Ketamine for Addiction

Ketamine has been used for decades as a medication for anaesthesia.  In recent years it has also been found to be a powerful antidepressant. This has led to research interest in the possibility that ketamine might prove effective in treating other mental health issues, including addiction.  Addiction involves compulsively engaging in a behavior in a way that causes harm to your quality of life.  Addiction to consuming a substance is known clinically as substance use disorder.  Could ketamine also be used to help people struggling with substance addiction?

What is addiction?

A simple story of addiction that has gained a lot of traction is the “chemical hook” hypothesis.  According to this story, certain substances have the ability to hijack our nervous system, creating a dependency that leads to a relentless drive to consume the substance.  This perspective looks to the substance itself and the way it interacts with your nervous system for an explanation of addiction.  If the chemical hook idea is all there is to addition, why doesn’t everyone who tries a potentially addictive substance become addicted? And how is it that people can become addicted to activities like sex that do not involve consuming a substance?  Clearly there is also something going on inside people that determines whether or not an addiction will develop.

What causes addiction?

Addiction is considered a biopsychosocial disorder.  This means that it has biological, psychological and social causes.  On a biological level there are clearly differences between substances when it comes to how likely it is that dependence will develop.  There is also a genetic component to how likely one is to develop an addiction.  The psychological piece is also crucial in order to understand addiction, however. In many cases, addictions serve to soothe underlying emotional pain.  When the causes of this suffering is found in the environment, there can also be a clear social cause for the tendency to seek respite in pleasure-producing addictions.  Different approaches to treating addiction can focus on any of these levels, or even multiple at the same time.

Ketamine psychedelic therapy’s origins in Mexico and the Soviet Union

Between 1964 and 1974, pioneering psychedelic therapist Salvador Roquet began using ketamine to help people in Mexico struggling with addiction.  He would ultimately be imprisoned for this work.  A decade later, in the mid 80s, researchers in the Soviet Union began experimenting with ketamine psychedelic therapy for addiction.  The initial research focused on alcoholism. Ketamine, in combination with psychotherapy, produced lasting effects in people struggling with alcoholism.  Approximately two thirds of alcoholic patients maintained total abstinence for at least a year following the ketamine treatment.  For those receiving other conventional treatments, only a quarter of people were abstinent a year later.

Can ketamine treat addiction?

At the end of the 20th century, the positive results with alcoholism indicated that ketamine was a promising treatment for addiction.   In the case of opioid addiction, researchers found that a shocking 85% of people addicted to heroin were abstinent one month following their ketamine treatment.   A quarter of the group remained abstinent at the one year mark.  This was compared to a group given a small dose of ketamine, only one in twenty remained abstinent at the one year mark in this group.  The therapy was also found to reduce cravings in participants.  Ketamine has also proved effective in reducing cocaine consumption.

What does ketamine treatment involve?

Most clinical trials on ketamine look at it in combination with psychotherapy.  In many clinics, however, ketamine is offered as a stand-alone treatment without therapy.  While you may have insight into your addiction during such a treatment, the psychological material isn't primarily what this approach is about.  Instead, this approach focuses on the physiological properties of ketamine for its therapeutic effect.  In either case, people receive an intravenous infusion of a subanesthetic dose of ketamine.  This dosage typically produces euphoric, relaxing and hallucinogenic effects and may be repeated multiple times.  Research has shown that multiple treatments can be twice as effective in treating heroin addiction than a single treatment.  Whereas roughly a quarter of people were abstinent after a year following a single treatment, half were of those who received multiple treatments were abstinent.

Why does ketamine help with addiction?

As a drug that acts on the brain, we might expect ketamine’s main therapeutic effects to occur on the biological level.  Ketamine acts on NMDA receptors, chemical docking sites on neurons that are involved in learning and memory.  By activating NMDA receptors, ketamine promotes the creation of new connections between neurons, a process that is thought to underly learning.  This process may enable people to change their behavior, and promote the ability to adapt one’s behavior.  It may also serve to disrupt old memories of associations with the consumption of the substance.  Associations of this kind often play an important role in relapse, as they can trigger memories of consuming the substance, and these memories can lead to craving.  Disrupting these memories and allowing the brain to learn new, healthier patterns of behavior may underlie ketamine’s therapeutic effects on the biological level when it comes to addiction.

Psychological effects

Since ketamine affects the brain, and the brain is responsible for our psychology, we might also expect ketamine to exert therapeutic effects on the psychological level.  The early research into ketamine as a treatment for alcoholism focused on the psychological level.  Under the paradigm of ketamine psychedelic therapy, participants were told that they might uncover insights into the negative consequences of their addiction.  The material was then worked through with a psychotherapist during the ketamine session.  Participants would be exposed to the smell of alcohol to trigger memories and associations and finally they would undergo group therapy in order to integrate the experience.  They found that participants developed more positive attitudes towards themselves and felt stronger purpose and meaning in their life following the ketamine psychedelic therapy.  The altered state itself can also be considered therapeutic here.   In an altered state, previously unconscious memories and associations can be uncovered.  This can act as a catalyst for working with psychological material in conventional psychotherapy.

Mystical experiences

From the first experiments into using ketamine to treat alcoholism in the Soviet Union to contemporary research, the occurrence of mystical experiences has also been proposed as a therapeutic component of ketamine therapy.  These experiences allow people to get outside of their own narrow view of the world and see things from a different perspective.  People can be left feeling a greater connection to the world and to others, creating a greater investment in actively creating meaning in their lives. This holistic effect, whereby people become motivated to pursue personal growth, may play a large role in keeping people from relapsing as the months and years pass by.

Treating depressive symptoms

Ketamine has been found to be highly effective as an antidepressant and this effect may also contribute to its use in addiction.  If one is consuming a substance in order to cope with the emotional pain of depression, addressing the depressive symptoms may alleviate the drive to consume the substance.  Ketamine’s antidepressant effects may also be due to the production of an altered state, combined with the enhancement of plasticity produced by the drug.  Ketamine also acts on the opioid system and, as a result, has pain killing properties.  Activation of the opioid system may help soothe any emotional pain that might underlie the addiction.  

Is ketamine addictive?

Is ketamine itself potentially addictive?  Some people do find that they develop problematic patterns of repeated use when consuming ketamine recreationally.  The risk of addiction is unlikely in a controlled clinical setting, however.  Once an addiction has developed, physical dependence can occur. This can make withdrawal an unpleasant experience.  The entire withdrawal process can take from several days to several weeks.  Rehab centres that offer psychological and behavioral therapies can be effective when attempting to overcome ketamine addiction.

Ketamine and addiction

Ketamine is now legally available in clinics as a treatment for depression and addiction.  It seems to exert powerful therapeutic effects at both biological and psychological levels, helping many to overcome challenging addictions.  As research into the therapeutic properties of ketamine continues, we can look forward to this therapy becoming a mainstream option for those struggling with their relationship to substances.

References

Krupitsky EM, Grinenko AY. Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. J Psychoact Drugs (1997) 29:165–83. doi: 10.1080/02791072.1997.10400185

Krupitsky E, Burakov A, Romanova T, Dunaevsky I, Strassman R, Grinenko A. Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up. J Subst Abus Treat. (2002) 23:273–83. doi: 10.1016/S0740-5472(02)00275-1

Dakwar E, Levin F, Foltin RW, Nunes EV, Hart CL. The effects of subanesthetic ketamine infusions on motivation to quit and cue-induced craving in cocaine-dependent research volunteers. Biol Psychiatry (2014) 76:40–6. doi: 10.1016/j.biopsych.2013.08.009

Dakwar E, Hart CL, Levin FR, Nunes EV, Foltin RW. Cocaine self- administration disrupted by the N-methyl-D-aspartate receptor antagonist ketamine: a randomized, crossover trial. Mol Psychiatry (2017) 22:76–81. doi: 10.1038/mp.2016.39

Krupitsky EM, Burakov AM, Dunaevsky IV, Romanova TN, Slavina TY, Grinenko AY. Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence. J Psychoact Drugs (2007) 39:13–9. doi: 10.1080/02791072.2007.10399860