Research on Using Ketamine and Psychological Therapy to Treat Severe Alcohol Use Disorder
New research published in The American Journal of Psychiatry has shown that low doses of ketamine along with psychological therapy can help treat people with severe alcohol use disorder (AUD) remain sober for a longer period of time.(1) Researchers from the University of Exeter in the United Kingdom conducted a clinical trial, the first of its kind, to examine whether a low dose of ketamine can be effective in preventing relapse in such patients when used together with psychological therapy. Ketamine is a common drug that is used as an anesthetic in both humans and animals.(2, 3, 4, 5)
Alcoholism is known to destroy lives and families, and there is an urgent need for new ways to help people suffering from alcoholism to cut down on drinking. The research team found that low and controlled doses of ketamine in combination with psychological therapy can help people remain off alcohol for a longer time as compared to a placebo. The results of the study are definitely encouraging since it is generally found that three in four people go back to heavy drinking within six months of quitting alcohol. This is why the results of this clinical trial represent a great improvement.
In the study, researchers conducted the trial on 96 people with a history of alcohol use issues but who were not using alcohol at that time. The study found that the participants who had ketamine along with psychological therapy successfully stayed totally sober for 162 days out of 180 days in the six months that followed. The 86 percent abstinence rate was found to be drastically higher than any of the other groups in the study.(6)
The research team reported that the group was more than 2.5 times likely to remain entirely abstinent from alcohol by the end of the trial as compared to the participants who were on a placebo. This study demonstrated that there is quite a lot of potential to use ketamine in the treatment of alcohol use disorder. Alcohol use disorder is known to be a complex illness to treat, and it requires an approach that can both manage the addiction cravings and also look after the mental health aspects of the disease. At the end of this study, it seems like ketamine and psychological therapy together are capable of targeting both these factors.
However, at the same time, it is important to note that there is no comparison trial to other forms of treatment such as acamprosate or naltrexone.(7, 8) Comparison trials are important in order to understand what would be the best approach for treating people with alcohol use disorder.(9, 10, 11)
Another factor that needs to be examined in the future is if ketamine helps decrease the overall consumption of alcohol. Typically it has been observed that no treatment is able to stop alcohol consumption altogether. So medications that can help reduce the consumption are very much in demand to help reduce the harmful effects of substances like alcohol.
Lastly, the therapeutic importance of therapy and psychosocial counseling is also important. The study highlighted why alongside medication, therapy is also needed to help treat people suffering from severe alcohol use disorder.(12, 13)
Looking at Ketamine
Ketamine is a drug that induces dissociation while providing pain relief and sedation. Ketamine has been used for many decades as a recreational drug, but it is only recently that medical experts have started exploring ketamine as a treatment option for depression.(14) The dissociative effects of ketamine are believed to be helpful for people who are battling alcohol dependence.(15)
When administered at the right levels and alongside therapy, ketamine can act as an antidepressant and also help block our depressive feelings or pain that comes along with alcohol dependency. One of the reasons behind why the combination of these two factors may work well together to treat alcohol dependency is because at low to moderate doses, ketamine can change the thought patterns and also block the restabilization of memories that users typically associate as a trigger for their relapse.(16, 17)
For people suffering from alcoholism, this may mean that they become more open to learning new information as part of their psychological therapy, which in turn, may help begin the healing process in a more effective manner, and that too without being affected by depressive thoughts of alcohol spoiling their life.
However, it is believed that while ketamine may help in the short term, therapy works better as a long-term stabilizer for people suffering from alcohol use disorder.
Conclusion: Need for New Treatments for Alcohol Use Disorder
With new research ongoing to discover new treatments for alcohol use disorder, there is a need to find new and better ways to approach substance misuse overall. Since the beginning of the COVID-19 pandemic, there has been a dramatic increase in risky drinking and substance abuse, along with conversion to alcohol use disorder. There are many treatment approaches to treating substance use disorder, but there is no improvement in the outcomes with these techniques. In fact, the numbers continue to climb upward. This is why there is a need to find and utilize new tools to offer patients and their families support to go through this difficult diagnosis.
Ketamine treatment is looking very positive as it works in the regions of the brain that get damaged by alcohol, and it helps grow neurons to heal the brain. However, uncontrolled use of ketamine can also be a problem as it is itself an addictive substance. This is why it is necessary to administer it in the right doses and have the right therapist involved. A good therapist will understand the best way in which to harness the power of ketamine while knowing how and when ketamine affects the structure of the neurons in the brain. A therapist is also needed to understand the best time when to apply psychotherapy as psychotherapy has to be delivered outside the period during which ketamine’s dissociating, and intoxicating consequences are in effect, but also within the time period of neuroplasticity in the brain.
According to the Centers for Disease Control and Prevention (CDC), heavy alcohol use causes over 95,000 deaths in the United States every year. This is why the agency recommends that women should not consume more than one drink a day, while men should not have more than two drinks in a day.(18)
If you or someone you know has an alcohol use problem, there are many agencies, like Alcoholics Anonymous, that help people deal with this problem and also provide help on therapies and prevention. It is essential to seek help at the right time before the condition changes into alcohol use disorder.
- Grabski, M., McAndrew, A., Lawn, W., Marsh, B., Raymen, L., Stevens, T., Hardy, L., Warren, F., Bloomfield, M., Borissova, A. and Maschauer, E., 2021. Adjunctive Ketamine With Relapse Prevention–Based Psychological Therapy in the Treatment of Alcohol Use Disorder. American Journal of Psychiatry, pp.appi-ajp.
- Pribish, A., Wood, N. and Kalava, A., 2020. A review of nonanesthetic uses of ketamine. Anesthesiology research and practice, 2020.
- Hirota, K. and Lambert, D.G., 1996. Ketamine: its mechanism (s) of action and unusual clinical uses. British journal of anaesthesia, 77(4), pp.441-444.
- White, P.F., Way, W.L. and Trevor, A.J., 1982. Ketamine—its pharmacology and therapeutic uses. The Journal of the American Society of Anesthesiologists, 56(2), pp.119-136. <https://watermark.silverchair.com/0000542-198202000-00007.pdf>
- Hirota, K. and Lambert, D.G., 2011. Ketamine: new uses for an old drug?. British journal of anaesthesia, 107(2), pp.123-126.2:36 PM 30-Jan-22
- 2022. [online] Available at: <https://www.sciencedaily.com/releases/2022/01/220111091401.htm> [Accessed 30 January 2022].
- Witte, J., Bentley, K., Evins, A.E., Clain, A.J., Baer, L., Pedrelli, P., Fava, M. and Mischoulon, D., 2012. A randomized, controlled, pilot study of acamprosate added to escitalopram in adults with major depressive disorder and alcohol use disorder. Journal of clinical psychopharmacology, 32(6), p.787.
- Yoon, G., Petrakis, I.L. and Krystal, J.H., 2019. Association of combined naltrexone and ketamine with depressive symptoms in a case series of patients with depression and alcohol use disorder. JAMA psychiatry, 76(3), pp.337-338.
- Kranzler, H.R. and Soyka, M., 2018. Diagnosis and pharmacotherapy of alcohol use disorder: a review. Jama, 320(8), pp.815-824.
- Grant, B.F., Harford, T.C., Dawson, D.A., Chou, P.S. and Pickering, R.P., 1995. The Alcohol Use Disorder and Associated Disabilities Interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug and alcohol dependence, 39(1), pp.37-44.
- Witkiewitz, K., Litten, R.Z. and Leggio, L., 2019. Advances in the science and treatment of alcohol use disorder. Science advances, 5(9), p.eaax4043.
- Shen, W.W., 2018. Anticraving therapy for alcohol use disorder: a clinical review. Neuropsychopharmacology reports, 38(3), pp.105-116.
- Caselli, G., Martino, F., Spada, M.M. and Wells, A., 2018. Metacognitive therapy for alcohol use disorder: A systematic case series. Frontiers in psychology, 9, p.2619.
- Jonkman, K., Dahan, A., van de Donk, T., Aarts, L., Niesters, M. and van Velzen, M., 2017. Ketamine for pain. F1000Research, 6.
- Ezquerra-Romano, I.I., Lawn, W., Krupitsky, E. and Morgan, C.J.A., 2018. Ketamine for the treatment of addiction: Evidence and potential mechanisms. Neuropharmacology, 142, pp.72-82.
- Berman, R.M., Cappiello, A., Anand, A., Oren, D.A., Heninger, G.R., Charney, D.S. and Krystal, J.H., 2000. Antidepressant effects of ketamine in depressed patients. Biological psychiatry, 47(4), pp.351-354.
- Malhi, G.S., Byrow, Y., Cassidy, F., Cipriani, A., Demyttenaere, K., Frye, M.A., Gitlin, M., Kennedy, S.H., Ketter, T.A., Lam, R.W. and McShane, R., 2016. Ketamine: stimulating antidepressant treatment?. BJPsych open, 2(3), pp.e5-e9.
- Centers for Disease Control and Prevention. 2022. Alcohol-Related Deaths. [online] Available at: <https://www.cdc.gov/alcohol/features/excessive-alcohol-deaths.html> [Accessed 30 January 2022].