Can MDMA Save a Marriage?

After 10 years of marriage, Ree, 42, and her husband were ready to call it quits. Even their therapist had given up, she said, in part because her husband “was so closed off, just unable to open up.”

“We loved each other a lot and we were very compatible, however, we didn’t know how to deal with conflict,” Ree said. She was often anxious about their relationship and could be “a little neurotic at times,” but the more she pushed her husband to connect, the more withdrawn he became. Their sex life suffered.

Then a friend suggested that they try the illegal drug MDMA, popularly known as Ecstasy or Molly.

For Ree — who, along with her husband, requested anonymity to speak about drug use, and is referred to by a nickname — the answer was an “immediate no.” MDMA, long associated with rave culture, is currently categorized as a Schedule I drug — meaning it has a high potential for abuse and no accepted medical use in the United States.

“We are about as strait-laced as you can come,” she said. “We’re not people who break laws or do drugs.”

Six months later, after reading “How to Change Your Mind,” the best-selling book by Michael Pollan that details his transformative experience with psychedelics, Ree reconsidered. And that’s how they found themselves in a secluded area of Utah at a large, rented house with a beautiful view of the mountains to trip on MDMA with five other couples.

“We literally said on the drive to this house, ‘If this doesn’t work, we’re done,’” Ree said.

In recent years, clinical trials have shown that MDMA, when combined with talk therapy, can bring relief to those suffering from post-traumatic stress disorder, a finding that has elevated MDMA’s reputation from party drug to potential therapeutic. Some couples, drawn to the drug’s ability to produce feelings of empathy, trust and compassion, have started using unregulated MDMA on their own in an effort to help them reconnect, improve communication and have better sex.

But experts warn that MDMA, an amphetamine derivative, can have serious side effects. And although MDMA is known for enhancing empathy, there is very little research on couples who use it together, which makes it difficult to know how beneficial or long-lasting its effects are or in what instances the drug might be effective for people having relationship difficulties.

Before MDMA was banned in the United States in 1985, the psychiatrist Dr. George Greer conducted over 100 therapeutic MDMA sessions with 80 people and was an author on an informal, observational study featuring 29 of them.

The participants didn’t volunteer with the intention of trying to heal a relationship, Dr. Greer said, but interestingly, every subject except one reported improved communication in their relationships after the MDMA session, either with a partner or someone else in their life.

Now that MDMA is illegal, some providers resort to clandestine MDMA therapy sessions, at times with disastrous results. A recent essay in Slate detailed one man’s harrowing experience after an underground psychedelic coach gave him methamphetamine “cut with a bit of MDMA” instead of the pure MDMA he was expecting during a guided session in 2019.

It is also risky for people to use MDMA on their own, experts warn.

“This can include everything from a ‘bad trip,’ to reckless behavior to psychiatric symptoms like panic attacks or physical effects like hypertension or interactions with other medications,” said Dr. Smita Das, the chairwoman of the Council on Addiction Psychiatry at the American Psychiatric Association.

Typical side effects of MDMA use include involuntary jaw clenching, nausea, racing heart and hot flashes or chills. And prolonged use can damage nerve cells in the brain that contain serotonin, a chemical that relays messages and helps regulate mood, sleep, pain, appetite and more.

“There is more to taking MDMA than making sure the compound is pure,” said Rachel Yehuda, the director of the Center for Psychedelic Psychotherapy and Trauma Research at the Icahn School of Medicine at Mount Sinai.

Some mental health providers are looking for ways to help patients without breaking the law. Last year the company Fluence, an organization that trains therapists to legally integrate psychedelics into their practice, taught more than 300 clinicians how to support clients using illegal psychedelics on their own, said Elizabeth Nielson, a psychologist and one of the company’s founders.

Fluence tells therapists not to advise their clients on how to obtain an illegal drug or how to use it. But they can discuss why their clients want the drug, what they expect will happen when using it and how to reduce harm. Then they can work with clients after they take the drug to process their experience.

Jayne Gumpel, a lead trainer at Fluence and a couples therapist who sees clients in Woodstock, N.Y. and New York City, said the public’s interest in psychedelics “is exploding.” Oregon, Washington, D.C. and a half-dozen municipalities have decriminalized psilocybin, and hundreds of ketamine clinics are popping up in the United States. To stay current, therapists need to have an understanding of these and other psychedelics, including MDMA, Ms. Gumpel added.

Most of her couples who have tried MDMA say it deepens their connection, she said. But a few have sought her help after having “really challenging and difficult experiences,” because of tainted MDMA or unprofessional (and in some cases, nonexistent) guidance, she added.

Charley Wininger, a psychotherapist in Brooklyn, N.Y., and the author of “Listening to Ecstasy: The Transformative Power of MDMA,” warned that the drug can serve as a “truth serum.”

“What if a partner confesses an affair?” asked Mr. Wininger, who has often worked with couples that use MDMA on their own. Without a trained therapist present, he said, they may not have the tools to process the experience in a constructive way.

Since the publication of his book, Mr. Wininger said couples interested in MDMA have “been coming out of the woodwork, seeking my assistance from all over the place.”

During their first trip on MDMA, Ree said she and her husband tearfully discussed things they had trouble speaking about for the last decade: How his emotional withdrawal had affected her self-esteem, and how sorry she was that she had continually pushed him to open up without understanding the pain he held inside.

“My husband started sharing with me for the first time all these thoughts and emotions,” Ree said. “It was him without the walls,” she added.

They also cuddled in bed for hours, skin to skin, describing all the things they loved about one another.

“For a person who has always had body image issues, to allow him to touch me — touch my stomach, the part of me I don’t love, was incredibly healing,” she said.

They continued using MDMA about twice a year to help them have difficult conversations, and each kept a list of topics that they would discuss while tripping. Ree said they both started seeing therapists. Now, about three years after they first tried MDMA, the blend of therapy and MDMA has improved their relationship and sex life, she added, and they no longer need the drug to speak openly with one another.

Depending on the outcome of a Phase 3 trial currently underway, the Food and Drug Administration could approve MDMA for therapeutic use in people with PTSD as early as the end of next year. But few studies have examined how effective the drug might be for couples.

A qualitative study published in January described how eight couples used MDMA privately to enhance their relationships, but to date there is only one published study in which couples received MDMA-assisted therapy in a clinical setting.

In the study, which was conducted in Charleston, S.C., and included only six couples, at least one member of each pairing was required to have a PTSD diagnosis. The participants without PTSD also took the drug.

By the end, five of the six people with PTSD no longer had symptoms and showed improvements in relationship satisfaction, the authors wrote.

Anne Wagner, a clinical psychologist in Toronto and one of the lead researchers of the study, said she is now seeking approval for a clinical trial with as many as 60 couples. As with the pilot study, at least one member of each couple will need to have PTSD.

When taking MDMA, “both people need to be prepared to actually dig in and communicate with each other, and not perceive it as ‘Oh, this is going to be a thing that fixes our relationship,’” Dr. Wagner said.

Samuel, 33, and his wife, Chris, 29, (who asked that they be referred to by middle names when speaking about drug use) live in North Carolina and turned to MDMA because all of their conversations about starting a family had ended the same way: She wanted a baby and he did not.

“There was this awful period of about two and a half months,” Samuel said, where “we would sometimes just look at each other and start crying.”

Years earlier a friend had given Samuel some MDMA, explaining that he and his wife took it twice a year to strengthen their marriage. Samuel now suggested that they try it. Chris was hesitant, but after months learning about the drug, they decided to take it on New Year’s Eve 2020.

Chris quickly felt nauseous. Samuel’s palms became sweaty, and Chris couldn’t stop laughing whenever she looked at them. But eventually, they started talking, and didn’t stop until hours later.

“I was able to daydream about how cool it would be to have a kid,” he said. “It feels like everything that you’ve ever cared about or held onto that was getting stuck in your throat or making you anxious, just melts.”

Then he began to realize that he had equated having a child with giving up everything that was important to him.

They tried MDMA again months later, and then once more after that, Samuel purchasing it on the dark web and testing the crystals with a home kit to ensure they hadn’t been tainted with other substances, like methamphetamine.

But MDMA alone didn’t solve their problems, he said. They committed to regular meditation and reflected on their experience in journals to figure out how to “bring that state of mind into our day-to-day-sober life, and be more present,” Samuel said.

Chris said she and Samuel felt more empathy and understanding toward one another, and their conversations about having a baby were no longer so tense.

Then, in late 2021, Chris unexpectedly got pregnant.

“We were not actively and intentionally trying to start a family, but, on the other hand, for once I was not being as careful as I could have been,” Samuel said. “We kind of let it happen.”

“I am still scared,” he added. “What is different now is that I’m more willing to be vulnerable and vocal about my needs.”