Editing MDMA (section)

===Reinforcement disorders===
<!--Dependence-->
Approximately 60% of MDMA users experience [[drug withdrawal|withdrawal]] symptoms when they stop taking MDMA.<ref name="Toxnet MDMA after-effects"/> Some of these symptoms include fatigue, loss of appetite, depression, and trouble concentrating.<ref name="Toxnet MDMA after-effects"/> [[Drug tolerance|Tolerance]] to some of the desired<!-- (e.g., euphoria) - need ref--> and adverse<!-- (e.g., loss of appetite) - need ref--> effects of MDMA is expected to occur with consistent MDMA use.<ref name="Toxnet MDMA after-effects"/> A 2007 [[Delphi method|delphic analysis]] of a panel of experts in pharmacology, psychiatry, law, policing and others estimated MDMA to have a psychological dependence and physical dependence potential roughly three-fourths to four-fifths that of cannabis.<ref name="pmid17382831">{{cite journal |vauthors=Nutt D, King LA, Saulsbury W, Blakemore C |title=Development of a rational scale to assess the harm of drugs of potential misuse |journal=Lancet |volume=369 |issue=9566 |pages=1047–1053 |date=March 2007 |pmid=17382831 |doi=10.1016/S0140-6736(07)60464-4 |s2cid=5903121 |author-link1=David Nutt |author-link4=Colin Blakemore}}<br />Lay summary: {{cite web |date=23 March 2007 |title=Scientists want new drug rankings |website=BBC News |url=http://news.bbc.co.uk/2/hi/health/6474053.stm |access-date=4 April 2008 |archive-date=2 December 2007 |archive-url=https://web.archive.org/web/20071202233524/http://news.bbc.co.uk/2/hi/health/6474053.stm |url-status=live }}</ref>

<!--Addiction-->
MDMA has been shown to induce [[ΔFosB]] in the [[nucleus accumbens]].<ref name="MDMA ΔFosB">{{cite journal | vauthors = Olausson P, Jentsch JD, Tronson N, Neve RL, Nestler EJ, Taylor JR | title = DeltaFosB in the nucleus accumbens regulates food-reinforced instrumental behavior and motivation | journal = The Journal of Neuroscience | volume = 26 | issue = 36 | pages = 9196–204 | date = September 2006 | pmid = 16957076 | pmc = 6674495 | doi = 10.1523/JNEUROSCI.1124-06.2006 }}</ref> Because MDMA releases dopamine in the [[striatum]], the mechanisms by which it induces ΔFosB in the nucleus accumbens are analogous to other dopaminergic psychostimulants.<ref name="MDMA ΔFosB" /><ref name="Nestler">{{cite journal | vauthors = Robison AJ, Nestler EJ | title = Transcriptional and epigenetic mechanisms of addiction | journal = Nature Reviews. Neuroscience | volume = 12 | issue = 11 | pages = 623–37 | date = October 2011 | pmid = 21989194 | pmc = 3272277 | doi = 10.1038/nrn3111 }}</ref> Therefore, chronic use of MDMA at high doses can result in [[neuroplasticity|altered brain structure]] and [[drug addiction]] that occur as a consequence of ΔFosB overexpression in the nucleus accumbens.<ref name="Nestler" /> MDMA is less addictive than other stimulants such as methamphetamine and cocaine.<ref>{{cite book| vauthors = Mack AH, Brady KT, Miller SI, Frances RJ |title=Clinical Textbook of Addictive Disorders|publisher=Guilford Publications |isbn=978-1-4625-2169-2 |page=169 |url=https://books.google.com/books?id=88W_CwAAQBAJ&pg=PA171 |quote=MDMA's addictive liability appears to be lower than that of other drugs of abuse....|date=2016-05-12}}</ref><ref>{{cite journal | vauthors = Favrod-Coune T, Broers B | title = The Health Effect of Psychostimulants: A Literature Review | journal = Pharmaceuticals | volume = 3 | issue = 7 | pages = 2333–2361 | date = July 2010 | pmid = 27713356 | pmc = 4036656 | doi = 10.3390/ph3072333 | quote = It seems to present a smaller addiction potential than cocaine or methamphetamine. | doi-access = free }}</ref> Compared with amphetamine, MDMA and its metabolite MDA are less reinforcing.<ref>{{cite book |vauthors=Ries R, Miller SC, Fiellin DA |title=Principles of addiction medicine. |date=2009 |publisher=Wolters Kluwer/Lippincott Williams & Wilkins |location=Philadelphia |isbn=978-0-7817-7477-2 |page=226 |edition=4th |url=https://books.google.com/books?id=j6GGBud8DXcC&pg=PA226 |quote=MDA and MDMA are less reinforcing than amphetamine... |access-date=11 January 2017 |archive-date=13 January 2023 |archive-url=https://web.archive.org/web/20230113000536/https://books.google.com/books?id=j6GGBud8DXcC&pg=PA226 |url-status=live }}</ref>

<!--Diagnostic criteria-->
One study found approximately 15% of chronic MDMA users met the [[DSM-IV]] diagnostic criteria for [[substance dependence]].<ref name=Steinkellner2011>{{cite journal | vauthors = Steinkellner T, Freissmuth M, Sitte HH, Montgomery T | title = The ugly side of amphetamines: short- and long-term toxicity of 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy'), methamphetamine and D-amphetamine | journal = Biological Chemistry | volume = 392 | issue = 1–2 | pages = 103–15 | date = January 2011 | pmid = 21194370 | pmc = 4497800 | doi = 10.1515/BC.2011.016 | quote = ...approximately 15% of routine MDMA users recently fit the diagnostic criteria for MDMA dependence according to the Diagnostic and Statistical Manual, fourth edition/DSMIV. }}</ref> However, there is little evidence for a specific diagnosable MDMA dependence syndrome because MDMA is typically used relatively infrequently.<ref name=Epstein2013>{{cite book|veditors=McCrady BS, Epstein EE|title=Addictions: a comprehensive guidebook|date=2013|publisher=Oxford University Press|location=Oxford|isbn=978-0-19-975366-6|page=299|edition=Second|url=https://books.google.com/books?id=MUYfAQAAQBAJ&pg=PA299|access-date=11 January 2017|archive-date=13 January 2023|archive-url=https://web.archive.org/web/20230113000537/https://books.google.com/books?id=MUYfAQAAQBAJ&pg=PA299|url-status=live}}</ref>

<!--Treatment-->
There are currently no medications to treat MDMA addiction.<ref>{{cite book|vauthors=Mack AH, Brady KT, Miller SI, Frances RJ|title=Clinical Textbook of Addictive Disorders|publisher=Guilford Publications|isbn=978-1-4625-2169-2|page=171|url=https://books.google.com/books?id=88W_CwAAQBAJ&q=mdma+addiction&pg=PA171|quote=There are no known pharmacological treatments for MDMA addiction.|date=2016-05-12|access-date=13 October 2020|archive-date=19 January 2023|archive-url=https://web.archive.org/web/20230119130056/https://books.google.com/books?id=88W_CwAAQBAJ&q=mdma+addiction&pg=PA171|url-status=live}}</ref>