Thus , the current state of research does not allow for the conclusion that long-term use of MDMA affects decision-making behavior in general .
Different cognitive impairments have been reported as a result of long-term MDMA/ecstasy use .
Increased impulsivity and altered decision-making have been shown to be associated with the development and maintenance of addictive disorders pointing toward the necessity to underst and a potential impairment of decision-making due to MDMA use .
Thus , assessing the long-term effects of MDMA is crucial in order to evaluate its controversially discussed therapeutic use .
The aim of this systematic review was to summarize the scientific literature on potential effects of chronic MDMA use on higher order decision-making processes in humans .
Behavioral and Functional Neuroimaging Evidence for Prefrontal Dysfunction in Methamphetamine-Dependent Subjects
Stimulant-dependent subjects show dysfunctions in decision-making similar to those seen in subjects with ventromedial prefrontal cortex lesions . Studies of drug craving , reward association , and decision-making have implicated dysfunctions of the dorsolateral and orbitofrontal cortex as a key neural substrate in subjects with stimulant dependence . Here , a functional magnetic resonance imaging ( fMRI ) study was carried out to determine the relationship between decision-making dysfunction and neural activation in different prefrontal areas . This investigation tested the behavioral hypothesis that  methamphetamine-dependent subjects in early sustained remission show decision-making dysfunctions that are consistent with an increased reliance on stimulus-contingent response selection . It was hypothesized that these decision-making dysfunctions are due to differences in task-related activation in the dorsolateral and ventromedial prefrontal cortex . Ten methamphetamine-dependent subjects were compared with ten age- and education-matched controls performing a two-choice prediction task and a two-choice response task during a fMRI session .  Response bias , latency , and mutual information measures assessing the underlying strategies of the decision-making sequences were obtained . First , methamphetamine-dependent subjects were more influenced by the immediately preceding outcome during the two-choice prediction task relative to normal comparison subjects . Second , methamphetamine-dependent subjects activated less dorsolateral prefrontal cortex ( BA 9 ) and failed to activate ventromedial cortex ( BA 10,11 ) during the two-choice prediction task compared with the two-choice response task . These results support the basic hypothesis that stimulant-dependent subjects exhibit fundamental cognitive deficits during decision-making that are consistent with both orbitofrontal and dorsolateral prefrontal dysfunction
Thus , the current state of research does not allow for the conclusion that long-term use of MDMA affects decision-making behavior in general .
Different cognitive impairments have been reported as a result of long-term MDMA/ecstasy use .
Increased impulsivity and altered decision-making have been shown to be associated with the development and maintenance of addictive disorders pointing toward the necessity to underst and a potential impairment of decision-making due to MDMA use .
Thus , assessing the long-term effects of MDMA is crucial in order to evaluate its controversially discussed therapeutic use .
The aim of this systematic review was to summarize the scientific literature on potential effects of chronic MDMA use on higher order decision-making processes in humans .