Effects & Dangers of Mixing Alcohol and MDMA (Ecstasy, Molly)

Ecstasy, also known as MDMA or “molly,” is what’s known as a substituted amphetamine, and is a drug that produces both stimulant-like effects as well as mild sensory and perceptual changes.¹ Using ecstasy can result in negative health effects, the risk of which increases when combined with other substances, such as alcohol.¹ This page will help you learn more about the combined health effects of alcohol and ecstasy how to get help for polysubstance use if you or a loved one are struggling.

What Is Ecstasy?

Ecstasy is a synthetic drug with stimulant-like effects similar to methamphetamine, which are sometimes known as entactogenic effects that elicit a sense of openness and well-being, as well as mild psychedelic effects.¹ The drug is most commonly encountered in capsule, powder, and tablet form.¹ Ecstasy can increase alertness, energy, and feelings of connectedness and warmth, and may also slightly alter visual and temporal perception.¹

The drug was popularized in nightclub settings, but its use has expanded to a variety of recreational and social environments. Though not approved for any medical uses, MDMA has more recently experienced renewed investigative interest for certain therapeutic uses.¹

The adverse health effects of ecstasy can range from mild to severe and vary depending on several factors, such as how much a person takes and whether the drug has been adulterated (meaning it contains other types of drugs).¹

Potentially negative health effects of ecstasy include increased blood pressure, nausea, and vomiting.¹ Regular use may also impact brain function and mood, increasing the risk of anxiety, depression, paranoia, and cognitive issues such as problems with attention and memory.¹ In rare cases, ecstasy use can lead to more serious health complications, including acute kidney injury, cardiac issues, dangerously high body temperature (hyperpyrexia), and rhabdomyolysis.^1,2

Combining Alcohol and Ecstasy

Ecstasy has historically been used in recreational settings where polysubstance use is common.³ Some studies have estimated that around 90% of people who use ecstasy also consume alcohol, with more than 70% of those consuming alcohol at dangerous levels.³ One study found that the risk of death in emergencies involving ecstasy doubled when alcohol was also consumed compared to using ecstasy alone.³

Polysubstance use occurs when a person uses more than one substance simultaneously or in short succession (such as taking alcohol and ecstasy together). Polysubstance use can occur for many reasons, including to enhance the effects of one substance with another.⁴ But no matter the reason for using alcohol and ecstasy together, the combination can be dangerous and may increase the risk of severe health effects.¹

Dangers of Mixing Alcohol and Ecstasy

Mixing alcohol and ecstasy is common, but the combination can increase the risk of severe health effects, including hyperpyrexia (dangerously high body temperature) and hyponatremia (dangerously low sodium levels).^1,3

Mixing alcohol and ecstasy can affect the body’s ability to regulate temperature and hydration.³ Ecstasy increases body temperature and, under certain conditions (like hot nightclubs), can lead to hyperpyrexia.³ This is, in part, because ecstasy causes vasoconstriction (narrowing of blood vessels), making it harder for heat to escape. Dehydration from alcohol use further reduces sweating, the body’s natural way of cooling itself down, which increases the risk of dangerously high body temperature.³

At the same time, alcohol mixed with molly can disrupt the body’s fluid and electrolyte balance, increasing the risk of hyponatremia.³ A metabolite of MDMA can stimulate the release of an anti-diuretic hormone that can make the body retain water.³ In an effort to stay hydrated in a setting of increased body temperature, a person may overconsume water, leading to severe hyponatremia, a condition where sodium levels in the blood become dangerously low.^3,5 At its most severe, this condition can result in cerebral edema (brain swelling), confusion, seizures, and, in some cases, death.³

The exact mechanisms of how alcohol and ecstasy work together to cause these conditions are not fully understood and may be due to many biological, chemical, and environmental factors.⁶ However, a review of available research shows an unquestionable increase in MDMA toxicity in the presence of alcohol.⁶

Alcohol, Ecstasy, and Addiction

Once a person begins to engage in polysubstance use, it can become increasingly difficult to stop.³ Concurrent use of multiple substances may increase a person’s risk of developing a substance use disorder (SUD). The development of one SUD can increase a person’s likelihood of developing another.⁴

Addiction is a severe form of SUD and is defined as a chronic, relapsing condition characterized by compulsive drug seeking and use despite negative consequences.⁷ An alcohol use disorder (AUD) is a type of SUD in which a person continues to use alcohol despite knowing its role in causing significant negative mental, physical, or social outcomes.⁸

Though its patterns of use often differ from more conventionally addictive drugs such as opioids, current research suggests that ecstasy can, in fact, be addictive, with some people reporting SUD symptoms related to use; however, more research is needed.¹ If you are concerned that you or a loved one may be addicted to alcohol, ecstasy, or another substance, talking to your primary care physician or a mental health professional can help you get a diagnosis and treatment recommendations.

Treatment for Alcohol and Ecstasy Misuse

If you or a loved one are struggling to control your alcohol or ecstasy use, treatment is available. Treatment may begin with a period of supervised medical detox, which provides monitoring, support, and medication (as needed) to help people withdraw from alcohol and certain other drugs.⁹ This can be an important first step in recovery for people who misuse alcohol, as potentially dangerous withdrawal symptoms can develop if a person who has been drinking heavily for a prolonged time abruptly stops.^9,10

Following medical detox with a formal treatment or rehab program can help people address the underlying causes of their substance misuse. While treatment varies depending on a person’s needs, it may include a combination of:

• FDA-approved medications: Though there are currently no FDA-approved medications for ecstasy use, there are medications that can help with AUD, including acamprosate, disulfiram, and naltrexone. These can help minimize cravings, reduce drinking, and prevent relapse.^10,11
• Behavioral therapies: These can help a person change their attitudes and behaviors related to substance use. A person can learn to manage stressful situations and triggers that might cause relapse. Behavioral therapies can also help people stay in treatment longer.^9,10
• Mutual support groups: These include groups like Alcoholics Anonymous (AA) or Smart Recovery, and are usually free, providing accountability, community, and ongoing support for people in recovery.¹⁰

These interventions may occur in different settings, including:

• Inpatient addiction treatment, which occurs in hospitals or residential settings, and provides 24/7 intensive care and treatment.⁹
• Outpatient addiction treatment programs, which vary in duration and intensity but are traditionally more flexible than inpatient programs.⁹
• Intensive outpatient treatment programs (IOP), which allow a person to live at home while still receiving a high level of addiction treatment. These programs require a person to attend 9 to 20 hours of treatment weekly.⁹
• Partial hospitalization rehab programs (PHP), which are typically a step up in intensity from an IOP, providing similar services, but for 4 to 8 hours daily. They are often comparable to inpatient or residential treatment in terms of the range of therapeutic offerings available to those undergoing treatment.⁹
• Aftercare programs, also known as continuing care, which provide ongoing care (e.g., sober living) after completing a formal addiction program.¹²

Getting Help for Alcohol and Ecstasy Misuse

If you or a loved one are struggling with compulsive substance misuse or addiction, treatment is available. American Addiction Centers (AAC) admissions navigators are available 24/7 to help you take the next step when you call . As a leading addiction treatment provider, our team is committed to your recovery. Call now to get answers to your questions about treatment, learn how to use health insurance coverage for rehab, and verify your insurance at an AAC facility.