general physical health, except for
her macula edema. In two separate sessions, she took a
much higher single dose (200 mg) and total dose (350 mg)
than any other subject because she had not responded to
lower doses. The side effects she reported during sessions
were nausea, a small amount of vomiting, jaw tension,
ataxia. urinary urgency . blurred vision , sweating. brief
short-term memory loss. and brief distortion in depth
perception with a brief hallucination . During the even ing
after the sessions. she experienced loss of appetite. a little
vomiting . less taste for alcohol. a strong body odor,
blurred vision. urinary urgency, a mild hearing impair-
ment. difficulty opening her jaws wide. insomnia and the
biting of her check during sleep. Her jaw-opening diffi-
culty continued for several days, along with two days of
fatigue and hoarseness. one day of feeling uncertain on
her feet and a brief visual illusion the second night. which
lasted only until she turned on the light. She also reported
a pleasant two -day relief from her usual sensitivity to light
in the eye with chronic macula edema.
Twenty-two (22) subjects reported jaw tension or
shaking. or teeth clenching during the session . Two of
these and one other also reported it for the day after.
Journal oj Psvchoactive Drugs
SUBJECTIVE REPORTS
Diazepam (5 mg) clearly relieved this effect in two sub-
jects. and propranolol (40 mg) also relieved it in two . One
subject (No . 12) who had taken propranolol at the start of
his session reported more jaw tension than he had had in
an earlier. identical-dose session without it. He wondered
if it was due to his purposefully more cognitive orientation
during the second session . None of the other eight subjects
who used propranolol during their sessions complained of
jaw or other muscle tension after taking it.
Twenty-three (23) subjects reported fatigue lasting a
few hours to a few days after the session ; for 16 this lasted
two days or less . Four of the 23 felt sleepy or tired during
the session. though one had also taken diazepam (5 mg) to
prevent the jaw clenching she had experienced with
MDMA in the past. One other subject felt tired late in the
session .
Eleven (II) subjects reported some insomnia the
night after the session. though three subjects reported
sleeping better. Eight subjects experienced muscle aches
or tightness: six during the sessions and four afterward for
a day or less. Six of the eight also had jaw tension .
All but one of the subjects lost their appetites during
sessions-though none found it unpleasant-and all had
fasted overnight or for a few hours before. Seven subjects
felt nauseated during sessions, most for about five to 30
minutes . Two reported stomach upset for the next one or
two days and one subject (No . 17) lost her appetite for
three days and was mildly constipated for a few days .
During the session she related her nausea to thoughts and
feelings about her parents when they were in German
concentration camps . After an unsuccessful attempt to
vomit. the nausea and neg ative feelings stopped . Two
subjects felt mildly nauseated during the evening after the
session and one other subject was constipated for a day .
Three subjects reported difficulty walking during the
session . Two reported feeling cold during sessions . Many
others mentioned coldness early in the sessions-though
not as a problem -and it usually lasted for less than 30
minutes. Two other subjects mentioned sweating during
ses sions. but it too was a common occurrence that was
only mentioned in passing .
The following undesirable physical symptoms were
each reported by only one subject: jittery vision earl y in
the session ; lip swelling . shakiness. and numb hands and
face. all during sessions : headache late in the session:
fainting the evening of the session (subject No . 16. who
thought it was psychosomatic because she had been think -
ing about her diffi cult relationship with her boyfriend
when it occurred) ; anorgasmia the day after; and de-
creased sexual desire for one to two days.
Pulse and blood pressure were measured in two sub-
jects . Subject No . 10 had a baseline pulse of 60 and blood
321 Vol. IX(4j Oct-Dec. 19X(,
 GREE R & TOLBERT
press ure oflJ0!50 . During the session. the maxim um pulse
recorded was 112. and the maximum blood pressure was
12X!70 . Subjec t No . II had a basel ine pulse of 64 and
blood press ure of IIO!7X. His pulse reached 100. and his
blood pressure wen t up to 154/XX. Readin gs we re taken 35
minutes after ingestion. when the subjec ts reported the
first sensa tions of M DMA . and afte r one hou r and 20
minutes. whe n side effects were felt most intensely .
S ixteen ( 16 ) subjec ts reported undesirable e motional
symptom s . Five reported anxiety or nervousness du ring
the sess ion. incl ud ing subjec t No . IlJ. T wo subjec ts expe-
rienced mi ld depressio n the day after. One subjec t re-
ported ment al fatig ue and one reported mild emotiona l
inflatio n. bot h for a day . One subject reported feel ing
lonely or sad for brief period s dur ing his sess ion. One
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other felt one to three minutes of fear and parano ia early in
his sessio n. and then a flattened affec t later in the eveni ng .
One subjec t (No . I X) descr ibed wa ves of physical and
emo tiona l "crud " duri ng his sess ion and over the next
few days. He believed it had built up ove r the previous few
days and felt he was ' "letting go " of it dur ing the sess ion .
One sub ject reported feeling sim ply more emotiona l afte r
her session. and subject No . 17 felt more emo tiona lly
vulnerable and off center for three to fou r days. inc lud ing
a few hour s of nonspeci fic anger two days after her ses -
sion .
Four sub jects describ ed undesirable cog nitive symp-
toms . O ne had a " raci ng mind " and o ne repo rted co nfu-
sion . both during the eve ning of the ir sess ions . Sub ject
No .6 said it was hard to work the nex t day beca use there
was " too much go ing on" inside her mind. and she fell
con fused about her relat ionship with her boyfriend for two
days. One su bjec t report ed five to seven da ys of "' nega tive
se lf-talk. "
Reali zati on of th e Session's Purpose
All but one subjec t had some purp ose or goa l. other
than curiosity . for having a sess ion and most had multipl e
reaso ns . Sixtee n ( 16 ) of these felt that their purp ose was
com pletely realized. four reported significant progress
made toward all their goa ls. and seve n felt that so me goa ls
were rea lized while others were not. One reported that his
curio sity was satisfied . but that no new learnin g abo ut
himsel f OCCUlTed .
Nine subjec ts implied they wa nted more cog nitive
understand ing of them sel ves and expressed it in several
ways : self-analysis: rational se lf-examination: learni ng
ubou t thcm sc lvcs : understand ing losses. fears or attitudes :
gaining insigh t into life patterns : objectivity with insights
into feeli ngs and behavior: and clarify ing thin king. T hree
of these subjects felt that this goa l was fully achieve d. one
said progress was made . one was less than satisfied with
Journal of l 's vchoa ct ivc Dru g»
SUBJ ECTIVE REPORTS
the result s. and four rep orted no result s at all in thi s area .
Of the e ight subjec ts who wa nted a peak ex perience
of a visionary or mystical natur e-or a sense of whole-
ness . con nectedness or enlightenme nt-six felt that they
realized such a goa l and two felt that they did not . Tw o of
the six and three others desired personal or spirit ual
grow th or sel f-ex plora tion. and all five felt that this pur-
pose was full y reali zed .
Six subjec ts wanted enha nced co mmu nication with
someone (ofte n their spouse ) takin g MDM A with them .
Five felt that th is occurred and o ne was less than satisfied .
One of the five also desired to have more o pen co m-
mun ication w ith people after the sess ion and rep orted
possible progress . T hree other subjec ts desired c lose ness
with their mates during the sess ion . and all said that they
achieve d it.
As ment ioned prev iously. five subjec ts had low-d ose
(50 mg ) sess ions specifically for the purpose of fac ilitat-
ing their creative wr iting. All repo rted be ing satis fied with
the result s .
Four subjec ts me ntioned fun or enjo yme nt as a goal.
One of these and two others want ed increa sed awa reness .
All six sa id that these goals were attai ned .
Three subjec ts wanted to change thei r personal ity or
behavior patterns in so me lasting way . Two reported
prog ress and one was less satisfied than he wa nted or
ex pected to be . O ne of the two. and two others. wanted to
work or move thro ugh emotional blocks . All three sa id
they made significant progress. O ne subjec t so ught to
resolve inner co nflicts regarding her husband . fro m whom
she was separated. and she also made progress .
Two subjec ts want ed to ex per ience a different state
of co nsc iousness . and two others des ired more awareness
of the ir feel ings . All four felt they real ized these goa ls .
One subject desired psychothera py for sadness at being
alone. and one other wanted to lessen his fear of rejection
durin g a session with friends . Both rep orted fully reachin g
these goa ls.
Cha nges in Psychiatric Disord ers
All nine subjec ts with Diagn ostic and Statistical
Manual or Me ntal Disorders (DSM-!II ) (A merican Psy-
chiatr ic Assoc iation IlJXO) d iagnoses reported significant
relief from their prob lems . T wo subjects reported full and
lasti ng remiss ions: subject No . 17 wit h a dysthy mic dis -
orde r (fo llow -up after nine month s) and subjec t No . 23
with a postuborti on simple phobia of se xua lity and possi-
ble pregnancy. A ll three subjec ts with atyp ica l or mixed
personalit y d isord ers (Nos . 5 .9 and 13 ) and the four other
subjects with de pressive d isord ers (adjust me nt d isord ers
with de presse d mood in Nos . 6 and 22. dysthymi c di s-
orde r in No . 17. and atypical depressio n in No . J 6)
Vol. I X(4 ) O ct-Dec . 19X6
 J REER & TOLB ERT
reported improvement.
Mood Cha nges
Eightee n ( IX) subjects described positive changes in
their mood or emotiona l sta te. lasti ng from several hours
10 several weeks. and averag ing about one wee k. Fourtee n
(14 ) reported having more good feelings. Five of these
specifica lly mentioned euphor ia or improved mood and
four mentioned an increase in energy . Eleve n ( I I) re-
ported fee ling more relaxed. ca lm. detached . serene and/
:)1' less anxious or ag itated . T wo reported increased alert-
ness for at least a few wee ks (one had j ust begun a lea ve of
absence from work) and two others felt more amorous or
sexual after their ses sions. In add ition. one subject felt
more physical relax ation after his sess ion.
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Attitudinal Changes
Twe nty- t hree (23) s u bjec ts repo rte d pos it ive
changes in attitude that lasted from a wee k to a follow-up
:ime of two years. Agai n. the average dura tion was rough-
ly a wee k. Eleve n ( I I) of these specifically mentioned
increased self-es tee m. Te n (I{)) subjec ts said they felt
'nore acceptance of negative experiences or more patient
in some way. four of these in relation to achieving the ir
life goals . Four subjec ts reported simply feeling more
oositivc , Three menti oned fee ling less guilty. three re-
oorted havi ng a more spiritua l orientatio n in their lives and
.wo felt more powerful. One subjec t eac h reported an
mcreasc in the followi ng characteristics: self-awa reness:
iopc fulncss: satisfactio n: luck y to have her position in life
with her husband and friends: and flex ibility to openness
o change . se lf-d iscipline and co mmitment. Another sub-
iec t descri bed a c lear and brisk fee ling with a sense that
here is more love in the world . One felt less self-
Jcfc ating , one felt less sel f-consc ious and inhibited . and
me feIt less needy.
Some attitude changes were primaril y interp ersonal
n nature and will be describ ed below. Nega tive changes
'eportcd by seve n subjects were previously discussed. but
'our of these also had some of the posit ive changes men -
ioncd above ,
rive subjec ts reported cha nges in the ir attitudes
oward deat h sinc e the ir sessions . Two now see death as a
.hunge and not an end . two others feel less fear of their
iwn or their parents' death s. and one subjec t found that he
hought more abou t dea th. thoug h his feelings about it
vcrc no d ifferent.
Belief Cha nges
Sixteen ( 16) subjects reported belief changes that
ocrsistcd after the sess ions. but rare ly did two report the
.ame specific change. All changes res ulted in more posi-
tournai (if l'svchoartiv« Drug'
SUBJECTIVE REPORT S
tive beliefs about them selves. individually or in relation to
others or the world in ge neral. Six subjec ts reported
greater self-acce ptance. se lf-co nfide nce. inde pendence.
self-co ntro l. or apprecia tion of being alive . Four ex press -
ed more interest or ability in pursuin g spiritual grow th and
three others reported a sense of unity wit h people . with the
world or with " bei ng." Four perceived an increase d
willingness to love . a greate r apprecia tion of others or a
greater ca paci ty for interperso nal warmth , Four learned
new ways to deal with psychological probl em s. two sa id
their beliefs in their limited possibiliti es were diminished
and one reported that his belie fs about him sel f and the
universe were strengthened and deepened .
Relationship Changes
Only two subjec ts reported negative changes in their
interperso nal relationships afte r sessions . One subjec t
(No. 22) felt more guilt around men for "a while." She
thought it resulted from an insig ht gai ned durin g the
sessio n co ncerning the childhood death of her broth er.
She also proceeded with a divorce . having separated from
her husband before the sess ion. The other subjec t (No . 19 )
has been menti oned above .
Eve ry su bject exce pt No . 25 rep ort ed positi ve
changes in their relationsh ips afte r sessions. and he said.
" It is possi ble that I have become more capable of ex-
pressi ng myself without having as much hesitation about
how people will respond to my openness ." Th e closeness
and enhanced co mmunication present durin g sess ions
continued for a few days to two yea rs (at follo w-up ) for
three of the five couples . In the two co uples who had prior
difficu lties. they resolved significant co nflicts after the
sessio n. Three subjec ts whose spouses were pre sent . but
not using MDMA . also reported more close ness and/or
impro ved co mmunication with them -two briefly. but
the other still at follow -up after 10 and a half month s . In
addition to the three co uples. 14 subjec ts reported the
same changes with peopl e other than the ir mates , In six of
these. the changes we re still present at follow -up betw een
four and 24 month s later . and in three others changes
lasted from one to seve ral weeks .
Ten ( 10 ) subjects reporte d that soo n after their ses-
sions they resolved con flicts with others. and for five of
these people the co nflicts co nce rned partn ers who did not
have a session with them. Two of the latter (one be ing
married) and two others (w hose partners we re also not
present for the session) reported the con tinued decl ine and
eve ntual termi nation of primary romantic relation ship s
that were already failing before the sess ions . On the other
hand . two subjects who both had so lo sessions subse-
quentl y got married (though not to eac h other) ,
An increase in the interpersona l ex press ion of fee l-
Vo !. I K(4 ) Oct- Dec. 19K6
 GR EER & TOLBERT
ings aft e r sessio ns was rep ort ed by seven subjects. An
inc rease in acceptance and/or tolerance o f othe rs afte r-
ward was rep ort ed by six subje cts . Three sa id that they
now avoid supe rficial soc ial interacti on s . tw o spec ifica lly
menti on ing cockt ail part ies . Three s ubjec ts rep ort ed
see ing ot he rs as more auto no mo us and less in term s of
their o wn need s and/or projections . Two sai d they fo und it
eas ier to as k for help o r mak e demands. O ne co uple
rep ort ed e nha nce d sex ua l e njoy me nt afterward -partl y
due to del ayed o rgas m- and o ne co uple ga ined more
a wa reness of their prior se xua l problem s .
Su bject No . 17 rep ort ed fee ling closer to he r mother .
seek ing o ut peopl e like her self mo re o fte n (while avoiding
egotistica l peopl e ). a nd bein g able to state her beli efs
mor e eas ily to o the rs . All oth e r re latio nship c ha nges were
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re port ed by one subject eac h and incl uded the fo llowing:
fee ling more co mpass iona te; havin g g rea te r freed om to
have frien ds a nd a wi lli ng nes s to risk mor e with them :
ac tua lly making more close friend s; feeling more fo rgi ve -
ness to ward ot hers (a lo ng wi th receivi ng fee dbac k fro m
frie nds abo ut " positive c ha nges in the heart" ); feeling
co mfo rt and rightness with wife : havin g a more co nfide nt
and comfortable attitude to ward wife w itho ut fear (with
more co nf ide nt a nd dir ect soc ial beh avior ): ex pe rienc ing
an inc reased aw are ness of w ife and o the rs. with more
e mpat hy: ha ving grea ter interest in others: recogni zing
ho w he d istances othe rs whi le wa nting to be c lose ; and
unde rstanding bett e r the rela tions hips wi th friends wh o
share d the sess ion .
Occupation C hanges
Six tee n ( 16) subjects rep ort ed positi ve c ha nges in
the ir wo rk si nce their sessio ns. Six fe lt bett er o n the job in
so me way: less dri ven , co mpulsive. ten se , stressed, tem -
pe ram ental or burne d o ut; more pati ent and toler ant ; or
repo rted ha vin g more fun wor king or having more e ne rgy
to do their wo rk . Four had imp ro ved wor k re lations hips
w ith mor e pati ence and toler an ce , co nnec ted ness , acce p-
tan ce o r j ust ge tting alo ng bett er w ith othe rs. Most sub-
jects did not say how lon g these cha nges lasted . but so me
indi cated a range of o ne to 10 days .
Three subjects rep ort ed a n increase in inco me s ince
the ir sess io ns . O ne had c ha nge d jobs . o ne had g rad uated
from sc hoo l a nd begun her pro fe ssion al ca ree r and o ne
had swi tc hed from the technical side of his work to the
man agem ent s ide . wh ere he e njoys spe nd ing more time
wi th peopl e . O ne subject (No . 19 ) rep ort ed increased jo b
sa tisfac tio n . whi le ano the r repo rted a decre ase , but ne ith-
er attribute d the c ha nge to their sess ions . O ne subject sai d
he had becom e more ac tive s ince his sess ions a nd o ne
subjec t sa id he had becom e more active in hi s ind ep end ent
pro fess io na l work.
Jou rno! or Psvchoacti vr Drugs
SUBJECTI VE REPORTS
Two subjec ts rep o rted negat ive c ha nges , S ubject
No . 6 found it harder to work the da y a fte r a sess io n and
subjec t No . 7 found it hard er to deal w ith dem ands a nd
was less interested in wo rk. but did not say for how lon g .
Activit y Changes
Six subjects reported c ha nges in their invol ve me nt
with ac tivities o the r than work . Two subjects joined
gro ups for spi ritua l g ro wth . On e noti ced an improvem ent
in his creative writing abi lities during the month s a fte r his
sessio n . whe n he took a lea ve of abse nce fro m work to
co mplete a book of poetry . O ne subject was ab le to
resume go lf (his lifet ime spo rt) after ye ars of back pain .
whi ch had required mult iple surge ries . ceased . Subjec t
No . IlJ too k up woodw or king for the first tim e . a nd o ne
subject sa id he e njoyed his ho bbies more . O ne rep ort ed a
dec rease in politi cal ac tivity. but did not attri bute it to the
sessio n .
Spiritual and Physical Practice C ha nges
Fou rtee n ( 14) subjec ts repo rted positive c ha nges in
the ir reg ular practi ces for imp ro ving their spiritua l or
ph ysical we ll-bei ng. Six subjec ts began some sort of
medi tation or spiritua l pract ice a fte r the ir sess io ns . T wo o f
th ese de scribed M D MA- like states occ urring d uri ng
medit ation . and one o ther sub ject sai d her med itati on had
impro ved. O ne subject. who co ntinued a previous prac-
tice . felt that med itati on was more imp ort ant a nd med i-
tated more ofte n with clearer goa ls in m ind . One subject
rep ort ed looking at Buddh ism (w hich he pr acti ced ) more
a naly tica lly than e mo tio na lly or spi ritua lly. bu t placed no
valu e j udgme nt o n the c ha nge ,
Three subjects had sta rted ne w exe rcise program s by
the tim e of follow-u p . while o ne had sto pped a pre viou s
routine . Two othe rs increased pri or exe rcise routines .
thou gh o ne sa id that it was du e more to adva nc ing age than
to his sessio n. O ne subject became more inter ested in
health food s and improved h is diet.
Substance Use Cha nges
Fo urtee n (14 ) of the 2S subjec ts w ho a ns we red
follow-up qu esti o nnair es re po rte d a decrease in the use of
mind - or mood -alt erin g subs ta nces. and thr ee rep ort ed
increases , Six repo rted a decrease in alcoho l int ake : two
co ntinued to drink less at foll o w-up . w ith o ne rep orting a
marked decrease in his inclination to do so : two stopped
d rinking co mp lete ly ; and o ne of the rem aining two sa id
the decrease lasted two to fo ur weeks . O ne sub ject re-
ported an increa se in co ns ump tio n fro m thr ee to five bee rs
a wee k , O ne o ther subject d id not feel like dr inking
a lco hol. coffee o r tea (as was her cus to m) aft e r her ses-
sio ns . but d id not menti on cha nges in lon g-te rm usc .
324 Vol. I S(4 ) Oct- Dec . I '.JX6
 GR EER & TOLBERT
Six subjects decreased thei r mariju an a intake : o ne
for o nly tw o to four week s. but the res t co nti nued to usc
less at fo llow- up. fou r to 18 months late r. O ne stop ped
entire ly and another rep o rted a decrease in his des ire for
mar iju ana . O ne of the six said ma riju ana e nha nce d the
se nsa tions she rem em bered fro m MDM A sess io ns . eve n
thou gh her actual usc decre ased s igni fica ntly. On e subjec t
had increased his mari ju ana use by foll ow-up tim e at nine
mo nths .
Five subjects repo rted a decreased caffei ne intake . In
four the c hange lasted . wi th o ne sto pping enti rely . In the
one rem a ining subject. the decrease lasted severa l days .
O ne subject who drank six to e ight c ups o f co ffee a day
a lso sto pped co mplete ly . but he does not re late it to his
M DMA sess ions . O ne nonc otf ee drinke r no w d rink s it
two to three tim es a week . and anot he r increased his use.
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but not soon af ter his sessio n .
T wo su bje cts co nti nue to smoke less tobacco . O ne
other rep ort ed a grea ter urge to smo ke a fter sessions .
One subjec t had co ntinued to refrain fro m cocai ne
usc for the four and a half months between his sess io n and
fo llo w- up . Ano the r reported a decre ased desire fo r
cocai ne . without menti oning a cha nge in use. Th ese we re
the o nly two freq ue nt user s of cocai ne in this study .
O ne subject rep ort ed less LSD use. o ne sai d he
desired all psyched eli cs less, whil e one sa id he desi red
them mor e . O ne subject had a much mor e introspect ive
psychedel ic ex perience , and one had a more e nha nce d
ex pe rie nce than usual. a fter M DMA sessions . On e sub-
ject sa id she would be interested only in MDMA to alter
her state of mind in the future becau se she' "learned fro m
it. "
Changes in Life Goals
Fiftee n ( 15) subjec ts cha nge d so me of thei r life goa ls
af ter sessions. a ll implying tha t they we re positi ve . Five
sa id they felt mo re commitment to the sa me goals or felt
that the ir goals we re closer or that they felt more inten se or
. 'e me rge nt." Fo ur othe rs rep ort ed a ch ange toward seek -
ing more se lf-aw areness. per son al gro wth and/or we ll-
bein g . Another four had g ive n up pur su ing goa ls that we re
not bein g ac hieved or we re trying less hard to reach the ir
goa ls. T wo subjects ' goa ls had shi fted aw ay from co n-
ce rns with mon ey and financia l sec urity . Indi vidu als re-
port ed the followi ng varied cha nges: a shift fro m avo id ing
the negat ive to seek ing the positi ve in life ; greater desire to
co mmunica te and bond w ith hu sb and : ha vin g a new goal
of understand ing relati on ships: becoming mor e active in
work. and a greate r inte rest in intell ectual ac tivities.
Changes in Experiences Being Sought Out
Nine subjec ts rep ort ed des irabl e cha nges in the kinds
Journal of Psychoactive Drugs
SUBJ ECTIVE REPORTS
of ex pe riences they sec k o ut in life . Four so ug ht more
trust. hon esty. ope nness . close ness. or d irect co m mu nica-
tion in thei r re latio nships -in addi tio n to ac tua l changes
in their re latio nships descr ibed above . O ne subject now
wa nts to be wit h mo re spiritua lly orie nted people . and
another seeks to offer more lo vin g se rvice to people .
T wo subjec ts so ught bo th to ex pe rie nce more lo ve
and opc n-hca rted ncss as we ll as mo re freed om to be
crea tive and /or artistic. Anot her two report ed now ha ving
a more spiritual orientat io n in their lives . while tw o others
found the mselves more amorous or sexual after the ir
sessions . Subjec t No. 19 so ug ht inte nsive psyc hoth erap y .
Changes in Experiences Being Avoided
Nine subjec ts descri bed posit ive c ha nges in the kinds
of experiences they avoi ded in life . T hree no w avoid
superf icia l socia lizing (two ment ion ing coc ktail parties).
while another avoids egotis tica l peop le . an d o ne now
avo ids hab itu all y takin g care o f ot hers in her rel a-
tion ships .
Tw o subje cts now avo id ' 's loth" or boring th ings.
O ne repo rts acce pting negative ex pe rie nces more (less
avoi da nce of them ). and anothe r (No . 19 ) c hose to face
prob lems rather than avoid the m . Th e latte r is a lso avoid-
ing a ll psychoacti ve dru gs . O ne subject is tryin g to avoid
" negative kar ma" for her self a nd ot he rs .
Changes in Attitudes Pre venting Self-actualization
Thirteen ( 13) subjects reported ch an ges in thi s area .
all for the better. Seve n rep ort ed gai ni ng las ting insight
into psych o logical problem s d uring the ir sess ions . T hree
sa id they ex pe rie nce less gui lt. suc h as that over e njoyi ng
sma ll pleasures . Tw o repo rted a decrease in limitin g be-
liefs abo ut their po ssibilities . On e o f these indi vidu als a lso
now fee ls less se lf-de fea ting a nd reco gni zes ho w he d is-
tances others while he wa nts to be close . O ne subjec t fee ls
less defe ns ive and co mpulsive. o ne sees that she can
change her de fen ses and o ne feels less impa tie nt and
rebe llio us . O ne rep ort ed feel ing less strong ly that e mo -
tion s sho u ld not be ex pressed. o ne fee ls les s se lf-
co nsc ious and inhibited and on e feel s less bound by anxi-
ety . Subject No . 17 sa id she " litera lly go t rid of a lot of
negat ive ma terial I had carried aro und w ith me foreve r. "
and now takes more risks in life . Ni ne mon th s a fter he r
sess ion. she sa id. " Tm con tinua lly ge tting be tter. brigh t-
er. hap pier. clearer and more grou nde d ." O ne subject
reported di ssol vin g " use less structures withi n the min d . "
a nd on e sa id th at her sessio n s ac c el er at ed h er
psych oth er ap y .
DISC USSION
MDMA was apparen tly physica lly safe for a ll 29
325 Vol. IX(4) Oct-Dec . 19X6
 GREER & TOLBERT
sub jects in thi s study . No sid e effect s we re se rio us and
onl y one subjec t had a s ide e ffect last more than a week .
Vita l sig ns recorded in two subjects re vealed so me in-
cre ase in blood pres sure and heart rate. These increases
would be sa fe in a health y person . but not in an yon e with
vasc ular di sease . Oth er co ntra indic atio ns are sta nda rd for
an y sy mpatho m ime tic dru g.
Onl y one subject (No . 19) ex pe rience d po stsession
psych olog ical d ifficulti es that were d isabling o r of more
than a fe w da ys duration . He had been briefl y d isabl ed by
the same sy mpto ms of anx iety a few yea rs earlier. During
the ses sion . he bec ame a fra id that he wo uld become
ove rwhe lmed by un wanted em otions . He worked at pre-
venting thi s from happening and becam e intermittentl y
a nxious in the process . He felt that othe r eve nts in hi s life
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were the ca uses of his postse ssion an xiet y . A yea r later he
eve n fe lt that his sess ion was probabl y benefic ial. Subject
No . 17 a lso had a past history o f di sabling anx iety attac ks.
but she had alr eady receiv ed a lon g course of psych oth e r-
ap y for them . In an y case . there is an indi cati on that
M DMA may predi spose people to a recurren ce of pre vi-
o us psych olo gical di sabilities .
In future stud ies . informing subje cts in detail of
possibl e risks in taking MDM A a nd e mphas izing them
shou ld be mand ator y a nd will appro priately di scourage
so me pro sp ecti ve subjec ts . Excl us io n of tho se w ith a pri or
psychol ogi cal d isabilit y-or an inab ility or un willingn ess
to have an y disturbing e xpe rience that might occur during
or afte r the sessio n- sho uld result in a sa fe popul ation for
c linica l tri als. It is also recommended that peopl e who
wa nt MDMA to c ure their probl ems should be excluded .
wh ere as peo ple wh o wa nt to use it to learn about them-
sel ves shou ld mak e good cand idates.
In regard to the e ffica cy o f MDMA for treating
psychi at ric d isord er s. all nin e su bjects with DSM -III di -
ag nos es reported s ignifica nt ben efit. with two reporting
last ing remi ssion . A trend a lso e xists toward relieving low
se lf-es tee m a nd increa sin g self- acc eptance and sel f-
co nfide nce . O ne sub jec t (No . 2 1) reported reli ef of back
pain from whic h he had suffered for a few yea rs . It is mo st
likel y that the ps ychosomatic co mpo ne nt in thi s di sorder
was rel ie ved . as opposed to a ny an atomi c abn o rm alit y .
MDMA might be useful in other medi cal co nd itio ns in-
volving a psychological factor. thou gh the re is no suppor t-
ing ev ide nce from thi s study .
In ge nera l. it is reason able to conclude that the s ing le
best usc o f MDM A is to facilitate mo re direct communi ca-
tion be twee n peop le invo lved in a sig nifican t e mo tiona l
rel ati on sh ip . No t o nly is co mmunicatio n e nha nce d during
the session . but a fterward as well. On ce a therapeuticall y
motivated per son has ex pe rienced the lack of true risk
invol ved in d irect and ope n co mmunica tio n. it can be
Journ al ( ~r Psvch ou rt ivc l irug»
SUBJECTIVE REPORTS
pra cti ced without the ass ista nce of MDM A . Thi s ab ility
ca n not o nly help resolve e xisting co nflicts. but it can a lso
pre vent future o nes from occ urr ing du e to un expressed
fear s or misunde rstandings . Regardless of the me ch a-
nism . mo st subjects ex pressed a grea ter se nse of ease in
relating to their partner s. friends a nd co-workers for da ys
to months aft er their sessio ns .
MDMA ' s use as an adj unc t to insi ght -oriented
psychotherapy was spec ifica lly recommended by s ix sub-
ject s. Man y fe lt that MDM A e nha nce d se lf-unde rstand ing
and was useful in their per sonal a nd spiritua l g ro wth .
A va lue in treating at least mild a lco ho l and o the r
dru g abuse is indi cat ed by the de c reas ed use (repo rted by
14 subjects) of subs ta nces that ha ve psych ol ogical dep en -
den ce potential. So me subject s mentioned that these sub-
s ta nces s ee me d le s s a p pea ling a fter ex pe rie nci ng
MDMA. Th e ability not only to feel free of co nfl ict -
wh ich ca n be provid ed by man y dru gs of abuse - but a lso
to learn how to prevent co nfl icts in ev er yday life see ms
unique to MDM A as a ther apeut ic adj unct.
In a d d it io n. MDMA' s dimini sh ed ple asu rabl e
e ffec ts a nd ma rkedl y increased side e ffec ts wh en taken in
e ither large do ses or with grea te r frequ ency di st ingu ish it
fro m most dru gs of abu se. Subjects No s. 3 and I I took
fou r 50 mg suppleme nta l doses aft er their initi al dose .
Th ey fo und the fo urth do se to ca use only more agitation
and confusion without any pleasant effec ts at a ll . Som e
subje cts reported usin g MDMA o n thei r o wn . but only
subj ect No . 22 used it twi ce in the sa me wee k . Th e second
expe rie nce wa s therap euti call y useful. but left her de-
pressed a nd ex hausted for abou t two days . Th erefore .
both the po sitive expe rie nce of MDMA and the impracti -
calit y o f usin g it frequ entl y ca n moti vat e peopl e to find
othe r ways to ach ie ve a de sirable state o f mind in ev e ryday
life . Si xteen (16 ) subjects began o r inc rease d their med ita-
tion pra ctices or exe rc ise pro g ram s . which suppor ts thi s
co ncl usio n .
Pro viding the rep ort s of these 29 s ubjec ts ' ex pe ri-
e nce s w ill hop efull y e ncourage furth er research into the
ben efici al e ffects of MDMA . Presenting ev ide nce es ta b-
lishing the lim its of its usefulness sho uld di scourage a ny
mo vem ent to prom ote it as a soc ia l or psych ological
panacea .
ACKNOWLEDGMENTS
Th e aut hors wi sh to thank Jack Downing. M .D . .
Stanislav G ro t". M .D . . Rob ert Hau sne r. M .D . . Rodne y
Hou ghton . M .D . . Will Macl-lcndri c , M .D .. Ralph Met z-
ner. Ph .D. a nd John Perry . M .D . for servi ng as the pee r
review co mm ittee for thi s proj ect : A lex a nder Shul g in .
Ph .D . and A nn Shul gin for their suppo rt and instruc tio n:
326 Vo !. I X(4 ) Oc t-Dec. )9X6
 GREER & TOLBERT SUBJECTIVE REPORTS

and Mary Greer and Ron Romanik. M.D. for editorial

assistance.

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Brau n. U.: Shul gin . A T . & Braun . G . 19KO . Ce ntra lly active N-
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Ca liforn ia Hoard of Medical Quality Assurance . 19KO . Per sonal co m-
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Pharmacol og v of Hallu cinog rns. Ne w York : Per gam on .
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Journal l~f Psychoactive Drug s 327 Vol. 18(4) Oct-Dec. 1986