by Thaddeus Camlin, Psy.D.
Addiction treatment outcomes in the United States leave much to be desired. Most US addiction treatment is not evidence based. The time for easy access to varied, effective options in addiction treatment is long overdue. A recent study in Nature, one of the world’s most prestigious scientific journals, shows that ketamine can effectively reduce harmful drinking, especially when ketamine is given immediately following the induction of a craving. After a single session of what could be described as ketamine-assisted cue-exposure treatment, participants’ drinking frequency and intensity reduced rapidly and remained at about ½ of original consumption levels at a nine-month follow-up. The study in Nature calls for further research into ketamine therapy as a potentially highly effective approach to treating problematic alcohol consumption.
The Nature study’s approach of intentionally inducing cravings in some participants immediately before receiving ketamine added an exciting new element for consideration in how ketamine may help improve addiction treatment. The study included a group of participants who received ketamine but did not have a craving induced prior to administration, and that group did not see equally impressive results. Ketamine therapy alone did help reduce alcohol consumption, but at a significantly lower rate than those who received ketamine after craving induction.
The study uses the term ‘maladaptive reward memories’ to describe what is often referred to as ‘romanticizing’ alcohol. If you love a high quality single malt scotch, taking a nice big smell of Macallan 25 is probably going to spark a craving, or ‘maladaptive reward memories.’ Maladaptive reward memories are largely responsible for the classic sign of addictive problems – continued use despite negative consequences. When ketamine is administered immediately following, say, Macallan 25’s olfactory stimulation, some amazing neurological ‘stuff’ happens.
Ketamine ‘just happens’ to act heavily on the receptors (Methyl D-Aspartate Receptors to be exact) largely responsible for what researchers call memory reconsolidation. When familiar experiences pair with novel experiences the new information must be incorporated into our long-term memories. On the neurological level, the incorporation of new information into our old memories involves a cascading protein synthesis that reshapes the structure of neurons. Ketamine’s neurological action on the very receptors responsible for restabilizing our memories after the destabilizing effects of novel experience means it may beautifully facilitate a fast re-writing of an individual’s thoughts and attitudes about alcohol. According to a seminal figure in the field of addictive problems, Stanton Peele, a change in attitude towards a substance of choice is a key prognostic indicator of successful long-term change.
Modern science is now offering key insights into what neurological changes correspond to successfully overcoming addictive problems, and what pharmacological adjuncts might speed up the change process. We know that addiction treatment needs to diversify and generally improve. The results of the Nature study are preliminary and highly encouraging, as it appears ketamine may be a compound that helps to greatly improve methods and outcomes in the treatment of addictive problems.
