Ketamine: A Potential Game-Changer in the Fight Against Alcoholism

As the chief medical officer of a large addiction treatment center based in Jacksonville, Florida, I’ve been seeing a lot of ketamine action lately. But not in the way you might think.

Yes, we get patients at our center who are addicted to this notorious drug—a.k.a. "Special K," the “club drug,” and so on—but what’s more notable these days are a number of intriguing research studies showing ketamine to be a successful treatment for alcohol use disorder (AUD).

Because the available medications for treating AUD are underutilized and often ineffective, this emerging news about ketamine for AUD is especially hopeful.

Quick Ketamine History and Context

A synthetic substance, ketamine was developed in the early '60s as an anesthesia treatment to keep people from feeling pain from injury or during surgery. It’s still used today and is especially common in veterinary hospitals.

Originally administered intravenously, ketamine is classified as an anesthetic. It generates feelings of dissociation, sedation, and anesthesia in higher doses. It gained notoriety in the '90s as a club drug and can be quite addictive. Ketamine has also shown benefits for pain management for both chronic and acute pain in emergency room settings. It is now approved by the FDA (including in nasal spray form) as an effective treatment for depression.

The Emerging Evidence Regarding AUD

Though ketamine is achieving promising outcomes for treatment-resistant depression, it remains in the testing stage as a medication for AUD. No addiction treatment center is using it yet, but I believe we will get there soon.

Here’s why I say that. A U.K. study published in January 2022 is simply the latest in a string of studies showing ketamine’s promise for AUD. In the study, subjects who had recently detoxed from alcohol were put through one of four short-term protocols: ketamine-plus-psychotherapy, ketamine only, psychotherapy only, and full placebo.

When surveyed six months later, the ketamine-plus-therapy group achieved significantly better results than the other three groups, as measured by days of abstinence. As the researchers noted, past studies have shown that an average of three out of four people return to heavy alcohol use six months after quitting. In this study, that number was far lower.

Emphasizing the “Plus” in the Ketamine-Plus-Therapy Protocol

In most, if not all, of the recent studies on ketamine and AUD, it’s clear that ketamine paired with psychotherapy is the key to a successful outcome. After many years in the addiction treatment field, this doesn’t surprise me.

It’s the same thing we see in virtually all examples of medication-assisted treatment (MAT) we offer patients in addiction treatment. Proven MAT drugs like suboxone, methadone, and acamprosate always work best when they’re paired with therapy, counseling, and other behavioral treatments. The same thing looks to be true with ketamine; the therapy part is essential.

In the U.K. study, the therapy happened to be a mindfulness-style approach. In other studies, it’s been MET, manualized relapse prevention, or something else.

Looking Ahead to Ketamine Going Mainstream for AUD

To put this caveat in lay terms, I want to be clear: Ketamine is not to be messed with. It can be highly addictive for some individuals, you can overdose on it, and it must be administered in a controlled, low-dose manner in a clinical setting. Bottom line: It is essential that we follow rigorous guidelines for its use.

A good place to start is the consensus statement recently put out by the American Psychiatric Association (APA) on the use of ketamine for the treatment of mood disorders including depression.

The short version of the statement: The APA focused their guidelines on:

1. patient selection (it’s too risky for some people)
2. clinician training and experience
3. dosing (what, where it's given, and how much)

All three of those key areas—and likely others besides—are relevant to ketamine use for AUD and possibly other substance use disorders down the line.

My Final Take on Ketamine for Addiction Treatment

In reviewing the current treatments we have for AUD, the key ones include mutual support programs such as Alcoholics Anonymous, SMART Recovery, and various psychotherapies, including contingency management therapy.

Ketamine Essential Reads

Ketamine Today, MDMA Tomorrow?

Ketamine, Psychotherapy, and Interactions with Medicines

We also employ medications such as naltrexone and acamprosate, although efficacy is limited with these options, and thus so is use. Case in point: A 2019 national survey showed that just 1.6 percent of the 14.1 million U.S. adults with AUD were receiving medication for it.

In other words, AUD has few robust and effective treatments. AUD also causes massive personal, social, and economic damage in this country and worldwide, so we need to maintain a real sense of urgency in the search for better treatments.

Given all that, I believe it’s appropriate to take a bold, aggressive look at ketamine as a potential game-changer in the fight against AUD. So far, the results have been very promising. We need to keep going.