Treating addiction with an addictive drug: the ketamine paradox revisited
Frontiers in Psychiatry July 9, 2026 Alqassem Y. Hakami
Ketamine, a drug that rapidly alters brain connections, shows promise for treating both treatment-resistant depression and substance use disorders, particularly alcohol and cocaine addiction. When combined with psychotherapy, small-to-moderate Phase 2 trials found it reduced cravings and increased days of abstinence. However, results vary widely due to differences in dosing, comparison treatments, and follow-up lengths, and effects on preventing relapse have been inconsistent. Ketamine works by blocking NMDA receptors and boosting synaptic plasticity, which may help disrupt harmful reward memories. While supervised use causes only temporary side effects, the drug carries a clear risk of misuse, especially without supervision. Larger, longer studies are needed before it becomes standard care.