Substance Abuse

There have been three recent systematic reviews on the value of ketamine in substance use disorders.

 

Jones et al. (2018) conducted a systematic review of seven completed studies on the efficacy of ketamine in treating substance use disorders, including alcohol, cocaine, and opioid use disorders. While the cocaine studies showed improvements in craving, motivation, and decreased cocaine use rates, the studies were limited by small sample sizes, a homogeneous population, and short follow-up. Studies of alcohol and opioid use disorders found improvement in abstinence rates in the ketamine group, with significant between-group effects noted for up to two years following a single infusion, although these were not placebo-controlled trials. The authors suggest that these results indicate the potential for ketamine to facilitate abstinence across multiple substances of abuse and call for further investigation in addiction treatment. The review also provides an overview of six ongoing studies of ketamine in the treatment of alcohol, cocaine, cannabis, and opioid use disorders and discusses future directions in this emerging area of research..

 

In a Review of the Current Literature on the Therapeutic Potentials of Ketamine and Esketamine in Substance Use Disorders (SUD), Martinotti et al. (2021) found that when combined with motivational enhancement therapy, the psychoactive/mystical effects of ketamine were critical for producing a significant reduction in alcohol consumption in those who are prone to alcohol use disorder. Ketamine was also found to be useful as adjunctive medication for managing severe alcohol withdrawal syndrome and reducing benzodiazepine requirements. Furthermore, in cocaine use disorder, a single infusion of ketamine was found to significantly reduce cocaine use, relapse rate, and cravings. In heroin use disorder, a greater and longer-lasting reduction in cravings was obtained with high doses of ketamine, suggesting a dose dependence of the effects.

 

Walsh et al. (2022) conducted a comprehensive systematic review of ketamine for the treatment of mental health and substance use disorders, which provides support for robust, rapid, and transient anti-depressant and anti-suicidal effects of ketamine. Although evidence for other indications is less robust, it suggests similarly positive and short-lived effects. However, the authors caution that the conclusions should be interpreted with caution due to the high risk of bias in the included studies. Further research is needed to determine optimal dosing, modes of administration, and effective forms of adjunctive psychotherapeutic support.

 

Dakwar et al. (2020) conducted a pilot trial on combining a single ketamine infusion with motivational enhancement therapy for alcohol use disorder. The study found that the infusion improved measures of drinking in individuals with alcohol dependence who were engaged in motivational enhancement therapy.

 

In a small randomized controlled trial, Grabski et al. (2022) tested the efficacy of adjunctive ketamine with relapse prevention-based psychological therapy in the treatment of alcohol use disorder. The treatment was well tolerated, and no serious adverse events were associated with ketamine. Although the confidence intervals were wide, indicating that the study was a proof-of-concept, the results showed a significantly greater number of days abstinent from alcohol in the ketamine group compared with the placebo group at 6-month follow-up. The greatest reduction was observed in the ketamine plus therapy group compared with the saline plus education group. However, there was no significant difference in the relapse rate between the ketamine and placebo groups.

 

In a randomized clinical trial, Dakwar et al. (2019) investigated the efficacy of combining a single ketamine infusion with mindfulness-based behavioral modification to treat cocaine dependence. The study found that the infusion improved a range of important treatment outcomes in cocaine-dependent adults, including promoting abstinence, diminishing craving, and reducing the risk of relapse. However, further research is needed to replicate these promising results in a larger sample.

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See for more literature on Depression, Anxiety, Other Mental Health Conditions, Chronic Pain, Other Conditions.

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Other useful articles

• Tripping up addiction: the use of psychedelic drugs in the treatment of problematic drug and alcohol use (2017)

• ​Cocaine self-administration disrupted by the N-methyl-D-aspartate receptor antagonist ketamine: a randomized, crossover trial (2017)

• Ketamine for the treatment of addiction: Evidence and potential mechanisms (2018)

• Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories (2019)

• Neural Mechanisms Underlying the Rewarding and Therapeutic Effects of Ketamine as a Treatment for Alcohol Use Disorder (2020)

• Combining Ketamine, Brain Stimulation (rTMS) and Mindfulness Therapy (TIMBER) for Opioid Addiction (2020)

• Mystical-type experiences occasioned by ketamine mediate its impact on at-risk drinking: Results from a randomized, controlled trial (2021)

• Ketamine-facilitated behavioral treatment for cannabis use disorder: A proof of concept study (2021)

• Therapeutic potential of ketamine for alcohol use disorder (2021)