Why Ketamine-Assisted Psychotherapy May Be The New Vanguard Of SUD Treatment

By Peter Loeb, CEO of Lionrock

When the Coronavirus pandemic took the world by storm in early 2020, few people had any idea of the long-term complications it would bring. Among them, we now see a new mental health crisis, including substance use disorders (SUDs), which have emerged as a challenging co-morbidity of the pandemic. According to the CDC, drug overdose deaths increased by more than 28% from 2020 to 2021, tallying more than 100,000 last year. And during that same period, a staggering 41.1 million Americans were identified as needing SUD treatment. The data clearly point to the need for more effective and accessible care, including bringing to bear the most cutting-edge treatment offerings to help fight this highly stigmatized mental health issue. 

One of the more promising, new treatment methods for mood disorders is the use of psychedelic medications, including ketamine-assisted psychotherapy. Although many associate ketamine with illicit usage, it has proven to be effective in treating depression, anxiety and PTSD, when paired with psychotherapy. And more recently, ketamine has been shown to effectively treat SUDs as well. Considering that esketamine, a derivative of ketamine, is FDA-approved for treatment-resistant depression, a condition that often underlies or co-occurs with SUD, it's not surprising that it benefits those suffering with substance abuse as well. 

Given its still experimental status in terms of mainstream use, most providers do not yet offer psychedelics-assisted psychotherapy. While it is one of the few psychedelics which are already FDA-approved for mainstream use, ketamine still carries its own stigma as a recreational drug popular at raves or music festivals. But in reality, it's just one more example of pharmacological solutions already being used to treat SUDs and other mental health disorders. Another example, suboxone, is a combination of medications based on an opioid, which is now widely accepted by the medical community to treat opioid use disorder. The evidence that ketamine is a useful tool to help people struggling with SUDs is accumulating. In fact, in 2018, the NIH published a report titled "Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review" that reviewed previous studies and which concluded that "results suggest that ketamine may facilitate abstinence across multiple substances of abuse and warrants broader investigation in addiction treatment." 

Here are four reasons why ketamine treatment should be considered a viable option for treating SUDs:

• Ketamine is a strong NMDA receptor antagonist. What exactly does that mean? It means that ketamine is effective in reducing glutamate to block the rewarding or reinforcing effects of drugs in the brain, thus aiding the ability of those struggling with SUDs to abstain from use. 
•  Ketamine uses neuroplasticity to reshape neural pathways, making the benefits of talk therapy faster and more effective. We already know that ketamine infusion clinics offer fast-acting and efficient relief of depressive symptoms in those with mood disorders. We also know that talk therapy, particularly Cognitive Behavioral Therapy (CBT), is a proven tool for successfully treating SUDs. Early studies combining the two methods of treatment have shown signs of effectiveness, with benefits lasting six months or longer post-treatment in a group of people for whom many existing treatments just don't work.
•  Ketamine aids detox and recovery. In fact, data shows it helps prevent alcohol relapse and cravings. A University of Exeter 2022 study found that people with severe alcohol disorder were able to abstain from alcohol for longer when they were treated with low doses of ketamine combined with psychological therapy. This group was more than 2.5 times more likely to stay completely abstinent at the end of the trial than those on placebo. 
•  Ketamine effectively treats depressive symptoms, which often co-occur with SUDs. Studies show that ketamine rapidly improves depressive symptoms, particularly in patients with treatment-resistant depression, meaning those who don't respond to multiple standard antidepressants--about 30% of diagnosed adults in the U.S. Since the co-morbidity rate of mental illness and substance use disorder is about 50%, the connection between effective treatment of depressive symptoms and effective treatment of SUDs is indisputable. 

It nearly goes without saying that we have a massive mental health crisis in our country and a critical shortage of therapists and counselors. Although more accepted for mainstream use in the treatment of depression, it's becoming clear that ketamine-assisted psychotherapy is likely an effective tool in the treatment of SUDs as well. There are many paths to recovery, and the addition of ketamine-assisted psychotherapy to our collective toolbox is a new and exciting path towards helping people struggling with SUDs find a life in recovery.