Ketamine, a popular rave party drug, is also known to help break the addiction chain when used responsibly. This is not a surprise, as the pharmaceutical industry invented most street drugs, and they were meant to manage health conditions. Even drugs of natural origins, like opioids or cannabis, have many health benefits when used responsibly – however, they cause much harm if abused. So, the quote that the difference between the poison and remedy is in the dose remains as valid as ever.
Addiction is quite a complex phenomenon. It is also essential not to associate it with just street drugs. People may become addicted to relatively less harmful things like gadgets, video games, and even sex. This is because reinforcing specific behavior by repeating it causes certain brain changes. Addiction is not merely about habit. It is more harmful and occurs due to more severe brain changes. People with addiction have altered behavior. They experience pain and withdrawal when the object of addiction is eliminated, and they actively seek that substance or activity, even if it causes much harm.
There is a physiological addiction. It occurs when some substance causes certain body or brain changes. Hence, withdrawal of that substance of activity starts causing pain and distress. Then, there is also a psychological addiction, when a person may not suffer much physically when that particular substance is eliminated; nonetheless, one seeks that substance as it gives the person pleasure. Of course, most addictions have both physiological dependence and psychological components.
To make things even more complicated, not all kinds of dependence are addiction. For example, after taking some medication for a long, one may become dependent on the medication, and its withdrawal might cause issues like an upsurge in blood pressure, headaches, or other problems. However, this does not mean that the person is addicted to the drug.(1) Since such dependence does not show other addiction signs like withdrawal, distress, seeking substances, and more.
For example, some drugs may displace certain brain chemicals on prolonged use. Hence, discontinuing their use causes severe pain and other physical signs. This is an example of typical physiological dependence. However, a person also seeks that substance to experience pleasure – an example of a psychological component.
Neurobiology of Addiction
There is a reason why this article is exploring ketamine for managing addiction or ketamine for addiction treatment. Ultimately, addiction is always about brain changes leading to behavioral changes. Ketamine can help reverse brain changes caused by prolonged addiction by boosting brain plasticity and reducing pain and stress. However, what are those changes that occur due to addiction?
It is vital to understand that addiction is a chronic brain disease. It generally has three stages: intoxication, withdrawal, and preoccupation or seeking that substance. As people develop tolerance to any substance, they do get less pleasure, and intoxication may last for short, but withdrawal and substance-seeking behavior may become a significant part of life.(2)
Science also knows this has much to do with changes in the reward pathway. Thus, addiction is about changes in brain areas like basal ganglia, amygdala, and prefrontal cortex. It is also about changes in dopaminergic pathways since dopamine plays a significant role in reward pathways.(2)
All these changes in the brain mean the person seeks more substances or drugs, as the pleasure does not last for long. Moreover, these brain changes reduce one’s ability to resist urges. It is also about habit formation, repetitive behavior, or compulsivity.
Ketamine And Addiction Treatment
Ketamine is an anesthetic and pain killer. It is a US FDA-approved drug for use in medicine. However, it is also among the popular drugs of abuse. Ketamine addiction is also found in some people. Many individuals also use ketamine-laced drugs. Therefore, it is good to ask how ketamine could help with addiction treatment.
It is vital to understand that if some substance is abused, this does not mean that it cannot be used to treat medical conditions, including addiction. Just take the example of opioids. Millions of people use them responsibly to reduce their pain, and they do not get addicted to them. Only those who abuse opioids may get addicted. Or take an example of medications used to treat addiction, like buprenorphine and methadone. They might also cause addiction, as they have actions similar to opioids but milder.
Hence, it is vital to understand that the problem is not in the substance but rather with its misuse leading to brain changes. Hence, the only way to manage the resulting neurological condition is by reversing the brain changes by using mind-altering substances under medical supervision.
Ketamine is good in a way that when given by doctors or healthcare specialists, it does not cause high. It does cause some disorientation for a couple of hours. However, slow IV ketamine infusion used to manage drug addiction is safe and does not cause harm or dependence.
What is good about ketamine is that it is good for different kinds of addictions. It is good for those addicted to alcohol, cocaine, cannabis, opioids, and more. It is equally good for managing addiction to stimulants and brain suppressants. This is because it helps reduce pain and cravings, enhances motivation, and increases brain plasticity. People are more likely to stay sober after ketamine IV injection, and they have significantly reduced urge for a substance.
What does the science say about ketamine for breaking the addiction chain?
Ketamine has widely been used to manage various kinds of addiction. It is regretful that ketamine is still not widely used to manage substance abuse disorder or addiction. Nonetheless, many studies have been in this direction in the last 25 years with encouraging results.
Thus, one of the systemic reviews could identify seven clinical studies with good data. It found that ketamine was effective in managing different kinds of addiction like cocaine, alcohol, cannabis, and more. It could reduce cravings and reduce substance abuse rates. Moreover, it found that even a single low-dose ketamine IV infusion was enough to reduce substance dependence in many individuals. What is even surprising is that in some people, this effect is seen for several months or even years after a single ketamine IV infusion.(3)
Ketamine for alcohol addiction
Alcohol is one of the most common substances of abuse, as it is readily and legally available in many nations. Moreover, drinking it in small amounts is safe and helps people socialize and reduce stress. However, many people struggle to drink alcohol responsibly, and they develop alcohol dependence and become addicted to it.
There are many studies suggesting that slow and low-dose ketamine infusion may help get rid of alcohol addiction. Thus, those who are given ketamine therapy show lower alcohol-seeking behavior, and they also report better mood.
There could be many ways in which ketamine helps. Some experts suggest that this could be due to alcohol’s role in managing depression. Further, it appears that blocking NMDA receptors also helps. It seems that ketamine also influences glutamatergic pathways and improves neuroplasticity. Even more interesting is the fact that ketamine appears to be more effective for females than males. Researchers are unsure of why such a difference exists. It is quite likely that females are more likely to experience emotional disorders when living with alcohol addiction.(4)
Of course, it is also worth understanding that ketamine alone can help, but it would not be effective for all. It is not some magical solution to the problem of addiction. Hence, it is always good to combine ketamine therapy with other measures. Ketamine is especially good for use with psychotherapy. Studies also show that practicing mindfulness along with ketamine therapy may be more helpful to problem drinkers.(5)
Since ketamine improves brain plasticity, it helps make changes in life. It is exceptionally good for brain-rewiring. However, the brain must be rewired in the right way. It means that after IV ketamine therapy, one must engage in exercises like self-suggestion to make positive changes in the brain. Hence, one may consider psychotherapy or might engage in practicing mindfulness. This is especially helpful in the early few weeks after ketamine treatment.
Ketamine for Cocaine Addiction
What is good about ketamine is that it is also good for managing addiction to various stimulants, including cocaine. There has been much research into its role in managing cocaine addiction, and studies show that it works. Quite like alcohol addiction, it is more effective when combined with psychotherapy.
Many researchers are proposing the repurposing of ketamine for cocaine addiction treatment. Repurposing is about using the existing drug to manage new medical conditions. Why invent something new when there are already some drugs known to help with cocaine addiction? Why not just focus more on ketamine and carry out various clinical studies to understand how to use ketamine more effectively for managing cocaine addiction? This helps save costs. Moreover, ketamine is proven to be safe for humans when used under medical supervision.(6)
Of course, as is the case with alcohol dependence, ketamine is more likely to help when combined with psychotherapy, cognitive behavior therapy, mindfulness, social support, and other measures. One must remember that it promotes brain rewiring, and hence, it is vital to feed the brain with positive thoughts or suggestions after IV ketamine therapy.(7)
Addiction to drugs like cocaine is a severe health issue. Ketamine may help in many other ways, like reducing pain, withdrawal symptoms, reducing drug-seeking behavior. However, it is more likely to work for those who would like to get rid of their addiction. One should not think that using ketamine alone would be sufficient. It is just one of the helpful tools in the fight against substance abuse disorder.
Ketamine for Opioid Use Disorder
It is no secret that the US is going through an epidemic of opioid use disorder. In the last couple of decades, opioid misuse and, thus, addiction have risen significantly. Opioid overdose is among the leading causes of death among those addicted to various substances. Thanks to some of the measures, opioid addiction rates are now declining in the US, but it still remains a significant problem.
Doctors generally use low-dose oral opioids to manage the addiction. However, these drugs help only as long as the person keeps taking them. Very few individuals are able to get rid of their addiction with the help of oral drugs. Using those medications is more like substituting street drugs or illegal opioids with safer options. That is surely not a perfect way to manage opioid addiction.
Unlike other medications, ketamine is good as one just needs a weekly low-dose infusion. Since healthcare workers give such an infusion, there is almost no chance that a person would become ketamine dependent or start abusing it. There are many case reports about people recovering from opioid addiction with the help of ketamine. Moreover, ketamine is quite good for pain relief and easing withdrawal syndrome.(8)
Ketamine and Nicotine Addiction
Although nicotine or tobacco addiction has been declining globally, it still remains a significant problem. Nicotine is known to harm vascular health and also alter brain function. Hence, it is wise to consider IV ketamine therapy for nicotine addiction. Studies show that ketamine is quite good for it. It can help reduce nicotine-seeking behavior and may also help ease nicotine withdrawal. Moreover, ketamine seems to increase excitatory neurotransmission, thus neutralizing many harmful effects of nicotine on the brain.(9)
Ketamine is quite good for overcoming nicotine addiction, which is seen even in animal studies. For example, in one of the animal studies, researchers found that ketamine therapy could significantly reduce nicotine-seeking behavior in rats that were trained to self-administer nicotine. This shows that ketamine is effective and promotes brain changes that might help manage addiction.
Ketamine for Cannabis/Marijuana Addiction
Marijuana addiction is also pretty common. Finding treatment for marijuana addiction has become quite important, considering that its recreational use is legal in many parts of the world. Fortunately, early studies show that ketamine is also suitable for managing cannabis addiction. Some of the early studies show that low-dose IV ketamine infusion used along with behavioral therapy may help reduce cannabis addiction in individuals.
The Bottom Line
Addiction is a severe neurological condition requiring prolonged treatment. It is not just about psychological dependence, habit, or not even merely about physiological dependence. Addiction is much more complex, with much graver changes in various brain parts, especially affecting reward pathways and dopaminergic pathways.
Since the condition is so complex, no single remedy would work for all or in all cases. Getting rid of addiction requires a prolonged approach. One can only get rid of addiction by making significant brain changes. Ketamine works because it not only provides relief from pain and withdrawal but it also helps manage emotional issues and reduce depression severity. However, the most important way in which ketamine works is by increasing brain plasticity. This makes the brain more flexible, making it more likely to change.
It is also important to note that as ketamine increases brain plasticity, it works better when combined with other non-pharmacological interventions like psychotherapy, cognitive behavioral treatment, mindfulness, and so on. One has to keep reinforcing positive thoughts after ketamine therapy to experience its maximum benefits. Of course, ketamine also makes it easier to carry out other lifestyle changes. Thus, one should have a firm plan for lifestyle changes after ketamine infusion. Remember that after the infusion, your brain is more receptive to suggestions and ready for reprogramming.
There are many good things about ketamine. IV ketamine therapy is very safe and is not likely to cause any long-term side effects. There are two reasons for trusting this therapy. Firstly, it is a weekly low dose and slow IV ketamine infusion – less frequent dosing makes it safer. Secondly, IV infusion is done under supervision. Hence, there is almost no scope for a person to start abusing ketamine.
After repetitive ketamine therapy, its effect is long-lasting. Unlike other treatments, ketamine starts working from the first infusion and helps make long-lasting changes in life. Thus, ketamine therapy could be a transforming experience for many.
Finally, people need to understand that addiction is not just to street drugs. There are so many things one can get addicted to. There is an increasing concern about addiction to relatively benign things like electronic gadgets and even sex. These kinds of addictions might not be as harmful as substance addiction, but in the long run, any addiction is bad. Moreover, it is worth understanding that the underlying mechanism of all addictions is quite similar, which changes in reward pathways, dopamine levels, and so on. It means that all addictions are treated in more or less the same ways.
Hence, it is vital to carry out more studies to understand the role of ketamine therapy in managing different kinds of addictions. Nevertheless, existing studies show that ketamine is good for different addictions like alcohol, nicotine, opioids, stimulants, cocaine, and much more. Hence, if someone is living with addiction, exploring ketamine therapy is worth it. It is vital to use it along with other treatment modalities.
References
- Horowitz MA, Taylor D. Addiction and physical dependence are not the same thing. The Lancet Psychiatry. 2023 Aug 1;10(8):e23.
- Administration (US) SA and MHS, General (US) O of the S. THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION. In: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet] [Internet]. US Department of Health and Human Services; 2016 [cited 2024 Mar 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424849/
- Jones JL, Mateus CF, Malcolm RJ, Brady KT, Back SE. Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review. Front Psychiatry. 2018 Jul 24;9:277.
- Hilal F, Jeanblanc J, Naassila M. [Interest and mechanisms of action of ketamine in alcohol addiction- A review of clinical and preclinical studies]. Biol Aujourdhui. 2023 Jan 1;217(3–4):161–82.
- Gent EM. The promising therapeutic effects of ketamine and mindfulness based intervention for problem drinkers. 2023 Jun 29 [cited 2024 Mar 15]; Available from: https://osf.io/5sy4c
- Frimpong PO. Exploring Ketamine’s Repurposing for Treating Cocaine Use Disorder: A Ghanaian Perspective on Ethical and Legal Constraints. 2023;
- Gubser L, Trippel A, Engeli E. Boosting and guiding neuroplasticity by combining ketamine with neurofeedback-assisted learning – towards an individualized and integrated pharmaco-psychotherapy for cocaine addiction. 2023 Nov 9 [cited 2024 Mar 15]; Available from: https://osf.io/3nd5j
- Lalanne L, Nicot C, Lang JP, Bertschy G, Salvat E. Experience of the use of ketamine to manage opioid withdrawal in an addicted woman: a case report. BMC Psychiatry. 2016 Nov 10;16:395.
- Rowland LM, Beason-Held L, Tamminga CA, Holcomb HH. The interactive effects of ketamine and nicotine on human cerebral blood flow. Psychopharmacology. 2010 Mar;208(4):575.
