Ketamine and Alcohol

The medicine, Ketamine is classified by the FDA as an anesthetic, and is still used in many operating rooms in the USA for anesthesia.  Anesthesiologists sometimes refer to ketamine as a “dissociative anesthetic’ because of its important side effect: in most people, administration of ketamine results in a brief period of dissociation.  Dissociation is an altered state of consciousness, where a person uncouples from their sense of identity, and are then able to see themselves from the outside, not unlike in a dream state. When dissociation happens, can be associated with a mystical experience, where a person senses a higher power, their spiritual belief system, and even their relationship to the universe.  Even though dissociation has been thought of as a side effect, dissociation from ketamine actually appears to have an important value, in the field of mental health.

Ketamine, when combined with therapy, seems to make a new understanding of one’s life possible. These effects of ketamine on the brain ( sometimes called ‘neuroplasticity’) create a window in time where a meaningful new understanding of one’s life can occur.  In recent years, a form of ketamine has become recognized in  the world of therapy for “treatment resistant depression” (TRD), and also for suicidality.  Ketamine has gained FDA approval for these circumstances.  The successful role of ketamine in the treatment of Major Depressive Disorder (MDD)  led researches to wonder whether it might be useful for other conditions, like alcoholism, or alcohol use disorder (AUD).  In the past, the idea of using ketamine for any type of substance use disorder (SUD) was thought to be unwise,  but new scientific studies with ketamine treatment of AUD published in the 1990s have started to change this perception.  There are now multiple studies that suggest that KAP may actually improve the chances of sobriety for patients with AUD, even though further large scale studies are needed.

The original caution for using ketamine in these circumstances was based on the fact that ketamine is classified as a minor narcotic, with some real abuse potential.  This means that susceptible individuals who use unsupervised recreational ketamine on a daily basis can experience ketamine addiction: tolerance of the drug, and actual dependency on ketamine.  This kind of ketamine abuse creates the risk for overdose and death, as has been seen in the news on occasion.  Ketamine addiction is not something that is seen when it is used as an anesthetic in the OR, and ketamine addiction is also not something that is ordinarily seen in Ketamine Assisted Psychotherapy (KAP).  Addiction and abuse is a potential risk of any narcotic. Ketamine addiction is a result of chronic daily long term ketamine use, and of unsupervised recreational ketamine use.

In our practice, we regularly screen everyone to see if alcohol use or drug abuse might be part of their struggle.  This is because AUD and substance use disorder (SUD)  can be prominent symptoms of trauma, and often are one of the symptoms of post traumatic stress disorder (PTSD).  It turns out that studies have shown that psychedelic therapy like KAP can facilitate profound healing from PTSD.  It is my suspicion that relief of PTSD symptoms might be part of KAP’s mechanism of action  for effectiveness in some clients with AUD described in the medical literature.  For this reason, if we find that someone with PTSD who is struggling with alcohol or drugs, we might still be able to offer them KAP therapy. We have careful treatment policies in place for this situation.

The fundamental relationship between alcohol or drug use and trauma is brilliantly described by Gabor Mate MD in his book, “In the Realm of Hungry Ghosts”.  Mate  points out how difficult emotions constantly tend to resurface when they are related to (often childhood) traumas. The addict or alcoholic is someone who has  learned to medicate troublesome emotional material with a substance.  Substance use (including alcohol) can be a reflexive way to medicate old trauma.

I often explain to clients that the use of ketamine in KAP therapy is “180 degrees the opposite” of drug abuse. Clients who do KAP, actually turn to face the very trauma that they were previously avoiding with things like alcohol.  KAP is an action of pure courage. And that courage is what brings healing.

Kelson M, Burnett JM, Matthews A, Juneja T. Ketamine Treatment for Alcohol Use Disorder: A Systematic Review. Cureus. 2023 May 3;15(5)

Maté, G. (2018). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Vermilion.