MET Plus CBT for Ecstasy Use When Clients Are Depressed: A Case Series

• We present a brief clinical review and a description of MET plus CBT for ecstasy use
• We present two case descriptions of depressed clients who regularly use ecstasy
• Both clients experienced reductions in ecstasy use following treatment
• Both clients increased motivation to change and one reduced depression
• Study highlights the need to address the link between depression and ecstasy use

The second most commonly used group of illicit substances are amphetamine-type stimulants, which includes ecstasy. Chronic ecstasy use is associated with dependence, as well as cognitive and psychological impairments. When taken for self-medication purposes, chronic use may be supported by ecstasy’s immediate antidepressant-like effects. Interestingly, the most common outcome of ecstasy users seeking treatment is an antidepressant prescription. Psychological treatment may be a better option, as concurrently using antidepressants and ecstasy may have detrimental health effects. Unfortunately, the effectiveness of brief psychological treatment for ecstasy use has not been systematically examined for depressed clients. The present study describes an ecstasy use treatment comprised of three sessions of integrated motivational enhancement therapy and cognitive behavioral therapy and reports on its potential effectiveness with 2 depressed participants. In both cases, ecstasy use reduced to abstinence over 6 months follow-up, and these changes were associated with increases in URICA action subscale scores. One participant reported substantially reduced depressive symptomology after treatment, while the other sought additional treatment for depression. Results suggest that focusing on the relationship between ecstasy use and depression may lead to reductions in ecstasy use for depressed clients; however, clients who use ecstasy more frequently may require more extensive treatment that also targets depression directly. In addition, findings suggest that focusing on depression as a causal agent of ecstasy use may increase ambivalent clients’ motivation to reduce their ecstasy use.