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Published in final edited form as: J Psychoactive Drugs. 2009 Jun;41(2):113–120. doi: 10.1080/02791072.2009.10399904

Young Adult Ecstasy Users’ Enhancement of the Effects of Their Ecstasy Use

Hugh Klein 1, Kirk W Elifson 2, Claire E Sterk 3
PMCID: PMC3567839  NIHMSID: NIHMS437445  PMID: 19705673

Abstract

In this paper, we examine drug effect-enhancing behaviors practiced by young adult users of the drug, ecstasy. Between August 2002 and August 2004, 283 face-to-face interviews were conducted with active ecstasy users. Study participants were recruited in the Atlanta, Georgia metropolitan area using a targeted sampling approach.

The large majority of study participants (87%) engaged in at least one behavior specifically designed to bolster the effects of their ecstasy use, with 61% of the study participants reporting having engaged in at least three such behaviors during the past 30 days. Taking steps to boost one’s ecstasy-related high was associated with binging on ecstasy and a variety of adverse outcomes, such as experiencing a greater number of negative consequences resulting from ecstasy use and experiencing more ecstasy-related drug dependency symptoms. Multivariate analysis revealed several factors associated with greater involvement in effects-boosting behaviors, including race (not being African American), spending time with other drug users, using ecstasy for its touch-enhancing qualities, enjoyment of the music-and-ecstasy-use experience, and childhood maltreatment experiences. The implications of these findings for treatment, prevention, and intervention of drug problems among ecstasy users are discussed.

Keywords: ecstasy use, MDMA, young adults, enhancing drug effects

Simultaneously using multiple drug types as a means of enhancing the effects of a drug-related high and/or to soften the effects of coming down from a drug-related high are common occurrences (see, for example, Booth, Leukefeld, Falck, Wang, Carlson, & 2006; Feilgelman, Gorman, & Lee, 1998; Peters, Williams, Ross, Atkinson, & Yacoubian, 2007; Substance Abuse and Mental Health Services Administration, 2005). Polydrug use appears to exist without regard to the user’s drug of choice and has been reported among primary users of crack (Peters et al., 2007), methamphetamine (Booth et al., 2006), heroin (Backmund, Meyer, Henkel, Soyka, Reimer, & Schutz, 2005; Kaufman, Chitwood, Comerford, & Koo, 2004), and cocaine (Booth et al., 2006; Coffin, Galea, Ahern, Leon, Vlahov, & Tardiff, 2003). Among ecstasy users, few report using no other drugs and polydrug use appears to be especially common (Boeri, Sterk, Bahora, & Elifson, in press; Copeland, Dillon, & Gascoigne, 2006; Hansen, Maycock, & Lower, 2001; Hopper, Su, Looby, Ryan, Penetar, Palmer, & Lukas, 2006; Martins, Mazzotti, & Chilcoat, 2005; Schensul, Convey, & Burkholder, 2005; Wish, Fitzelle, O’Grady, Hsu, & Arria, 2006). This is of concern because polydrug use has been linked to an elevated risk for drug-related problems and experiencing adverse consequences in various aspects of users’ lives (Feilgelman, Gorman, & Lee, 1998; Midanik, Tam, & Weisner, 2007).

Although many drug users use a variety of drugs in combination with one another in an effort to boost the effects of their drug-related highs, little has been written about other behaviors in which drug users may engage to achieve a similar goal. This absence of information is particularly noteworthy in the case of the drug ecstasy (a.k.a., MDMA), because users of this specific drug may be more apt than users of other drug types to engage in effects-enhancing practices. Among adolescent and young adult ecstasy users, use of the drug often is associated with “raves,” which are music/dance clubs that have been oriented toward camaraderie, physical closeness with others, and the enhancement of all of the senses (Bahora, Sterk, & Elifson, in press; Boeri, Sterk, & Elifson, 2004; Diemel & Blanken, 1999; Parrott, 2002; Sloan, 2000). Toward this end, many ecstasy users use a variety of strategies to enhance the high. For instance, glow sticks are being used to increase the visual psychedelic effects of ecstasy use (Morrissey, 2008). As another example, surgical and other types of facial covering masks are used along with inhaled vapor rubs (e.g., Vick’s Vaporub) to heighten the euphoric effects of ecstasy intake (Morrissey, 2008). As a third example, some MDMA users like to be rubbed with lotions or soft-textured objects because tactile contact with these products while high on ecstasy enhances the effects of the latter (Porrata, 2008). To date, our knowledge of the extent to which ecstasy users engage in these high-enhancing behaviors is limited. Consequently, there is limited research on the problems that may arise from engaging in these high-enhancing behaviors, or the factors that are associated with ecstasy users’ greater/lesser involvement in practicing high-enhancing behaviors. In this paper, we examine these issues in a community-recruited sample of young adult ecstasy users.

Methods

Procedures

The data presented in this paper are part of a cross-sectional study, Project X, on ecstasy use. The principal goals of this study were to examine life issues and challenges, substance use and abuse, psychological and psychosocial functioning, and a variety of HIV-related risk behaviors among young adult ecstasy users. Between August 2002 and August 2004, 283 young adults who actively used ecstasy were interviewed in Atlanta, Georgia.

To be eligible for participation in Project X, study participants had to be between 18 and 25 years of age and they had to be active ecstasy users, which was defined as having used ecstasy on at least three different days during the 90 days prior to their interview. Exclusion criteria included being in drug treatment or any other institutional setting, being unable to conduct the interview in English, and being intoxicated at the time of the interview.

The initial recruitment was based on information from our own previous research, information obtained from other local drug researchers, and information from local social and health service providers. Using ethnographic mapping, we identified additional locations for recruitment (Boeri, Sterk, & Elifson, 2004). We employed targeted sampling (Watters & Biernacki, 1989) to identify public and private locations from which to recruit potential study participants. Passive recruitment, involving the posting of flyers in local music venues and areas with greater concentrations of young adults, was also utilized. Individuals who called the project phone line listed on the flyers were screened over the phone using the same short form that recruiters presented. A team of ethnographers and interviewers, including five females (three Caucasian, one African American, and one Asian American) and three males (two African American and one Latino), conducted the recruitment and interviewing.

Once a potential respondent was identified as meeting the eligibility criteria, interviews were scheduled with interested individuals. The interviews were held at mutually agreed upon central locations and included such venues as the project offices, the participant’s home, a local restaurant or cafeteria, coffee shops, community centers, and the interviewer’s car. The informed consent procedures (which had been approved by both Georgia State University’s and Emory University’s Institutional Review Boards) were reviewed and signed prior to the collection of any data. On average, the face-to-face interviews lasted 90 minutes. They were conducted using a computer-assisted interview (i.e., CASI). Study participants received $25 compensation for their time.

Measures

Data were collected using an instrument developed specifically for this study, based on formative research among ecstasy users. Some items used in the assessment were derived from instruments that have been shown to produce both valid and reliable results from drug users. These include items from the Risk Behavior Assessment as developed by the National Institute on Drug Abuse (Needle, Fisher, Weatherby, Chitwood, Brown, et al., 1995), the Addiction Severity Index (McLellan, Luborsky, Cacciola, Griffin, Evans, et al., 1985), and the Global Appraisal of Individual Needs (Dennis, Rourke, Lucas, Zien, Clayton, et al., 1995).

The main variables of interest in these analyses are “drug use and drug-related problems” and “ecstasy high-enhancing behaviors.” Drug Use and Drug-Related Problems were measured with several items: (1) the extent to which study participants reported experiencing positive effects as a result of their ecstasy use (continuous scale measure comprised by nine items, Cronbach’s alpha = 0.80), (2) the extent to which respondents reported experiencing negative effects as a result of their ecstasy use (continuous scale measure comprised by 15 items, Cronbach’s alpha = 0.73), (3) the number of negative effects experienced during the past 30 days as a result of “coming down from” ecstasy (continuous scale measure comprised by six items, Cronbach’s alpha = 0.65), (4) ever having binged on ecstasy (yes/no), (5) the number of drug dependency symptoms experienced as a result of ecstasy use (continuous scale measure comprised by seven items, Cronbach’s alpha = 0.63), and (6) the number of different drug types used during the past 30 days (continuous measure). Ecstasy high-enhancing behaviors were measured using a nine-item scale (Cronbach’s alpha = 0.78), with higher scores indicating the taking of more steps to enhance the effects of one’s ecstasy use. The scale’s items include the use of masks (to heighten drug effects), glow sticks (to heighten the visual sensory experience), fans (for their cooling and visual sensory effects), soft-textured objects (to enhance the drug’s physical sensations), pacifiers, chewing gum, and lollipops (for the prevention of teeth clenching and for the heightening of taste sensations), orange juice (for the prevention of dehydration and for the heightening of taste sensations), and vapor rubs or vapor inhalers (to heighten the olfactory sensory experience1).

In the second part of the analysis, in which the focus is on identifying variables that are associated with greater/lesser involvement in people’s ecstasy-enhancement efforts, several types of predictor variables were considered. Demographic characteristics included in these analyses were gender (male versus female), age (continuous measure), race/ethnicity (dichotomous measure comparing Caucasians to non-Caucasians), marital status (dichotomous measure comparing “involved” versus other-than-“involved” persons), and sexual orientation (coded as heterosexual versus other-than-heterosexual). Several substance use/abuse items were also used in these analyses, including a number of items specific to the ecstasy use experience. These measures were: using ecstasy for its touch-enhancing properties (continuous scale measure, Cronbach’s alpha = 0.80), enjoying the combination of lights/lighting and ecstasy use (continuous scale measure, Cronbach’s alpha = 0.81), enjoying the combination of music and ecstasy use (continuous scale measure, Cronbach’s alpha = 0.75), age of first alcohol use (continuous measure), age of first alcohol intoxication (continuous measure), number of alcohol-related problems experienced during past 30 days (continuous scale measure, Cronbach’s alpha = 0.83), and age of first illegal drug use (continuous measure). Finally, a few items were used to assess childhood/adolescent experiences with neglect, and childhood/adolescent and past-year experiences with emotional abuse, physical abuse, and sexual abuse. These items were taken from Bernstein and Fink’s (1998) Childhood Trauma Questionnaire.

Analysis

The first part of the analysis was undertaken to assess whether or not taking steps to enhance one’s ecstasy high was related to a variety of drug use/abuse measures. The independent variable was a continuous measure, and five of the six dependent variables were also continuous measures. For these particular analyses, simple regression was used. For the other variable (i.e., whether or not the person had ever binged on ecstasy), the dichotomous nature of the outcome measure resulted in the choice of logistic regression as the analytical tool.

The second part of the analysis, which was designed to identify the factors that were predictive of the extent to which study participants engaged in high-enhancing activities after using ecstasy, was undertaken in two steps. Initially, separate bivariate analyses were conducted to determine whether taking effects-enhancing steps (now used as the dependent variable) was related to the various independent variables under consideration (e.g., race, gender, drug use factors, childhood maltreatment experiences, etc.). For testing the bivariate relationships, whenever the predictor variable was dichotomous (e.g., gender), Student’s t tests were used. Whenever the independent variable was continuous in nature (e.g., age of first drug use, extent of childhood maltreatment experienced), simple regression was used. Analytically, the next step was for items to be entered into a multivariate model. Both forward selection and backward elimination approaches were used, to make sure that the order of entry or removal from the equation did not affect the outcome of the analysis. Only statistically significant contributors were retained in the final equation. Throughout these analyses, results are reported as statistically significant whenever p<.05.

Results

Almost all study participants (87.3%) reported engaging in at least one of the nine possible ecstasy-related high-enhancing behaviors studied, with the majority reporting engaging in at least three of these (61.5%). The mean number of ecstasy-enhancing behaviors reported was 3.6 (s.d. = 2.6, range = 0–9). Among the most common of these behaviors were the use of vapor rub or vapor inhalers (50.9%), glow sticks (48.8%), fans (35.3%), soft-textured objects (33.6%), and the use of facial masks (17.3%) to enhance the user’s full sensory experience during the ecstasy use episode.

As Table 1 shows, there were a number of ways in which enhancing ecstasy’s effects corresponded to people’s overall drug-use behaviors. The more behaviors in which people engaged to bolster their ecstasy high, the greater the number of adverse effects they reported experiencing as a result of their use (F = 41.92, p<.0001). Similarly, the more effects-enhancing behaviors in which ecstasy users engaged, the greater their number of ecstasy-related drug dependency symptoms was (F = 9.49, p=.0023). Moreover, the greater the number of effects-enhancing behaviors, the greater their total number of different drugs used was (F = 55.05, p<.0001). Also, there was a direct relationship between the extent to which people tried to enhance the effects of their ecstasy use and their likelihood of having binged on ecstasy at some point in their lives (OR = 1.25, CI95 = 1.13–1.38, p<.0001). In contrast to the preceding, enhancing one’s ecstasy high was not found to be related to the number of positive ecstasy use-related effects that people reported or to the number of negative effects they reported experiencing as a result of “coming down” from an ecstasy high.

Table 1.

Enhancing Ecstasy’s Effects and Drug Use Outcomes

Drug Use Outcome b (β) Statistical Significance
Recently-experienced positive effects of ecstasy use 0.10 (0.11) p=.0755
Recently-experienced negative effects of ecstasy use 0.44 (0.36) p<.0001
Ecstasy-related drug dependency symptoms experienced 0.13 (0.18) p=.0023
Number of different drug types used (past 30 days) 0.32 (0.40) p<.0001
Recently-experienced negative effects when coming down from ecstasy use 0.01 (0.02) p=.7002
Ever binged on ecstasy 0.22 (0.32) p<.0001
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Having established a link between taking steps to enhance an ecstasy high and substance use/abuse-related measures, the next step in the analysis was to identify the factors associated with enhancing one’s ecstasy high. Two of the demographic variables examined were found to be related to boosting one’s drug-related high: age and race. The younger study participants were, the more they tended to do to try to bolster the effects of their ecstasy use (F = 7.73, p=.0058). African Americans engaged in less than half the number of ecstasy-boosting behaviors as their nonblack counterparts did (1.9 versus 4.6, t = 10.10, p<.0001).

Several of the drug-related measures studied were found to be associated with the extent to which people took steps to enhance their ecstasy-related high. People who lived with other drug users engaged in approximately 25% more ecstasy effect-enhancing behaviors than those who did not live with substance abusers (3.8 versus 3.0, t = 2.28, p=.0234). Persons who “hung out with” drug abusers reported engaging in nearly triple the number of effect-boosting activities than their peers who did not spend time with drug abusers (3.7 versus 1.3, t = 2.95, p=.0035). The younger people were when they had their first drink of alcohol (F = 4.21, p=.0411), the younger they were when they first became intoxicated as a result of drinking (F = 4.71, p=.0308), and the more alcohol-related problems they had experienced recently (F = 4.53, p=.0341), the more things they reported doing to boost their ecstasy-related high.

Similarly, several of the ecstasy-specific items were related to the extent to which people took steps to enhance the effects of their ecstasy use. For example, the more that people reported using music in conjunction with their ecstasy use (F = 25.05, p<.0001) or the more that they liked to use lights and lighting in conjunction with their ecstasy use (F = 28.53, p<.0001) or the more that they used ecstasy for its touch-related qualities and sensations (F = 20.04, p<.0001), the more things they tended to do to buttress the effects of the drug. As a final example, the greater the level of risk that people perceived to result from ecstasy use, the more they tended to take steps to enhance their ecstasy high (F = 6.09, p=.0142).

In addition to the preceding, several of the childhood maltreatment measures were also linked to boosting one’s ecstasy high. Included among these were the amount of emotional abuse experienced during one’s formative years (F = 4.84, p=.0287), the amount of emotional abuse endured during the past year (F = 4.77, p=.0299), and the extent to which one had been neglected or abused sexually, physically, and emotionally during one’s childhood and adolescence (F = 5.60, p=.0186). For all of these measures, maltreatment was associated with engaging in a larger number of high-enhancing behaviors.

The final step in the analysis was to enter the preceding items into a multivariate equation, to determine which ones contributed significantly and uniquely to the prediction of the extent to which people took steps to enhance their ecstasy high. In all, as Table 2 shows, five such variables were identified. They were: race (not being African American), spending time with drug abusers, enjoyment of the combination of ecstasy and music, using ecstasy for its touch-enhancing qualities, and the extent to which people had been maltreated during their formative years. Together, these items explained 38.1% of the total variance.

Table 2.

Predictors of the Extent to Which People Did Things to Enhance Their Ecstasy High

Predictor Measure b (β) Statistical Significance
Race = African American −2.55 (0.44) p<.0001
“Hanging out with” substance abusers 1.70 (0.11) p=.0238
Enjoying the music-and-ecstasy combination 0.10 (0.16) p=.002
Using ecstasy for its touch-enhancing properties 0.06 (0.20) p=.0001
Total amount of childhood maltreatment experienced 0.00 (0.11) p=.0306
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Discussion

Before discussing our main conclusions, we would like to acknowledge three potential limitations of this research. First, the data collected as part of this study of young adult ecstasy users were all based on uncorroborated self-reports. Therefore, the extent to which respondents underreported or over reported their involvement in risky behaviors is unknown. In all likelihood, the self-reported data can be trusted, as numerous authors have noted that persons in their research studies (which, like the present study, have included fairly large numbers of substance abusers) have provided accurate information about their behaviors (Anglin, Hser, & Chou, 1993; Higgins, Budney, Bickel, Badger, Foerg, & Ogden 1995; Jackson, Covell, Frisman, & Essock, 2004; Yacoubian & Wish, 2006).

A second possible limitation pertains to recall bias. Respondents were asked to report about their beliefs, attitudes, and behaviors during the past 30 days, the past 90 days, and the past year, depending upon the measure in question. These time frames were chosen specifically (1) to incorporate a large enough amount of time in the risk behavior questions’ time frames so as to facilitate meaningful variability from person to person, and (2) to minimize recall bias. The exact extent to which recall bias affected the data cannot be assessed although other researchers collecting data similar to that captured in this study have reported that recall bias is sufficiently minimal that its impact upon study findings is likely to be small (Jaccard & Wan, 1995).

A third possible limitation of these data comes from the sampling strategy used. All interviews were conducted in the Atlanta, Georgia metropolitan area. There may very well be local or regional influences or subcultural differences between these women and those residing elsewhere that could affect the generalizability of the data. Additionally, the chain referral sampling approach used to identify study participants is not a random sampling strategy, and there may be inherent biases in who was/not identified as potential study participants in this research. A good discussion of the issues pertinent to this issue may be found in Heckathorn (1997), along with strategies that can be employed to minimize any bias that could result from the use of a chain-referral sampling approach.

Despite these possible–and, we contend, minimal–limitations, we believe that many interesting and important findings came about in the present study. First, the study results showed that nearly all of the young adult ecstasy users participating in this research took specific steps other than polydrug use as part of their drug-use rituals/practices to boost the effects of their ecstasy use. Indeed, the majority of them engaged in at least three such effects-enhancing behaviors. The most common of these behaviors were the use of vapor rub or vapor inhalers, glow sticks, fans, and/or soft-textured objects to maximize the sensory effects of ecstasy use. Although simultaneously using other drugs in combination with one’s drug of choice is a common occurrence among users of illegal drugs wishing to bolster their drug-related “highs” (Falck, Siegal, Wang, Carlson, & Draus, 2005; Kurtz, Inciardi, Surratt, & Cottler, 2005), engaging in these sensory-enhancing practices is not a common behavior among users of most drug types. Unto itself, the use of vapor inhalers or glow sticks or soft objects is not problematic. When it comes to providing drug treatment to ecstasy users, however, involvement in these practices is likely to be of greater concern because, as part of ecstasy users’ drug-use rituals, they also become part of the behavioral repertoires that must be addressed and “undone” or “unlearned” if treatment is to be successful. Basically, the more complicated or the more highly ritualized the drug-use process is for people, the more difficult it tends to be to treat. Thus, our findings suggest that among young adult ecstasy users, special attention may need to be paid to those who engage in a variety of effects-enhancing practices.

This is all the more true when one considers our findings pertaining to the relationship of taking steps to bolster one’s ecstasy use effects and actual drug (ab)use behaviors. In this regard, we found that the more behaviors in which people engaged to increase the effects of their ecstasy use, the more likely they were to have experienced negative effects as a result of their ecstasy use, the more drug dependency symptoms they were likely to have experienced as a result of their ecstasy use, and the greater the likelihood was that they had binged on ecstasy at least once before. These findings indicate that the young adults who engage in the greatest number of effects-enhancing behaviors vis-a-vis their ecstasy use are the ones who are experiencing the greatest number of adverse consequences as a result of their ecstasy use as well. In addition to the obvious drug treatment-related implication here, there may also be a prevention-related and/or an intervention-related implication inherent in this finding: Depending upon exactly when in a person’s ecstasy use history the effects-bolstering behaviors begin, the onset of such behaviors may signal a growing involvement and a developing problem with the use of the drug, ecstasy. If this is, indeed, the case, then it indicates that prevention and intervention workers in the drug abuse field might be able to minimize harms resulting from ecstasy use by targeting users who are beginning to involve themselves in behaviors such as using vapor inhalers, glow sticks, and the like in conjunction with their ecstasy use. Learning more about the factors that lead to the onset of these effects-enhancing behaviors and about the temporal relationship of this onset to the initiation of problematic ecstasy use would be fruitful avenues for future research.

Our findings pertaining to the predictors of greater/lesser involvement in ecstasy-related effects-enhancing behaviors identified several factors worthy of note and brief discussion. First, we found that, compared to members of other racial groups, African Americans engaged in significantly fewer ecstasy-boosting behaviors. This may be the result, at least in part, of the relative newness of the drug in the African American community and the fact that ecstasy has not become entrenched among African American young adults to the extent that it has among their Caucasian counterparts (Ompad, Galea, Fuller, Edwards, & Vlahov, 2005; Schensul, Diamond, Disch, Bermudez, & Eiserman, 2005). It is also possible that there are normative and cultural differences in the social settings in which African Americans and members of other racial/ethnic groups use ecstasy. Relatively little has been published specifically on the subject of racial differences in ecstasy use, leading some researchers to comment that there is a need–perhaps a greater need than ever before, with the recent proliferation of the drug into minority communities–to study ecstasy use in minority populations (Novoa, Ompad, Wu, Vlahov, & Galea, 2005; Ompad et al., 2005). We concur with this recommendation.

The present research also revealed that spending a greater amount of one’s personal time with substance abusers was associated with more involvement in ecstasy-related effects-enhancing behaviors. It seems likely to us that at least some the drug (ab)users with whom the young adult ecstasy users in this study spent their leisure time were more experienced drug (ab)users than the study participants themselves and, therefore, may have been the persons responsible for introducing them to the effects-enhancing practices in question. This highlights the importance of changing drug abusers’ social networks and the way that people spend their social/leisure time if they wish to recover from drug abuse. Other researchers have noted the importance of doing this (Bond, Kaskutas, & Weisner, 2003; Booth, Kwiatkowski, Iguchi, Pinto, & John, 1998; Edelen, Tucker, Wenzel, Paddock, Ebener, Dahl, & Mandell, 2007).

Our multivariate analysis also showed that two specific properties of the ecstasy use experience were associated with greater involvement in effects-enhancing behaviors: using ecstasy for its touch-enhancing qualities and enjoying the combined music-and-ecstasy-use experience. Taken together, these particular findings suggest that the persons who do the most things to enhance the effects of their ecstasy use are the same ones who also enjoy other sensory aspects (e.g., music, sensual touch) of the ecstasy use experience. Although numerous authors have written about users’ various subjective experiences using ecstasy (see Baylen & Rosenberg, 2006), little has been written in the scientific literature about the role that such factors as music and sensual touch play in ecstasy use or in ecstasy use-related problems. Some information about this subject may be found in Theall, Elifson, and Sterk’s (2006) analysis of the role that sensual touch plays in young adult ecstasy users’ HIV risk practices, as well as in De Almeida & Silva’s (2005) study of ecstasy users in Brazil. Overall, however, additional research is needed in order to understand more fully the relationship of effects-enhancing behaviors among ecstasy users and the broader role played by the ecstasy use sensory experiences from music and sensual touch.

Finally, we would like to address the last of our multivariate findings–namely, the direct association between the amount of childhood maltreatment experienced and the number of ecstasy-related effects-enhancing behaviors practiced. Previous studies have reported a link between childhood neglect, physical abuse, sexual abuse, and/or emotional abuse and subsequent use of the drug ecstasy (Brennan, Hellerstedt, Ross, & Welles, 2007; Singer, Linares, Ntiri, Henry, & Minnes, 2004; Swanston, Plunkett, O’Toole, Shrimpton, Parkinson, & Oates, 2003). Worthy of note, however, is the fact that these studies have reported only generally on an association between childhood maltreatment and greater ecstasy use in adulthood, and did not address the specific finding that we ourselves obtained pertaining to childhood maltreatment and engaging in effects-boosting practices. The finding expands the previous research by documenting yet one more way in which childhood maltreatment experiences lead to adverse outcomes in adulthood. It also highlights the need to consider previously abused young adult ecstasy users as an “at risk” group that potentially is in need of targeted intervention.

In conclusion, this community-based study of young adult ecstasy users found that the large majority of these individuals reported engaging in practices other than polydrug use that were specifically intended to bolster the effects of their ecstasy-related sensory experience. Moreover, most ecstasy users who took steps to increase the effects of their ecstasy use engaged in a variety of these behaviors. Doing this was associated with a variety of negative outcomes, including greater negative consequences resulting from using ecstasy, ever having binged on ecstasy, and experiencing a larger number of ecstasy use-related drug dependency symptoms. A closer examination of the data revealed several factors that were linked with greater involvement in effects-enhancing behaviors, including not being African American, spending more of one’s leisure/social time with other drug abusers, using ecstasy for its music-enhancing and touch-enhancing qualities, and having been victimized by neglect, physical abuse, sexual abuse, or emotional abuse during childhood and/or adolescence.

Acknowledgments

This research was supported by a grant from the National Institute on Drug Abuse (R01-DA014232).

Contributor Information

Hugh Klein, Department of Sociology, Georgia State University, Atlanta, Georgia

Kirk W. Elifson, Department of Sociology, Georgia State University, Atlanta, Georgia

Claire E. Sterk, Rollins School of Public Health, Emory University, Atlanta, Georgia

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