MDMA and Social Anxiety in Adults with Autism
If you are anything like the average person, you probably know at least one person in your life who falls on the autism spectrum. For many, this neurocognitive atypicality can cause numerous struggles ranging from mild communicative and intellectual disabilities to extreme social deficits. Autism is inherently a spectrum, meaning that people you may know are all affected by the disorder differently. However, one quality that frequently accompanies a diagnosis of autism is social anxiety. Social anxiety is generally described as a fear of scrutiny from others and an avoidance of social interactions. Autistic individuals who do not have as much social awareness as their neurotypical peers are often faced with the pressure to conform to societal norms, placing them at greater risk for mental illnesses like social anxiety (Joshi et al., 2012; Tantam, 1991, 2000). Having a diagnosis of social anxiety on top of the social deficits that autism brings can cause some real challenges.
Not only do those with autism often have social anxiety, they also frequently require treatment for conditions like generalized anxiety, trauma, and depression. The conventional treatments used for these same issues in neurotypical individuals often prove to be ineffective in those with autism. Many of the typical treatments for anxiety disorders like SSRIs, MAOIS, and benzodiazepines also do not have enough clinical evidence to determine whether they can truly be effective for autistic individuals. Not only is this true regarding medicinal treatments, but it is also the case that it is more difficult to find success in psychotherapy as well. The social deficits that accompany autism can make it extremely challenging to establish an effective rapport with a psychologist, which in turn can lead to countless frustrating failed attempts at getting help. These factors make it essential to search for new treatments for autistic individuals, and particularly adults whose issues often receive less research attention than children.
Now entering the picture: MDMA. More commonly known as the street drug Ecstasy or Molly, MDMA is a psychoactive compound that does not naturally exist on its own. MDMA has been illegal in the United States since the mid-1980s, despite ample research from before it was banned suggesting therapeutic potential. The drug became illegal after concerns about its possible neurotoxicity, but these claims were based on faulty research. Early in MDMA research, one benefit scientists discovered was that the drug could help people talk openly and honestly about themselves and their relationships. MDMA acts as an indirect serotonergic agonist, meaning it increases the amount of serotonin released by interacting with the serotonin transporter, and transporting into the nerve terminal. MDMA has also been shown to be an inhibitor of presynaptic serotonin, dopamine, and norepinephrine.
Aside from the hormonal benefits that MDMA can potentially give its user, the drug also increases levels of the neurohormone OT (Dumont et al., 2009). This is a neuropeptide characterized by pair bonding and social affiliation, which is something we know can be a struggle for many autistic individuals. OT also lessens the amygdala’s response to anxiety-provoking stimuli and increases interpersonal trust. Higher levels of OT also lead to other changes in social perception for someone with social deficits, such as a less extreme reaction to threatening faces and improved empathy accuracy. Altered OT function has also been suggested as a potential underlying cause for the social differences commonly seen in autism. Combining the use of MDMA as a way to improve OT functioning with a therapeutic setting aimed at bettering functional skills may be an effective method of treating social skill issues in those with autism.
In more recent years, researchers have used different methods of self-reporting to hear first-hand accounts from adults on the autism spectrum about their experiences with MDMA. Danforth (2013) found that 91% of respondents said they experienced increased feelings of empathy/connectedness and 86% notes an ease of communication. Importantly, the participants in this study reported their positive effects of MDMA to be much more strongly experienced than their negative effects, and none of the subjects rated anxiety symptoms in the “strongly experienced” category, which could help reduce some of the fear that the stigma around psychedelics has formed.
Another reason not to be afraid of MDMA as a form of treatment for social anxiety in adults with autism is that, compared to other common treatments like SSRIs that have to be taken daily, the positive effects of MDMA can be long term after only one dose. Danforth reported that 72% of the participants who were experienced with MDMA/Ecstasy said they felt “more comfort in social settings,” and 12% reported that the effect lasted for two or more years. These were not the only promising findings from this study, as “77% of the MDMA/ Ecstasy-experienced group reported that they found it ‘easier than usual to talk to others’ as an effect of taking MDMA/Ecstasy, and 18% indicated that the effect lasted up to one year or longer.” Another positive finding showed that “22% of the MDMA/Ecstasy experienced group reported ‘increased insight into own thought processes’ that persisted for two or more years.” These benefits are added to reports that the experience of MDMA was, compared to hallucinogens like LSD and psilocybin, more mild, shorter acting, and did not induce cognitive distortions and perception changes of body image and sense of self. Rather, the drug still allowed for increased introspection without the negative aspects of other drugs stated previously.
Whether you know someone with high-functioning autism, or you have a friend or loved one whose autism is debilitating, each and every person on the spectrum deserves treatment to help improve their lives. We all suffer from different turmoils at different points of our lives, but those with autism need scientific research on their team to help them lead the most fulfilled life that is possible. MDMA has proven to be a drug that has the potential to change the social functioning in autistic adults, and after more research, could change the lives of many people on the spectrum.
Dumont GJH, Sweep FCGJ, van der Steen R, Hermsen R, Donders ART, Touw DJ, et al. Increased oxytocin concentrations and prosocial feelings in humans after ecstasy (3,4-methylenedioxymethamphetamine) administration. Soc Neurosci 2009;4(4): 359–66.
Joshi G, Wozniak J, Petty C, Martelon MK, Fried R, Bolfek A, et al. Psychiatric co-morbidity and functioning in a clinically referred population of adults with autism spectrum disorders: a comparative study. J Autism Dev Disord 2012;43(6):1314–25.
Tantam D. Asperger syndrome in adulthood. In: Frith U, editor. Autism and Asperger’s syndrome. Cambridge, MA: Cambridge University Press; 1991. p. 147–83.
Tantam D. Psychological disorder in adolescents and adults with Asperger syndrome. Autism 2000;4(1):47–62.
One thought on “Is MDMA the Answer for Social Anxiety in Autism?”
I appreciate your assessment of the benefits of MDMA for individuals experiencing social anxiety from the Autism Spectrum. What current therapies exist for individuals experiencing social anxiety? Additionally, as discussed with other drugs like psilocybin and LSD, therapeutic benefits derive from debriefing and interpreting one’s experience with a guide. The influence of set and setting in combination with the chemicals seems to be incredibly important. If an individual is nonverbal on the Autism spectrum, and thus less able to interpret their experience with the assistance of others, are the chemical benefits still present? I am sure limited research on this subject exists, but it would be interesting to consider the role of set and setting in an MDMA experience, and the potential limitations of this therapy for nonverbal individuals.