Mixing Molly and Alcohol

Key Takeaways

• MDMA triggers the release of dopamine, norepinephrine, and serotonin. By influencing these brain chemicals, it produces a variety of immediate and long-term effects. 
• People take MDMA and alcohol together to prolong euphoria and decrease alcohol’s sedative effects.
• MDMA is a stimulant, while alcohol is a depressant. The substances have opposing effects. Mixing the two is dangerous.
• In case of MDMA and alcohol overdoses, seek immediate help. Hyperthermia requires prompt medical attention.
• There is no specific treatment for MDMA abuse, though some users find behavioral therapies to be helpful.

What is Molly (MDMA)?

The recreational drug MDMA became popular in the club scene in the 1980s. Its use declined in the following decades, but is still commonly used today. 

MDMA is short for 3,4-methylenedioxymethamphetamine. It’s also known as molly, ecstasy, E, and X. 

MDMA is a synthetic drug with stimulant and hallucinogenic properties. It’s usually sold as a capsule or tablet, though it’s also available in liquid and powder forms. 

Molly is short for “molecular.” This refers to the pure powder packed in capsules. However, some products may contain caffeine, cocaine, or other drugs.¹

MDMA is illegal in the U.S. It’s a Schedule I drug, meaning it has a high potential for abuse and no medical use.²

MDMA is commonly mixed with alcohol to prolong the pleasurable effects. However, this combination is harmful and can lead to unpredictable effects.

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How Does Molly Affect The Body?

It only takes 15 minutes for MDMA to enter the bloodstream and reach the brain. The drug activates three brain chemicals:^{3, 4}

1. Dopamine

A “feel good” hormone that plays a part in how you feel pleasure. It also acts on the brain’s reward system. There’s a link between low dopamine levels and mental illnesses. Addictive behavior is a product of too much dopamine. 

2. Norepinephrine

A stress hormone produced during emergencies. It increases heart rate and blood pressure, making it risky for people with heart and cardiovascular issues. 

3. Serotonin

A mood stabilizer that plays a part in sexual arousal, emotional closeness, and empathy. Too much serotonin can lead to extreme nerve cell activity and dangerous symptoms. There’s also a link between low serotonin levels and mental illnesses. 

MDMA’s activation of these brain chemicals causes immediate effects like:

• Euphoria or “high” feeling
• Increased extroversion
• Increased energy
• Lowered inhibition
• Emotional closeness
• Empathy

These effects last about 3 to 6 hours. Some users take another dose once the impact of the first one fades.

Not all immediate effects of MDMA feel good. Some users experience:^{1, 3, 4}

• Involuntary jaw clenching and teeth grinding
• Muscle cramping
• Nausea and vomiting
• Blurred vision
• Increased body temperature
• Chills or sweating
• Increased blood pressure and heart rate
• Dehydration

MDMA produces metabolites that can interfere with the metabolism process. If a user takes high doses within a short time, MDMA can build up rapidly and magnify its harmful effects. 

MDMA overdose can cause life-threatening symptoms like:^{1, 3, 4}

• Hyperthermia (a sharp rise in body temperature)
• Dizziness, faintness, or loss of consciousness
• Panic attacks
• Irregular heartbeat
• Heart failure
• Kidney failure
• Seizures

Moderate users may still feel some of MDMA’s effects one week after they take the drug. These after-effects include:^{1, 3, 4}

• Irritability
• Aggression
• Impulsiveness
• Depression
• Anxiety
• Confusion
• Restlessness
• Sleep problems
• Lack of appetite
• Reduced sexual drive and pleasure
• Memory and attention problems

How Does Alcohol Affect The Body? 

As a depressant, alcohol relaxes the central nervous system, leading to:^{5, 6}

• Relaxation
• Increased extroversion
• Lowered inhibition

However, some drinkers experience adverse effects like:^{5, 6}

• Slow reflexes
• Blurred vision
• Drowsiness
• Frequent urination
• Sleep problems 
• Impaired balance, movement, and coordination
• Nausea and vomiting
• Headache
• Dehydration
• Hangover
• Memory loss

Alcohol overdose can lead to more severe symptoms like:^{6, 7}

• Alcohol intoxication 
• Confusion
• Passing out or difficulty remaining conscious
• Vomiting
• Dulled responses
• Hypothermia (extremely low body temperature, which causes blue or pale skin)
• Severely slurred speech
• Irregular or slow breathing
• Slow heart rate
• Seizures

Long-term alcohol use can cause further health complications:^{5, 6}

• Stomach ulcers
• Liver damage and diseases (like fatty liver, alcoholic hepatitis, and cirrhosis)
• Pancreatic damage
• Diabetes
• Irregular heartbeat
• Heart failure
• Stroke
• High blood pressure 
• Increased body temperature
• Hormone imbalance
• Cancer
• Weakened immune system

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Why Do People Mix Molly and Alcohol?

Alcohol and MDMA are commonly used together at clubs, parties, music festivals, and other big gatherings. 

MDMA is an illegal, recreational drug that is commonly co-abused with alcohol.^{8, 9, 10} In the U.S., 95% of MDMA users take it with alcohol.¹¹

People mix molly and alcohol to:

• Prolong the euphoric effects of MDMA 
• Decrease the sedative effects of alcohol

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What Happens When You Mix MDMA and Alcohol?

MDMA is a stimulant, while alcohol is a depressant. The two substances have opposing effects. This is why mixing alcohol and MDMA is dangerous.

It’s not well-understood how MDMA and alcohol interact with each other. But studies have shown that combining the two substances does have harmful side effect, including: 

Prolonged Euphoria

In a study involving 9 human volunteers, the combination of MDMA and alcohol caused longer-lasting euphoria than using MDMA alone.¹⁰ However, this can also increase the abuse potential of either MDMA or alcohol.⁸

MDMA and alcohol both activate dopamine. Mixing the two substances magnifies the release of this brain chemical. Because of this effect, people take more MDMA or drink more alcohol to maintain the euphoria.  

One study on mice supports the heightened risk of substance abuse. Mice pre-treated with MDMA consumed more alcohol to get the same reward feeling achieved at lower doses.¹²

Reduced Alcohol’s Effects

MDMA can reverse alcohol’s sedative effects. However, it doesn’t reduce drunkenness.¹⁰ 

People may feel sober when, in fact, they’re drunk. This can lead to dangerous consequences like accidents due to drunk driving.

Increased Blood Levels of MDMA

The way the body uses MDMA changes when alcohol is involved.⁸ For example, the MDMA-alcohol combination increases blood levels of MDMA by 13% as compared to taking MDMA alone.¹⁰ 

The liver metabolizes both MDMA and alcohol. Alcohol slows down MDMA metabolism and causes a build-up of the drug. This build-up can magnify MDMA’s toxic effects.⁹

Serious Risks of Combining Molly and Alcohol

MDMA can cause mental and physical problems. Alcohol can too. The adverse effects are further magnified when the two substances are used together. 

Here are some serious risks caused by mixing MDMA and alcohol:

Increased Risk of Drug Abuse

The MDMA-alcohol combination can cause longer-lasting euphoria. However, to prolong this effect, users need to take more MDMA or drink more alcohol.⁸

Impaired Learning and Memory

In a study on adult mice, MDMA and alcohol both impair learning and memory. This is possibly due to the imbalance in the activities of dopamine and serotonin. The study suggests that the adult brain may be sensitive to damage caused by MDMA and alcohol.¹³

Distorted Perception

MDMA and alcohol both affect people’s awareness of their surroundings. As a result, users may experience problems with movement and coordination. Activities that are typically easy (like driving) also become unsafe and difficult.

Serotonin Syndrome and Depletion

MDMA and alcohol both trigger the release of serotonin. 

Together, the two substances can lead to abnormally high amounts of serotonin in the brain. This condition is called serotonin syndrome. It can cause dangerous symptoms like agitation, confusion, and rapid heart rate. 

Long-term use of MDMA and alcohol can also deplete serotonin once the hormone’s effects fade. Serotonin depletion is linked to mental illnesses like depression, anxiety, and sleep problems.¹⁴

Fetal Brain Abnormalities

Pregnant MDMA users are reported to drink more alcohol than non-MDMA users. This co-use can damage the brains of fetuses.^{8, 15, 16}

Overheating and Dehydration

MDMA disrupts the body’s ability to control temperature, especially in a hot party environment. It can lead to hyperthermia, a sharp rise in body temperature.⁴

Alcohol and MDMA can dehydrate. Alcohol increases urination. By taking MDMA and alcohol together, you risk becoming dehydrated and overheating.¹⁷ 

Organ Damage

The MDMA-alcohol combination puts pressure on the liver, kidneys, and heart.¹⁷ In particular, hyperthermia (extremely high body temperature) can cause liver, kidney, and heart failure, even death.⁴

Increased Sexual Risk

MDMA and alcohol both lower a person’s inhibition. MDMA also promotes emotional closeness. 

Regular MDMA users who binge drink alcohol put themselves at a higher risk of unsafe sex.¹⁸ This also increases the risk of contracting or transmitting HIV and hepatitis.³

Withdrawal Symptoms

Suddenly stopping alcohol use can cause withdrawal symptoms. Some regular MDMA users also report unpleasant effects after they stop taking the drug.^{1, 3}

However, researchers are still uncertain about whether MDMA can cause withdrawal symptoms. They do know that MDMA targets the same brain chemicals as other addictive drugs.

Overdose Risk

MDMA and alcohol increase overdose risk. The symptoms can be life-threatening and cause long-term brain damage.

Contamination Risk From Other Drugs

Capsules sold as molly or ecstasy are supposedly pure. However, they may contain other illicit drugs like cocaine, ketamine, or methamphetamine. This is dangerous, as the drugs can magnify each other’s harmful effects.³

Treatment for Molly and Alcohol Overdose & Addiction

Treatment for molly and alcohol overdose/addiction include:

Overdose Treatment

MDMA and alcohol usually have different symptoms. For example, MDMA causes hyperthermia, while alcohol causes hypothermia. 

MDMA increases heart rate; alcohol slows it down. Still, there are some similarities, including seizures, nausea, and vomiting. 

When treating substance overdose (including alcohol and MDMA), the general approach is to stabilize ABC: 

• Airway
• Breathing
• Circulation

Some things doctors can do to treat MDMA overdose include:¹⁹

• Intubation: if the patient requires airway protection from MDMA or is in respiratory failure
• Benzodiazepines: if the patient experiences tachycardia (rapid heart rate) or hypertension (high blood pressure)
• Decreasing body temperature: if the patient is experiencing hyperthermia (a sharp rise in body temperature)

Hyperthermia requires prompt medical attention. This is because the body cannot survive the spike in body temperatures for a long time. Hyperthermia can cause muscle breakdown, electrolyte imbalance, kidney failure, or fatal swelling of the brain. 

Some treatment options for hyperthermia include: 

• Ice bath for rapid cooling
• Benzodiazepines for controlling shivering and agitation
• Cyproheptadine for serotonin syndrome 

Some things doctors can do to treat alcohol overdose include:⁶

• Intubation to open the airway, remove blockages, and help the patient breath
• Intravenous drip to replenish water, blood sugar, and vitamin levels
• Catheter to drain urine so people don’t wet themselves

Addiction Treatment

There are various approaches for alcohol addiction treatment, ranging from behavioral therapies to medications.²⁰
MDMA addiction has no specific treatments. Some MDMA users find behavioral therapy to be helpful.³