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Lieb R, Schuetz, CG, Pfister H, von Sydow K, Wittchen H-U. 
“Mental disorders in ecstasy users; A prospective-longitudinal investigation”. 
Drug Alcohol Depend. 2002;68:195-207.
OBJECTIVE: To investigate the relationship between ecstasy use and mental disorders in a representative sample of adolescents and young adults.

METHODS: Data for this investigation were drawn from the Early Developmental Stages of Psychopathology (EDSP) study, an epidemiological/longitudinal study in which 14/24 year-olds were examined prospectively over a period of about 4 years. Results are based on N/2462 participants who completed the whole study period and for whom drug use behavior could be determined.

RESULTS: (1) Ecstasy users, compared with non-users, were at significantly increased risk of DSM-IV substance related disorders, including alcohol use disorders (52.6 vs. 15.6%; OR/5.6, 95% CI/3.8/8.1). Further, ecstasy users also had a higher risk of alcohol use disorders, when compared with users of other illicit substances (52.6 vs. 40.3%; OR/1.7, 95% CI/1.1/2.4). (2) Ecstasy users had significantly higher rates for almost all DSM-IV mental disorders examined when compared with non-users (any non-substance use disorder: 68.7 vs. 44.5%; OR/3.1, 95% CI/2.1/4.4) and compared with users of other illicit drugs (any non substance use disorder: 68.7 vs. 55.5%; OR/1.8, 95% CI/1.2/2.6). (3) Ecstasy users also reported significantly higher rates of prescription medicine use, though they did not use more medical services than non-drug users. (4) Analyses of temporal patterns of ecstasy use and disorder onset revealed that the first use of ecstasy was secondary to the onset of DSM-IV mental disorders in the majority of cases. Still, subjects with mental disorders at baseline also showed a significantly increased risk for initiation of ecstasy use during the 4-year follow-up period. Conclusions: Care should be taken in cross sectional studies in interpreting mental disorder signs and symptoms merely as a consequence of ecstasy use, as ecstasy use might be associated with the use of multiple substances, and onset of mental disorder is more likely to precede rather than to follow use of ecstasy and related substances.
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