Social Workers' Perspectives on the Feasibility, Appropriateness, and Acceptability of MDMA-Assisted Therapy for Adolescent PTSD

Background and purpose. The Food and Drug Administration (FDA) has accepted a New Drug Application for MDMA-AT (MDMA-AT) for adults with posttraumatic stress disorder and has granted it priority review with a target approval date in mid-2024. If approved, MDMA-AT will likely be investigated in populations not currently represented in clinical trials, such as adolescents with PTSD. Up to 15% of adolescents who experience trauma go on to develop PTSD, and current treatments in this population are lacking in efficacy. Given their work with adolescents and training to deliver interventions for PTSD, social workers are uniquely poised to offer meaningful contributions to MDMA-AT for adolescents. As we anticipate clinical trials for MDMA-AT to include adolescents, we must begin to assess social workers’ beliefs about MDMA-AT for adolescents as they are likely to be involved in providing this novel treatment.

Methods. The study includes data from a national sample of social workers who work with adolescents investigating attitudes and beliefs about MDMA-AT. The sample (n=222) was predominantly female (89%), with a mean age of 45 (SD=12.3) and 15 (SD=15.38) years of professional experience on average. Participants were randomized to read one of two vignettes. Each vignette asked participants to imagine they were working with an adolescent client who was interested in enrolling in a clinical trial for severe, treatment-resistant PTSD. One group was told the clinical trial was for MDMA-AT, and one group was told the trial was for Selective Serotonin Reuptake Inhibitor (SSRI-Assisted Therapy). Participants then rated the associated treatment's acceptability, appropriateness, and feasibility. All participants then rated items assessing drug stigma, perceptions of drug risk, and psychedelic knowledge.

Results. Compared to participants in the MDMA-AT condition, those in the SSRI condition reported significantly higher mean ratings of the acceptability (p<.001; d=.72), appropriateness (p<.001; d=.72), and feasibility (p<.001; d=.64) of medication-assisted treatment. There were no differences in mean ratings of knowledge of psychedelics and perceptions of SSRI risks between groups. However, perceptions of MDMA risk were greater among those in the MDMA-AT condition (p<.001; d = .59). Notably, in the MDMA-AT condition, ratings of psychedelic stigma and perceived risk of MDMA were positively correlated (r = .46, p <.001), such that increased stigma related to increased perceived risk of MDMA. Moreover, greater psychedelic knowledge was significantly related to less stigma (r = -.33, p <.001) and less perceived risk of MDMA (r =-.21, p < .001).

Conclusions and Implications. Taken together, these findings suggest that social workers have concerns about the acceptability, appropriateness, and feasibility of MDMA-AT for adolescents with PTSD. Furthermore, stigma about psychedelics is associated with perceptions of perceived risk for MDMA-AT. These findings indicate possible barriers to clinical trial recruitment and engagement as well as future intervention implementation. Therefore, we must develop and evaluate MDMA-AT training for social workers who specialize in adolescent mental health, aiming to decrease stigma about psychedelics and emphasize knowledge building about MDMA-AT for adolescents with PTSD.