MDMA, Internal Family Systems therapy, and the Minnesota model in the resolution of C-PTSD-induced alcohol and diazepam addiction—A retrospective case study

In February 2023, Australia became the first country in the world to allow psychiatrists to prescribe 3,4-methylenedioxymethamphetamine (MDMA) for post-traumatic stress disorder (PTSD). This may have left interested clinicians looking for practical examples of the use of MDMA. In the 1950s and 1960s, psychedelics were successfully utilized in the treatment of alcoholism. This case study, the first of its kind in recent years, illustrates in detail how and why MDMA, combined with Internal Family Systems therapy (IFS), can promote abstinence. The case features a man in his forties with a long history of addiction to alcohol and diazepam. The addiction appeared as an attempt to avoid emotional pain caused by witnessing severe, chronic domestic violence in early childhood perpetrated by an alcoholic stepfather. While alcohol temporarily suppressed complex post-traumatic stress disorder (C-PTSD)-related anxiety, it also created intolerable shame and a feeling of inadequacy, which in turn resulted in increased use of alcohol. SSRI medications initially helped somewhat but failed to resolve the issues in the long term. C-PTSD presented itself not only as anxiety and depression but also as physical tensions and pains, and their relaxation with various substances caused intense pleasure, leading to addiction. Later, diazepam was prescribed as a substitute for alcohol. While alcohol use was reduced, an addiction to diazepam emerged instead. There appeared to be a lack of understanding about the causal relationship between adverse childhood experiences (ACEs) and the addiction, as well as the severity of the condition. Eventually, after several failed attempts at quitting and a suicidal period, the patient accepted that he needed more intensive external help, enrolled in a 28-day retreat utilizing the Minnesota abstinence model, felt unprecedented safety and acceptance, gained insight about the ACEs as a cause of his alcoholism, and was able to give up alcohol and diazepam, but the abstinence was fragile and stressful to maintain. Regardless, 'the most painful issues' caused by witnessing life-threatening domestic violence remained unresolved. A single session combining MDMA and IFS therapy allowed him to safely re-experience these events in an embodied manner. A later IFS session without MDMA complemented the outcome of resolving his C-PTSD and stabilizing his abstinence. (Initial version: January 5, 2023; https://doi.org/10.13140/RG.2.2.31521.48480)