In a small study of eight cocaine-dependent individuals, ketamine infusions produced mystical-type experiences that helped explain increased motivation to quit cocaine a day later. Participants received two doses of ketamine (0.41 mg/kg and 0.71 mg/kg) and a control drug lorazepam (2 mg) in random order. Ketamine, especially the higher dose, caused significantly stronger mystical-type effects than lorazepam. The intensity of those mystical effects, but not dissociative symptoms, predicted greater motivation to stop using cocaine 24 hours after infusion. The findings suggest that psychological experiences during ketamine treatment may contribute to its anti-addiction benefits, though larger studies are needed.
Substance use disorder is common among psychiatric patients and often goes untreated, negatively affecting health. This review provides a neuroscience-based framework for psychiatrists to address SUD. It describes how pharmacotherapy can target craving, intoxication, and withdrawal to interrupt the substance use cycle. The neuroscience of stress is reviewed, including medications that act on neurotransmitter systems involved in alarm and fear. Treatments that promote neuroplasticity, such as ketamine, psilocybin, and transcranial magnetic stimulation, are discussed. The review concludes with resources and practice guidelines for physicians.