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A 2024 narrative review published in Alpha Psychiatry explores ketamine’s growing role in the treatment of substance use disorders (SUDs) — including alcohol, opioids, cocaine, and cannabis. The review compiles findings from preclinical research, clinical trials, and case studies, showing that ketamine may significantly reduce cravings, substance use frequency, and relapse risk across a range of addictions.

As psychedelic-assisted treatments gain traction, this review positions ketamine as one of the most promising candidates for neurobiological and psychological disruption of addiction cycles.

Review Overview

  • Publication: Alpha Psychiatry, 2024
  • Type: Narrative clinical review
  • Focus: Ketamine’s efficacy and mechanisms in managing addictive behaviors
  • Substances covered:
    • Alcohol
    • Opioids
    • Cocaine
    • Cannabis
  • Methods analyzed: Case reports, open-label studies, controlled trials, and mechanistic investigations

Key Findings by Substance

1. Alcohol Use Disorder (AUD)

  • Ketamine reduced alcohol cravings and days of heavy drinking in multiple studies
  • When paired with motivational enhancement therapy (MET) or CBT, effects were longer lasting
  • Neuroplasticity-related mechanisms (e.g., BDNF increase) may help break compulsive drinking patterns

2. Opioid Dependence

  • Ketamine showed promise in:
    • Reducing opioid withdrawal symptoms
    • Enhancing detox success rates
    • Lowering relapse during post-detox recovery
  • Effective when used alongside naltrexone or psychotherapy for trauma-related addiction

3. Cocaine Addiction

  • Early evidence suggests ketamine can:
    • Disrupt reward-memory circuitry tied to cocaine use
    • Enhance abstinence rates following multiple sessions
    • Support emotion regulation and impulse control

4. Cannabis Use Disorder

  • Fewer studies, but some cases noted reduced urges and improved self-regulation
  • The review calls for more targeted trials, especially in adolescent and young adult populations

Mechanisms of Action in Addiction

Ketamine’s effectiveness may stem from its ability to:

  • Interrupt maladaptive reward circuitry in the brain (e.g., mesolimbic dopamine system)
  • Enhance synaptic plasticity, enabling behavioral flexibility
  • Promote memory reconsolidation — weakening the emotional intensity of drug cues
  • Reduce depression and anxiety, common relapse triggers

These neurobiological shifts are thought to create a “window of opportunity” for therapeutic change and behavioral reinforcement.

Integration With Psychotherapy

The review emphasizes that ketamine works best when paired with structured therapy, such as:

  • Cognitive Behavioral Therapy (CBT)
  • Motivational Enhancement Therapy (MET)
  • 12-step support frameworks
  • Trauma-informed modalities

Ketamine may prime the brain for receptivity, but therapy builds the behavioral infrastructure needed for lasting sobriety.

Safety and Considerations

  • Ketamine was generally safe in controlled settings
  • Side effects included:
    • Transient dissociation
    • Dizziness or nausea
    • Mild increases in blood pressure
  • No evidence of substance substitution or increased misuse when administered therapeutically

Clinical Implications and Future Directions

  • May be useful for relapse prevention, especially after detox or inpatient rehab
  • Ideal candidates may include those with treatment-resistant SUD, co-occurring trauma, or chronic relapse histories
  • Larger, controlled studies are needed to:
    • Determine optimal dosing protocols
    • Clarify which therapies synergize best with ketamine
    • Establish long-term abstinence and recovery rates

Final Thoughts

The 2024 Alpha Psychiatry review highlights ketamine’s multifaceted potential as a treatment for addiction — not just to reduce cravings, but to rewire the brain, rebuild behavior, and restore agency in recovery. Though still early in development, ketamine-assisted addiction treatment is emerging as a viable, neuroscience-informed strategy in the fight against chronic substance use.

Reference
Alpha Psychiatry (2024). Ketamine in Addiction Treatment: Mechanisms and Emerging Evidence Across Substance Use Disorders. Full Text PDF