Ketamine Therapy and Substance Use Disorder: A Comprehensive Guide
Substance use disorder (SUD) —known colloquially as substance addiction— has been on the rise in the United States.
What makes SUD challenging to work with is that individuals compulsively continue destructive behaviors due to an ingrained biological or psychological drive. This is despite negative, often obvious consequences which affect their health and safety, their emotional wellbeing, and those around them.
To date, SUD has been treated using existing modalities like talk therapy, medications, or rehabilitation facilities.
Given its potential to affect positive behavioral change through neurobiological mechanisms, ketamine treatment is uniquely positioned as an asset in an SUD patient’s healing process.
The goal is to help those challenged with substance use disorder to retake ownership of their life, and reduce the overwhelming drive of these addictive behaviors.
What is substance use disorder?
The National Institute of Mental Health (NIMH) defines substance use disorder as:
“...a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe, with addiction being the most severe form of SUDs.”
Substance use disorder often has roots in feelings of emptiness, or as a response to traumatic experiences. It’s an unhealthy way to cope with a perceived lack in the individual's life, whether a lack of self-worth, feelings of love and happiness, or feelings of safety and security.
Criteria for a substance use disorder diagnosis
The Diagnostic and Statistical Manual of Mental Disorders’ fifth edition (DSM-5) is used by medical and mental health professionals to diagnose and treat mental health conditions.
The following are the individual criteria for substance use disorder:
- Using more of a substance than intended or using it for longer than you’re meant to.
- Trying to cut down or stop using the substance but being unable to.
- Experiencing intense cravings or urges to use the substance.
- Needing more of the substance to get the desired effect — also called tolerance.
- Developing withdrawal symptoms when not using the substance.
- Spending more time getting and using drugs and recovering from substance use.
- Neglecting responsibilities at home, work or school because of substance use.
- Continuing to use even when it causes relationship problems.
- Giving up important or desirable social and recreational activities due to substance use.
- Using substances in risky settings that put you in danger.
- Continuing to use despite the substance causing problems to your physical and mental health.
The ultimate diagnosis depends on the number qualifying criteria above the patient meets, based on a severity scale:
- One symptom could indicate an individual is at risk.
- Two or three criteria point to a mild substance use disorder.
- Four or five symptoms show someone has a moderate substance use disorder.
- Six or more criteria indicate a severe substance use disorder, which signals an addiction to that substance.
The severity of SUD helps clinicians and mental health professionals determine and recommend a proper course of treatment.
Why substance use disorder is difficult to overcome
Part of what makes substance use disorder difficult to overcome is its dualistic nature: It affects both the brain’s neurobiology, and the individual’s personality, including their behavior.
Addressing one aspect without adequately addressing the other will make it much more difficult to overcome the addictive pattern or the disorder itself.
Changing the neurobiology without changing the behavior may result in a momentary reprieve. But with deeply rooted addictive behaviors, this reprieve will be short-lived as the addictive patterns will lead the individual right back to where they started. This is commonly referred to as a “relapse.”
Similarly, addressing the behavioral patterns without healing the neurobiology will present many problems from lack of focus, cravings, and withdrawal symptoms. These withdrawal symptoms can be life-threatening based on the substance and severity of addiction.
This makes the process of healing difficult —if not impossible— for an individual to overcome without professional and medical intervention.
Why Ketamine shows promise in treatment of substance use disorder
Research continues to show that ketamine may be uniquely suited to address substance use disorder and addictive behaviors.
One of the powerful and unique features of ketamine as a psychedelic medicine is that it works directly on the neurobiology and the psychology of the individual, significantly helping them manage SUD.
Ketamine has strong neurobiological healing effects on the brain itself. Through neurobiological mechanisms, it helps to facilitate an increase in brain-derived neurotrophic factor (BDNF). This increases neuroplasticity by healing and repairing neuronal structures in the brain.
In addition to these neurological changes, ketamine’s dissociative and psychedelic properties help individuals gain new perspectives on their life. This helps them come to a deeper understanding of themselves, and can provide transformative insights and experiences.
This provides individuals with the strength and space to change their self-image, deeply ingrained behavioral patterns, and worldview.
Ways ketamine therapy can help those diagnosed with SUD
Ketamine therapy can help manage addiction and SUD in the following ways:
- Neuronal Healing: Ketamine treatment can positively impact neuronal health and healing. A healthier brain is a strong foundation to begin working on the psychological aspects of addiction and SUD.
- Increased Neuroplasticity: By increasing neuroplasticity via increases in BDNF, ketamine treatment can make the brain more receptive to behavior change. This makes long-lasting, healthier habits easier to begin and more robust once they are established.
- Perspective/Insights: The psychedelic properties of ketamine can help individuals gain key insights into the present and their past, and their attitude toward both. This helps address the root of SUD and addictive behaviors at the psychological levels.
- Emotional Healing/Wholeness: Ketamine treatment and the psychedelic experience can help individuals cultivate deeper self-love, form a more positive self-image, and these can give individuals the strength and power necessary to make healthier choices and avoid harmful patterns of behavior.
- Antidepressant & Anxiolytic Effects: For many individuals, after just a single dosing session, ketamine has lasting antidepressant and anxiolytic (anxiety-relieving) effects, lowering the impact of cravings and helping cultivate a positive, enduring mood for clients.
By facilitating healing experiences, ketamine treatment helps individuals heal their neurobiology, see a different path forward for themselves, and make bold, better decisions for themselves and for their futures.
Ketamine and overall mental health
While substance use disorder is a standalone diagnosis, it’s likely to emerge alongside or as a result of other mental health disorders, such as anxiety, depression, suicidality, and eating disorders, among others. This is known as “comorbidity.”
Addressing overall mental health through medicinal or therapeutic interventions can lower dependency on substances by regulating mood, or providing additional relief from the stresses of life.
Ketamine has a long history and strong track record of being effective in helping individuals manage and mitigate a host of mental health disorders.
From its enduring antidepressant and anxiety-reducing effects, to helping individuals gain new perspectives and self-love, ketamine continues to show potential in addressing many mental health challenges.
By helping reduce the ‘fuel’ that drives addiction and SUD, ketamine therapy once again steps in as a powerful ally for individuals working to manage their reliance on substances and addictive tendencies.
If an individual is able to move towards greater levels of health and wholeness in themselves, the addictive substances and patterns of behavior are not as compelling, and use and dependency can reduce naturally.
Diagnoses of substance use disorders are climbing, with substance use becoming a pseudo-replacement for a perceived lack of love, belonging, or safety and stability.
Through sustained use of substances as a coping mechanism, substance use disorders take a toll on both the biology and psychology of the individual.
Ketamine works on both neurobiological and the psychological levels to promote healing and behavioral change, which makes it uniquely suited to help individuals overcome SUD and addictive behaviors.
Existing studies treating SUD with ketamine therapy are showing promising results, and there are many anecdotal stories from clients who have made great strides in managing their SUD with a care team there to support them.
If you or someone you know is dealing with substance use disorders and comorbid mental health conditions like anxiety and depression, ketamine therapy may be a potential solution.
You or they can verify eligibility for treatment with Mindbloom by taking our brief assessment.
This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.
Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.
Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).
Do not proceed with ketamine treatment if any of the following apply to you:
- Allergic to ketamine
- Symptoms of psychosis or mania
- Uncontrolled high blood pressure
- CHF or other serious heart problem
- Severe breathing problem
- History of elevated intraocular or intracranial pressure
- History of hyperthyroidism
- Other serious medical illness
- Pregnant, nursing, or trying to become pregnant
Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.
While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.
- In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
- Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
- Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom® clinician before proceeding with treatment.
- The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
- Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
- Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
- Continue to take antihypertensive medication as prescribed
- Avoid hangovers or alcohol intake
- Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
- Ketamine treatment should never be conducted without a monitor present to ensure your safety
Take the first step toward healing
According to SAHMSA, over 9 million Americans experience both substance use disorder and a comorbid mental illness such as depression or anxiety each year. Speak with our affiliated clinicians about how ketamine can help you regain control of your life.