Monday, December 2, 2019

Ketamine May Benefit Patients in Treatment for Alcohol Dependence

A single infusion of ketamine in combination with psychotherapy may help people with alcohol use disorder to reduce or stop drinking, according to a pilot study published today in AJP in Advance. Compared with participants who received the sedative midazolam, those who received ketamine had a lower likelihood of alcohol use over a three-week period.

“Although alcohol-related costs exceed 1% of the gross national product in developed countries, most affected individuals are not in treatment,” wrote Elias Dakwar, M.D., of Columbia University Medical Center and colleagues. “Of those in treatment, a large number do not respond to available medications or behavioral treatments. More effective pharmacotherapy options are needed, as well as methods to enhance efforts aimed at behavioral modification.”

The study included 40 treatment-seeking adults with a DSM-IV diagnosis of alcohol dependence but no other substance use. All participants received weekly motivational enhancement therapy sessions—focused on strategies to promote motivation and change substance use behaviors—over a five-week period. During the second week of therapy, the participants received one 52-minute infusion of either ketamine or midazolam, followed by an additional motivational enhancement therapy session 24 hours later. (Midazolam was chosen as the active control because it alters consciousness without any known persistent effect on alcohol dependence, the authors noted.)

During the three weeks after infusion, 47.1% of participants in the ketamine group reported drinking alcohol and 17.6% reported drinking heavily on one day (more than four drinks for men and more than three drinks for women), whereas 59.1% of participants in the midazolam group reported drinking alcohol and 40.9% reported drinking heavily on one day. The participants in the ketamine group also had a longer average time before a relapse, which was considered the first heavy drinking day or dropout from the study; six participants dropped out of the study from the midazolam group compared with zero participants in the ketamine group.

“[T]he study findings represent a first step in understanding a potential clinical role for ketamine in the treatment of alcohol use disorder,” the authors concluded. “The question remains whether a single ketamine infusion would promote abstinence in the long term and whether there is indeed synergy with behavioral treatments.”

To read more about the use of ketamine with psychotherapy, see the AJP study “A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial.”

(Image: iStock/toddtaulman)

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