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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.
It only takes 15 minutes for MDMA to enter the bloodstream and reach the brain. The drug activates three brain chemicals:3, 4
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.
A stress hormone produced during emergencies. It increases heart rate and blood pressure, making it risky for people with heart and cardiovascular issues.
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:
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
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
Moderate users may still feel some of MDMA’s effects one week after they take the drug. These after-effects include:1, 3, 4
As a depressant, alcohol relaxes the central nervous system, leading to:5, 6
However, some drinkers experience adverse effects like:5, 6
Alcohol overdose can lead to more severe symptoms like:6, 7
Long-term alcohol use can cause further health complications:5, 6
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:
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:
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
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.
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
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:
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
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
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.
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
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
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
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
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
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.
MDMA and alcohol increase overdose risk. The symptoms can be life-threatening and cause long-term brain damage.
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 include:
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:
Some things doctors can do to treat MDMA overdose include:19
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:
Some things doctors can do to treat alcohol overdose include:6
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
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