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Science continues to analyze and explore new ways to look at how traditionally used medicinal substances can be used for addiction recovery. I’ve written about medically assisted treatments (MATs) in previous posts and though I don’t believe that medication is the be-all and end-all in addiction treatment, it is sometimes a necessary component to the recovery care for many people with alcohol or substance use disorders. It’s certainly part of the harm reduction approach, which I am an advocate of.
Ketamine is one of those drugs. First used during surgery and then popular in the party scene, it is now showing promise for helping to treat alcohol addiction and mental health conditions.
What is ketamine?
Ketamine, as an intravenous (IV) anesthetic, has been used medically for sedation since 1970. It is also known as a veterinary medicine and animal tranquilizer and has gained popularity as a party drug because of the sense of the euphoria and sense of disconnection it creates in the user.
Ketamine increases heart rate and blood flow, relaxes airways and increases muscle tone. People who have been administered ketamine in surgery will appear awake (eyes remain open) but are in a dissociative state.
“The medical benefits of ketamine far outweigh potential harm from recreational use.” —Marie-Paule Kieny, Assistant-Director General for Health Systems and Innovation at WHO.
According to the World Health Organization (WHO), ketamine is listed as an "essential medicine," and among the safest and most efficacious ones known to science.
What uses does ketamine have?
Ketamine has been traditionally used as a surgical anesthetic, but it has also been shown to be effective in the treatment of depression and alcohol use disorders.
Surgical anesthetic. Ketamine is most commonly used by vets as an animal tranquilizer or by aestheticians for sedating adults or children prior to surgery. It works as a fast-acting anesthetic which is useful for doctors and veterinarians when conducting minor surgeries. It also lasts a short duration of approximately 30 to 60 minutes and so it doesn’t take hours to wear off like some other sedatives.
However, there are side effects of ketamine, particularly when it's administered in large doses, that have been discovered since its introduction to surgeries in the 1970s including:
- Hallucinations or psychosis after surgery.
- Changes in body image and sensory perception.
- Many patients report their experience of ketamine as distressing and disorienting.
It is now less commonly used on human patients than animals in surgery.
Club drug. How does ketamine work in a party atmosphere? The substance produces what is known as a dissociative, or “out of body” experience, and people who use it may feel euphoric, pleasant, happy, or relaxed, or report having enhanced sensory abilities. It may be used as an ‘escape’ from reality.
Ketamine can actually cause people to hallucinate — hearing or seeing things that aren’t real. They may also be unable to move their body due to feeling completely detached from their body and surroundings (known as a K-Hole). The ‘high’ of ketamine may last for up to an hour but the effects of use may still be present some hours later.
The negative effects of ketamine use as a party drug include:
- Dizziness, headaches, blurred vision, nausea.
- Long-term hallucinogenic or psychotic effects may include confusion, loss of reality-based sensory experiences, speaking difficulties, and mind/body dissociation.
- Ketamine may also cause seizures which lead to brain damage.
- Due to the feeling of body detachment, it can make people prone to accidents and hurting themselves.
- Physically, ketamine can cause stomach pain and severe bladder problems including pain when urinating. In extreme cases, this can lead to the need for the bladder to be removed altogether.
It's no surprise when you look at the risks of ketamine use that it may cause people to be concerned about its use in non-surgical treatments. However, when monitored, controlled, and individualized, the use of ketamine can be beneficial. It’s when the drug is not regulated and is misused outside of treatment purposes that it can cause long-term psychological and physical health problems.
Depression. In a previous post, I explored the research being undertaken in testing a ketamine nasal spray as a fast-acting antidepressant. This means people can reap the benefits of ketamine much faster than traditional antidepressants, which often take up to six weeks to have a clinical response. The early research suggested that ketamine could have an effect within just a few hours.
The potential benefits of ketamine in depression treatment include:
- Fast-acting to reduce depressive symptoms which may be helpful when time is of the essence or for patients who have not responded to other antidepressants.
- It blocks the NMDA receptors. NMDA plays a crucial role in our mood stability and because depression damages this area of the brain, traditional antidepressants work to repair the damage by infusing serotonin. Ketamine, on the other hand, delivers serotonin directly by blocking the NMDA receptors and reducing depressive symptoms within a few hours.
- Less is more. Traditional antidepressants tend to be taken on a daily basis; however, one dose of ketamine can last several days.
- Ketamine is already FDA approved as it's currently used as an anesthetic which means approval for other uses may be quicker than newer drugs on the market.
On the downside, ketamine must be carefully monitored and there are concerns about the potential misuse or abuse of the drug because of its party drug reputation. What’s more, due to the lack of long-term studies on ketamine for depression, it’s impossible to know what the effects of the drug may look like months or years down the track.
Alcohol addiction treatment
Ketamine can be used to disrupt harmful patterns of behavior, including those associated with alcohol use disorder. While one of the negative side effects of ketamine is the disruption of memory formation, in the context of alcohol use disorder, that could actually work as a positive side-effect. In other words, it can be used to override the memories that drive alcohol use and related behaviors.
Remember, ketamine blocks the brain receptor called NMDA (effective in treating depressive symptoms) which not only regulates mood but is also required for memory formation. So if someone is given ketamine, it could weaken the triggers associated with alcohol use, or even erase the memory altogether. This could be quite powerful, particularly since there are many environmental factors associated with alcohol abuse including social settings, and drinking associations.
Researchers based at University College London are testing whether the administration of three doses of ketamine in conjunction with psychological interventions could help people with alcohol use disorder by disrupting the memories associated with drinking. Not only do they hope that it will reduce alcohol-related harmful behavior, but that it will have the added side effect of reducing any depressive-related symptoms.
How exactly does it affect memory formation? Scientists have demonstrated that ketamine promotes the growth of new neural connections in the brain which is essential in the process of learning and forming new memories. In people who are depressed or have an alcohol use disorder, it is thought that these processes are impaired. That’s where ketamine comes in. It can help people be more receptive to new information, increase their planning skills and break memories associated with drinking behavior. The best part? All of these effects could then enhance the effects of traditional psychological therapies which work to treat the underlying causes of why the addiction developed in the first place.
However, there is not enough research into the negative side-effects of ketamine (such as hallucinations and the ‘out of body’ experience). High abuse potential for this drug requires that we study it well and monitor initial use with individuals who struggle with compulsive substance use in order to make sure there isn't simply a replacement of use.
Is ketamine a valid alcohol addiction treatment?
I'm all for anything that can help minimize symptoms of addiction, whether you are using Kratom (an herb) to minimize opioid addiction or naloxone to help curb alcohol cravings. It’s worth keeping an open mind. That being said, medical providers must not become so hyper-focused on treating the symptoms of addiction that they forget about addressing the underlying causes such as environmental factors and biological factors, and trauma.
A drug like ketamine could be part of a medication-assisted therapy approach, meaning it is a supplement to a comprehensive program that must include a behavioral component, such as cognitive behavioral therapy; it is not a magic bullet.
What is exciting about this research is that it offers people options. There is no one-size-fits-all when it comes to the treatment of alcohol use disorders.
