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


CONCLUSIONS
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.
Centre for Research on Ageing, Health and Well-being, the Australian National University, Canberra, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. Electronic address: rebecca.mcketin@anu.edu.au.
Rebecca
R
McKetin
National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, Australia.
Jan
J
Copeland
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, Australia; Centre for Emotional Health, Department of Psychology, Macquarie University, Australia.
Melissa M
MM
Norberg
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Medicine (Psychology), University of Tasmania, Australia.
Raimondo
R
Bruno
Centre for Youth Substance Abuse Research (CYSAR), Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, Australia.
Leanne
L
Hides
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Laila
L
Khawar
D000293:Adolescent; D000328:Adult; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000494:pharmacology*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000494:pharmacology*; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology; D013997:Time Factors; D055815:Young Adult
D013287:Illicit Drugs; D018817:N-Methyl-3,4-methylenedioxyamphetamine
3; 4- methylenedioxy-N-methylamphetamine; Dependence; Diagnosis; Ecstasy; Prevalence; Withdrawal