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Alcohol and Health

The Risks and Effects of Combining Alcohol and MDMA: Drinking on Molly

November 9, 2023
18 min read
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Reframe Content Team
A team of researchers and psychologists who specialize in behavioral health and neuroscience. This group collaborates to produce insightful and evidence-based content.
November 9, 2023
18 min read
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Certified recovery coach specialized in helping everyone redefine their relationship with alcohol. His approach in coaching focuses on habit formation and addressing the stress in our lives.
November 9, 2023
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Recognized by Fortune and Fast Company as a top innovator shaping the future of health and known for his pivotal role in helping individuals change their relationship with alcohol.
November 9, 2023
18 min read
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Reframe Content Team
November 9, 2023
18 min read

Ever heard someone talking about "molly" and wondered, "Who's that?" No, molly isn’t the name of your friend's roommate or your neighbor’s new pet. In fact, molly is a street name for the drug MDMA — a drug that promises temporary euphoria and heightened sensations (at a steep price, of course, as it comes with significant health risks).

The idea of combining uppers such as MDMA with alcohol can be tempting. However, mixing alcohol and MDMA might not lead to the fun-filled night you're expecting — instead, it could be a recipe for disaster. Let's dive into the science behind this combination and see why they don’t play nicely together.

Part 1. Meet Molly: What Is MDMA (Ecstasy)?

First of all, what is molly? MDMA stands for 3,4-methylenedioxymethamphetamine, a synthetic drug that alters mood and perception. Chemically, molly shares properties with both stimulants and hallucinogens, which means it can increase energy and pleasure while distorting sensory perceptions.

Structurally, MDMA (also known as ecstasy) is similar to stimulants like methamphetamine and hallucinogens like mescaline. This unique combination explains why it has a mixed bag of effects on our bodies.

Not That Innocent

While molly might sound intriguing, it comes with a host of risks. MDMA can cause a range of bodily responses:

Increased heart rate and blood pressure. Imagine your heart doing an extra round of cardio — but without the benefits. That's the kind of strain MDMA can put on it.

  • Nausea. MDMA makes some users feel queasy.
  • Chills or sweating. The body's internal thermostat can go haywire, leading to sudden chills or intense sweating.
  • Teeth clenching. Some users might find themselves clenching their jaw or grinding their teeth.
  • Muscle tension or tremors. Our muscles might feel tight, and we might notice minor tremors, particularly in our hands.
  • Blurred vision. MDMA can dilate pupils, sometimes leading to altered or blurred vision.
  • Dehydration. MDMA is a diuretic, so we pee more. It also diminishes our perception of thirst, so we don’t even notice how dry we’re getting.
  • Fatigue. While there might be an initial boost of energy, as the drug wears off, it can leave users feeling drained and exhausted.

Our minds aren't left untouched, either. Initially, many users feel a rush of joy or euphoria and a heightened connection to others, making them more talkative or touchy-feely. However, some people might experience less-desirable mental effects:

  • Anxiety or paranoia. Not all experiences are rosy. Some people might feel a surge of anxiety or even paranoia, as if they're being watched or judged.
  • Confusion. Our thinking can become muddled, leading to moments of disorientation or confusion.
  • Sleep disturbances. MDMA can lead to insomnia, making it tough to drift off even when the party's over.
  • Intensified sensory perceptions. Lights might seem brighter, sounds more resonant. The world can feel amplified.
  • Hallucinations. In higher doses, MDMA can cause hallucinations, making users see or hear things that aren't there.
  • Emotional sensitivity. Feelings, both positive and negative, can be magnified. This can lead to emotional rollercoasters, with users shifting from joy to sadness more rapidly.
diagram showing long-term effects of mixing alcohol with MDMA

Down the Rabbit Hole: The Long-Term Effects

Occasional party antics might seem harmless, but frequent or heavy MDMA use can lead to some prolonged concerns:

  • Dependency. Over time, regular use can result in increased tolerance (needing more of the drug to achieve the same effects) and dependency (a compulsive need to keep using).
  • Cognitive impairment. Chronic MDMA use might impair memory and decrease cognitive function
  • Emotional well-being. Long-term use can lead to mood swings, depression, and anxiety. 
  • Damage to serotonin-producing neurons. MDMA affects levels of serotonin, a neurotransmitter related to mood, sleep, and appetite. Over time, heavy use can damage these serotonin-producing neurons, leading to prolonged mood disturbances.
  • Danger of impurities. Another sneaky issue with MDMA is that what's sold as "pure" often isn’t. Many MDMA tablets or capsules contain other drugs or fillers. This means we might be exposing ourselves to other unknown substances and their accompanying risks.

Through the Years

Now that we’ve met molly, we can turn to the next question — where did “she” come from? As it turns out, molly isn’t a new kid on the block — MDMA (aka ecstasy) has been around for over a century. In 1912, a German pharmaceutical company called Merck first synthesized MDMA. The company aimed to create a drug to control bleeding, but MDMA didn’t fit the bill. For many years, it gathered metaphorical dust on the laboratory shelves.

It wasn’t until the 1970s that the drug resurfaced in the US — not for medical treatments, but as a tool to assist in psychotherapy. Some therapists believed it helped patients open up and communicate better. However, it's important to note that this use was never approved by the FDA — with good reason. (After all, it “worked,” but only in the sense that amphetamines “work” for treating colds or heroin “works” for getting rid of a headache: the risks, to put it mildly, are not worth it).

By the 1980s, molly had found “her” way into the party scene as a recreational drug. And while those flashing disco lights and energetic dance moves might seem like distant history, molly still lingers.

Around the Globe: The Legal Status of MDMA

So, we’ve covered MDMA's effects and dangers, as well as its history in the U.S.. But where does it stand on the world stage? Let's explore the legal status of MDMA around the world.

  • United States. The U.S. classifies MDMA as a Schedule I substance under the Controlled Substances Act. This means it's considered to have a high potential for abuse and no accepted medical use, making its production, distribution, and use illegal.
  • Canada. North of the border, MDMA is a Schedule I drug under the Controlled Drugs and Substances Act. Possession, production, and distribution are illegal, with violators facing potential imprisonment.
  • United Kingdom. MDMA is classified as a Class A drug, putting it in the same category as heroin and cocaine. Possession and supply offenses carry severe penalties, including lengthy prison terms.
  • Germany. MDMA is listed under the Narcotics Act, making its unauthorized production, distribution, and possession illegal. Penalties range from fines to prison sentences.
  • Netherlands. Often seen as liberal when it comes to drug policies, the Netherlands still classifies MDMA as an illegal List I substance. However, personal possession of small amounts might not always lead to prosecution.
  • Japan. MDMA is classified under the Narcotics and Psychotropics Control Act. Possession or distribution can lead to rigorous penalties, including long prison sentences.
  • Singapore. Known for its strict drug laws, Singapore categorizes MDMA as a Class A controlled drug. Penalties are severe, with heavy fines, long prison terms, and even capital punishment in cases of trafficking large amounts.
  • Australia. Down under, MDMA is a Schedule 9 prohibited substance under the Poisons Standard. Its unauthorized manufacture, distribution, and use can lead to serious legal consequences.
  • New Zealand. MDMA is classified as a Class B drug, making its unauthorized possession, manufacture, and distribution illegal, with potential prison sentences for violators.
  • Brazil. In this South American country, MDMA is illegal. Possession for personal use can lead to educational measures and community service, and trafficking can result in prison sentences.
  • South Africa. MDMA is categorized as a Schedule 7 substance, making its unauthorized possession and distribution illegal, with potential penalties including fines and imprisonment.

Part 2. Drinking on Molly: Why Do People Mix Alcohol and MDMA?

Now let’s switch gears a bit and see what happens when alcohol is in the picture. What’s behind the allure of mixing molly with booze? Many people drink alcohol to feel relaxed and sociable. On the other hand, MDMA is taken for its stimulating effects, which include heightened sensations, emotional warmth, and an amplified perception of sights and sounds. It seems like they could complement each other, right? Well, not exactly.

The Unintended Side Effects

Alcohol acts as a depressant, slowing our central nervous system. This means it can reduce anxiety, lower inhibitions, and cause drowsiness. Conversely, MDMA (ecstasy) is a stimulant, speeding up various bodily functions and heightening sensations.

However, when combined, ecstasy and alcohol don't just cancel each other out. Instead, they act as antagonists inside our body, potentially straining our system. Here are the main side effects that can happen as a result of the mix:

  • Dehydration and overheating. Both alcohol and MDMA can cause dehydration. Alcohol does this by increasing urine production, while MDMA increases heart rate and body temperature. Combined, they can lead to severe dehydration and even hyperthermia (dangerously elevated body temperature). A study in Neurotoxicity Research found that recreational use of MDMA was likely to lead to dehydration and overheating due to “profuse sweating while vigorously dancing under unfavorable conditions such as high ambient temperatures and insufficient fluid suppletion” and that alcohol tended to amplify the effect.
  • Increased toxicity. Alcohol can exacerbate the toxic effects of MDMA on the liver, leading to potential long-term damage. A study in Critical Review Toxicology confirmed the increased toxicity of MDMA when combined with booze.
  • Impaired judgment. While alcohol alone can cloud our judgment, adding MDMA can make decision-making even more erratic, putting us in potentially risky situations. 
  • Intensified hangover. Everyone's familiar with the groggy feeling after a night of drinking. Throw MDMA into the mix, and we’re looking at an intensified come-down, with feelings of exhaustion, depression, and irritability.
  • Cardiovascular risks. Both substances increase heart rate; combining them amplifies the strain on your heart.
  • Danger of overdose. Because alcohol's depressant effects can mask some of MDMA's stimulant effects, there's a risk of consuming more of either substance than intended. According to a study in Addiction Biology, combining booze with molly tended to lead users to consume larger quantities of both substances due to the higher levels of dopamine released by the brain in response to the combo.
  • Decreased awareness of intoxication. It's harder to gauge how intoxicated you are, which can lead to dangerous situations, including accidents or other harmful scenarios.

Hyponatremia: A Sneaky Danger of Mixing Molly With Alcohol

Have you ever heard of the term "hyponatremia"? It may sound like a rare plant species or an ancient civilization, but it's a medical condition that can be serious, especially when mixing alcohol and MDMA. 

Hyponatremia is a fancy term for a low sodium concentration in the blood. Sodium, that same stuff we have in our salt shakers, plays a critical role in many of our body's processes, including nerve function, muscle contractions, and maintaining proper fluid balance.

How Do Alcohol and MDMA Contribute?

For one thing, MDMA can sometimes make people feel super thirsty. If we drink large amounts of water to quench this thirst, especially while dancing and sweating, we can end up diluting our blood’s sodium levels. Alcohol amplifies this effect by suppressing the release of an antidiuretic hormone, causing more fluid retention in the long run (after initially making us lose water).

Moreover, both dancing (commonly associated with MDMA use) and alcohol can make us sweat. Sweating causes a loss of salt from the body, which can further lower sodium levels if not adequately replenished.

Signs To Watch Out For

Hyponatremia is no joke, and it can escalate quickly. Here are some symptoms to be aware of:

  • Nausea or vomiting
  • Headache
  • Confusion or disorientation
  • Fatigue or restlessness
  • Seizures
  • In severe cases, coma or even death

Staying Safe

If someone consumes MDMA (which carries its own set of risks!), it's important to be mindful of fluid intake. Here are some quick tips:

  1. Balance is key. Don't chug vast amounts of water in a short time. Sip slowly and replace lost electrolytes, perhaps with sports drinks.

  2. Watch the booze. Since alcohol can exacerbate the risk of hyponatremia when combined with MDMA, it might be a good idea to skip the booze.

  3. Stay informed. Awareness is half the battle. Know the signs of hyponatremia and be prepared to seek medical attention if things seem awry.

Alcohol and MDMA: 7 Steps To Stay Safe

Finally, here are some steps you can take to stay safe when alcohol and molly are in the picture.

  • Know what you're taking. Before consuming any substance, research it thoroughly. Know the potential risks and effects on your body. This knowledge will keep you safe.
  • Stay hydrated. If you're in a situation where you're consuming either substance, keep water handy. Regular hydration can mitigate some of the adverse effects.
  • Limit intake. If you're trying to reduce or quit alcohol, stick to your goals. Avoid environments where you might be tempted to mix substances.
  • Check in with yourself. Listen to your body. If you feel off or unwell, seek help immediately.
  • Have a trusted friend. If you're going out, have a trusted friend with you who's aware of your limits and can help if things go south.
  • Avoid mixing substances. As we've seen, combining alcohol and MDMA has multiple risks. It's always safer to avoid mixing any substances.
  • Seek support. If you're struggling with substance use, seek out support groups, therapy, or apps like Reframe that provide science-backed methods to help you cut back or quit.

Summing Up

In the fun of social gatherings, it's easy to get swept up in the moment. But your health and safety come first. The next time you're faced with the decision to mix alcohol and MDMA, remember the science, and opt for choices that prioritize your well-being. After all, the best memories are those where you felt your best, both during the moment and the morning after!

Summary FAQs

1. What is MDMA, commonly known as Molly?

MDMA, or 3,4-methylenedioxymethamphetamine, is a synthetic drug that has stimulant and hallucinogenic properties. It's popularly known as molly or Ecstasy and has been around since the early 20th century.

2. Are there side effects of using MDMA on its own?

Absolutely. MDMA can cause a range of physical effects like nausea, chills, sweating, and blurred vision. It can also impact psychologically, leading to anxiety, paranoia, and hallucinations.

3. How dangerous is it to mix alcohol with MDMA?

The combination can be risky. Statistics indicate heightened chances of dehydration, hyperthermia, increased toxicity, and impaired judgment when these substances are mixed.

4. I've heard of hyponatremia in relation to MDMA and alcohol. What is it?

Hyponatremia refers to a low sodium concentration in the blood. Both alcohol and MDMA can contribute to this condition, leading to symptoms like nausea, confusion, seizures, or even more severe outcomes.

5. How does the world view MDMA legally?

Most countries, including the U.S., Canada, UK, Japan, and many others, have restrictions or bans on the production, distribution, and use of MDMA, classifying it as a controlled or prohibited substance.

6. If someone does choose to consume MDMA, how can they mitigate the risk of hyponatremia?

It's crucial to be mindful of fluid intake, not to drink excessive water in a short time, and consider skipping alcohol. Replacing lost electrolytes with sports drinks can also help.

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The Reframe app equips you with the knowledge and skills you need to not only survive drinking less, but to thrive while you navigate the journey. Our daily research-backed readings teach you the neuroscience of alcohol, and our in-app Toolkit provides the resources and activities you need to navigate each challenge.

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The Reframe app is free for 7 days, so you don’t have anything to lose by trying it. Are you ready to feel empowered and discover life beyond alcohol? Then download our app through the App Store or Google Play today! 

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