In a new study, researchers found that a single infusion of ketamine, combined with outpatient behavioral therapy, helped alcohol-dependent individuals abstain from drinking for a few weeks after the treatment.
The findings could lead to a new approach to the treatment of alcohol use disorder.
The research was conducted by a team at Columbia University and elsewhere.
In 2017, alcohol use disorder affected an estimated 14.1 million adults and 443,00 adolescents in the U.S., resulting in 88,000 deaths, according to the National Institute of Alcohol Abuse and Alcoholism.
Those with alcohol use disorder are unable to stop or control alcohol use despite adverse social, occupational, or health consequences.
In a previous study, the team had shown that one dose of the anesthetic ketamine combined with behavioral modification therapy promoted abstinence and reduced cravings in people dependent on cocaine.
Based on those findings, they thought it would be valuable to test this combination of therapies in people with alcohol use disorder, which is much more pervasive.
In the new study, 40 people with alcohol use disorder who were seeking treatment were randomized to receive either a single sub-anesthetic dose of ketamine or midazolam (a drug used to treat alcohol withdrawal).
All participants also received motivational enhancement treatment, a type of psychotherapy that has shown only modest success in helping people with alcohol use disorder.
The researchers hypothesized that motivational therapy may work better when combined with a single ketamine infusion at the beginning of therapy.
The team found the ketamine group had a higher likelihood of abstinence; 82% remained abstinent at the end of the study, 3 weeks after getting the infusion, compared to 65% of the midazolam group.
The ketamine group also took longer to relapse and had fewer heavy drinking days than the midazolam group.
In addition, those who stopped drinking after the ketamine infusion was more likely to resume abstinence after relapse than the midazolam group.
Ketamine treatment was well tolerated, without any adverse effects or misuse of the study drugs.
Researchers are not certain how ketamine helps people abstain from drinking.
One possibility is that ketamine addresses addiction-related vulnerabilities, like low motivation and low resilience, that contribute to problematic use.
This may create a window where they can benefit more from behavioral treatment and lay the groundwork to meet their goals.
The findings add to a growing body of evidence that a single dose of medications with powerful psychoactive effects, such as MDMA, psilocybin, and ketamine, may have immediate and long-lasting effects on behavior, especially when integrated with psychotherapy.
The lead author of the study is Elias Dakwar, MD, associate professor of clinical psychiatry at Columbia University Vagelos College of Physicians and Surgeons.
The study is published in the American Journal of Psychiatry.
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