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  • Writer's pictureDr. Harold Pierre

Ketamine Addiction and Abuse: A 2023 Comprehensive Review

Updated: Dec 7, 2023

Ketamine addiction and abuse is an escalating public health issue that requires attention. This comprehensive guide examines ketamine addiction symptoms, withdrawal, treatment options, and dangers to increase awareness around responsible ketamine use.


What is Ketamine?

Inscription Ketamine. Top view of the table with stethoscope, pen and medical documents. Health care concept copy

Ketamine is a fast-acting dissociative anesthetic substance initially created in the 1960s and used medically for anesthesia. In recent years, ketamine has also shown potential as a rapid-acting antidepressant. Ketamine is also used for pain management in the operating room as well as outpatient chronic pain medication management. In these settings by experienced medical guidance, ketamine is generally a safe medication.


However, ketamine is increasingly being abused recreationally. Ketamine can lead to addiction as well as severe health consequences. Understanding ketamine addiction is key to preventing its abuse.


How Ketamine Works in the Brain


Ketamine is a dissociative anesthetic agents due to its mechanism of action. Pharmaceutical ketamine functions as an N-methyl-D-aspartate (NMDA) receptor antagonist. It is a Drug Enforcement Administration Schedule III controlled substance.

NMDA receptors bind the excitatory neurotransmitter glutamate and are critical for learning, memory formation, and other brain functions. Ketamine blocks NMDA receptors, interrupting glutamate signaling.


This NMDA receptor blockade is responsible for the “dissociative” psychological effects of ketamine. It detaches conscious awareness from sensory input and the environment.

Ketamine also indirectly stimulates opioid receptors and increases dopamine release. This contributes to the euphoric effects that promote its recreational misuse.


Is Ketamine Addictive?


Yes, regular recreational use of ketamine can easily lead to addiction. Both psychological and physical dependence develops.


Tolerance manifests rapidly as the brain adapts to the presence of ketamine with reduced NMDA receptor activity. Higher doses are required to get the original effects which increases dangers.


Withdrawal syndrome occurs when a physically dependent individual stops ketamine use suddenly. The brain is deprived of ketamine's effects on neurotransmitter systems.

According to the National Institute on Drug Abuse (NIDA), ketamine addiction occurs because:

  • It strongly activates the brain's reward system by stimulating dopamine release

  • Chronic users develop tolerance and require more frequent dosing or higher amounts to get the desired high

  • Cessation results in a negative emotional state and physical symptoms that drive compulsive drug use

Ketamine meets the diagnostic criteria for a substance use disorder involving impaired control, social problems, risky use, and pharmacological indications like tolerance and withdrawal.


What are Ketamine Withdrawal Symptoms?


Stopping heavy, prolonged ketamine use often causes an unpleasant withdrawal syndrome. Ketamine withdrawal symptoms include:

Physical withdrawal symptoms:

  • Chills, hot flashes, and excessive sweating

  • Hand tremors and shaking

  • Muscle tension, cramps, and pain

  • Insomnia and vivid nightmares

  • Diarrhea, nausea, and vomiting

  • Increased heart rate and blood pressure

  • Headaches

  • Fatigue and low energy

Psychological withdrawal symptoms:

  • Powerful cravings for ketamine

  • Heightened anxiety

  • Irritability and restlessness

  • Depressed mood

  • Impaired concentration

  • Mental cloudiness and disorientation

Onset occurs quickly within 24 hours of last use. Psychological symptoms peak around 3-4 days while physical symptoms peak from 5-10 days. Some symptoms like cravings, depression, and anxiety may persist for weeks or months during protracted withdrawal.


How is Ketamine Abused?


Ketamine as a recreational drug comes as a liquid or a white powder. It is known by street names like Special K, Vitamin K, Jet K, and Cat Valium. Abusers may inject, snort, smoke, or swallow ketamine.


It's dissociative effects is called a "K-hole." It's an out-of-body, near-death dissociative state that ketamine abusers aim to achieve with high doses. Ketamine is combined into drinks as a date rape drug due to its ability to sedate and confuse. Mixing ketamine with alcohol also intensifies the desired effects.


The number of Americans misusing ketamine doubled from 2006 to 2016 per the National Survey on Drug Use and Health. Young adults aged 18-25 have the highest rates of abuse.


What are the Signs and Symptoms of Ketamine Abuse and Addiction?

  • Inability to stop misusing ketamine despite persistent physical, social, or legal problems

  • Increased tolerance to ketamine with need for higher doses to achieve intoxication

  • Excess time and money spent obtaining, using, or recovering from ketamine

  • Failing obligations at work, school, or home due to recurrent ketamine use

  • Continued use despite hazardous risks like operating machinery or driving

  • Persistent desire, cravings, or unsuccessful efforts to cut down ketamine use

  • Use of ketamine instead of engaging in social, recreational, or occupational activities

  • Recurrent ketamine use in physically hazardous situations

  • Failure to fulfill major roles and responsibilities due to ketamine

  • Excessive time spent using or recovering from ketamine effects

What are the Short-Term Side Effects of Ketamine?


Ketamine on warning road sign copy

Ketamine causes:

  • Dissociation - distorted perceptions of sight and sound, detached from reality

  • Hallucinations - visual or auditory

  • Impaired motor function - inability to move purposefully

  • Dangerous risk-taking behavior

  • Confusion and problems thinking

  • Memory loss

  • Ketamine can also cause nausea and vomiting

At small doses of ketamine (25-50mg) create alterations in consciousness, sensations, and self-awareness. Higher recreational doses (150-200mg+) cause more pronounced dissociation, visual hallucinations and scary nightmares.


Exceeding safe dosing dramatically increases the risk of negative psychological and physical effects:


Psychological Dangers

  • Panic attacks

  • Terrifying hallucinations

  • Psychosis

  • Depersonalization

  • ideas of reference

Physical Dangers

  • Respiratory depression

  • Cardiovascular collapse

  • Sedation coma

  • Amnesia

  • Nausea, vomiting

  • Seizures

  • Death

Prolonged or heavy ketamine intoxication requires emergency care to maintain airway, breathing, circulation, and prevent complications.


What are the Long-term Effects of Ketamine Abuse?


Beyond the acute effects during intoxication, prolonged ketamine abuse poses many health risks:


Urological Damage

  • Ulcerative cystitis - Severe inflammation of the bladder wall causing pain and bleeding

  • Reduced bladder capacity - Frequent painful urination

  • Incontinence

  • Kidney dysfunction and failure

Ketamine is concentrated in urine. Repeat exposure damages the lining of the lower urinary tract. Urological effects appear after 1-2 years of heavy use.


Gastrointestinal Damage

  • Abdominal pain

  • Liver function impairment

  • Biliary duct dilation

  • Vomiting, reflux

The mechanism involves reduced smooth muscle contraction in the biliary tract and stimulation of dopamine receptors causing nausea.


Cognitive Deficits

  • Impaired memory

  • Reduced attention span

  • Slower thinking speed

  • Difficulty concentrating

  • Impaired verbal fluency

Brain imaging of chronic ketamine users shows reduced white matter integrity and dysfunction in memory-related brain regions. Cognitive effects persist after stopping use.


Psychological Dependence

Regular, escalating ketamine use causes addiction in up to 20% of users. Psychological cravings and compulsive use develops.


Physical Dependence

Frequent use leads to tolerance, requiring higher doses to achieve intoxication. Repeated high-dose use also causes painful withdrawal when stopping.


Mental Health Problems

Anxiety, depression, and psychotic symptoms are risks during withdrawal. Ketamine may worsen underlying psychiatric disorders. Suicidal behavior is a concern in vulnerable individuals.


Signs of Ketamine Overdose


Recognizing overdose early is key. Warning signs include problems walking, blurred vision, delirium, and loss of consciousness. Confusion proliferates, senses disconnect, and a dreamlike stupor sets in.


Ketamine overdoses rarely kill directly, but ketamine can cause respiratory depression or aspiration of vomit. And mixing ketamine with alcohol or opioids amplifies each drug’s deadliness exponentially.


Within the brain, ketamine unleashes a chemical vortex, binding glutamate receptors while triggering dopamine bursts. Glutamate governs communication between neurons, and its disruption fractures consciousness into dissociative pieces. Dopamine spikes weave delusions and hallucinations into the dissociative quilt.


Timely medical intervention can halt the spiral. Supportive care maintains vital functions while the drug runs its course. The hallucinatory hurricane typically passes in an hour as ketamine is metabolized. But doctors carefully monitor breathing and airway security, as loss of proper oxygenation poses the greatest danger if effects linger.


While most fully recover, permanent damage is possible following severe overdoses due to ketamine’s neurotoxic effects. Hence preventing overdose on ketamine is paramount. For ketamine, moderation is key – sticking to responsible dosing in safe settings. And those who witness overdoses shouldn't hesitate to call for help – saving a life often hinges on speed. For in neurological crises, minutes matter.


How to Treat Ketamine Addiction and Withdrawal?

Overcoming ketamine addiction requires professional addiction treatment programs and long-term lifestyle changes. A combination of therapies maximizes success.


Detoxification

Medically-supervised detoxification manages ketamine withdrawal safely. It provides medical oversight, monitoring, and medications to alleviate symptoms for those struggling with ketamine withdrawal. Completing detox prepares patients for rehabilitation.


Inpatient Rehabilitation

Residential rehab treatment involves living full-time at a treatment center for 30-90 days. It removes individuals from environments and triggers tied to their addiction.

Inpatient rehab provides intensive services:

  • Individual and group counseling

  • Cognitive-behavioral therapy (CBT) to modify addictive behaviors

  • Motivational enhancement and support groups

  • Psychoeducation about addiction

  • Relapse prevention skills training

  • Treatment of co-occurring mental health disorders

Outpatient Treatment

Outpatient programs offer similar services as inpatient but allow residing at home. Options include:

  • Partial hospitalization programs (PHP) - structured day treatment

  • Intensive outpatient programs (IOP) - 3+ hours/day for 3-5 days per week

  • Traditional outpatient therapy - 1 hour weekly

Outpatient treatment is stepped down after completing residential rehab or for milder addictions. Flexible programming accommodates work or school.


Medications


Certain medications help control ketamine withdrawal and cravings during detox and recovery:

  • Benzodiazepines - clonazepam, lorazepam - for anxiety, insomnia, muscle tension

  • Antiemetics - ondansetron, promethazine - for nausea and vomiting

  • Alpha agonists - clonidine, lofexidine - for autonomic symptoms like increased heart rate and blood pressure

  • Anticonvulsants - gabapentin, pregabalin - for neuropathic pain and cravings

Peer Support Groups


Support groups complement treatment and offer camaraderie through shared experiences. They provide emotional assistance, sober social interaction, and motivation. Examples include Narcotics Anonymous, SMART Recovery, and alumni programs.


Principles of Effective Ketamine Addiction Treatment


Research shows certain principles and services boost recovery from ketamine addiction:

  • A personalized treatment plan tailored to the individual's needs and severity of addiction

  • Assessment and treatment of co-occurring mental health issues like depression or trauma

  • Inclusion of family in the treatment process

  • Education about ketamine addiction and skills training for relapse prevention

  • Follow-up care and monitoring such as continued therapy, coaching, or support groups

On average, 3-6 months is recommended for rehab, with the ability to extend treatment as needed. Those with long-standing addictions or dual diagnoses require more extensive treatment.


How to Prevent and Stop Ketamine Addiction?


The most effective way to avoid ketamine addiction is to not initiate recreational use. However, for developing or current addictions, the following steps are vital:

  • Seek intensive professional addiction treatment. Inpatient rehab provides the highest level of support and structure during early recovery when relapse risks are greatest.

  • Eliminate access to ketamine. Stop associating with people who use ketamine or supply drugs. Avoid parties or environments triggering use.

  • Adopt lifestyle changes and find new rewarding activities. Replace ketamine abuse with exercise, hobbies, socializing, work, or volunteering.

  • Learn to manage cravings, triggers, and stress. Have plans to distract yourself and cope with temptation to use ketamine again.

  • Participate in alumni support groups after treatment. Ongoing mutual aid provides accountability and motivation.

  • Use medication assisted treatment if needed. Drugs like naltrexone may be prescribed on a long-term basis to reduce cravings.

The Dangers of Ketamine Abuse and Warning Signs of Addiction


Ketamine and painful human condition, pictured as a wooden human figure pushing heavy weight to show how hard it can be to deal wiht Ketamine in human life, 3D illustration copy

Uninformed or casual ketamine use quickly can spiral into a devastating addiction. Knowing the risks facilitates early intervention before permanent consequences:


Physical warning signs:

  • Recurrent ketamine intoxication and binging

  • Using higher doses or more frequently to get high

  • Declining physical health and hygiene

  • Chronic urological or abdominal pain

  • Bizarre physical symptoms when forced to stop use

Behavioral warning signs:

  • Using ketamine secretly or solitary

  • Obtaining, using, or recovering from ketamine at the expense of normal obligations

  • Failed attempts to cut back or quit ketamine

  • Risk behaviors like driving intoxicated or combining with alcohol

  • Financial difficulties due to spending money on ketamine

Psychological warning signs:

  • Preoccupation with ketamine and intensifying drug cravings

  • Reckless actions while intoxicated like aggression or self-harm

  • Blackouts, memory problems, and disorientation

  • Paranoia, hallucinations, and strange beliefs

  • Sudden changes in behavior and attitude

  • Mood swings - euphoria, depression, irritability

Risky ketamine abuse damages health, relationships, finances, jobs, and reputation. Seeking substance abuse treatment can halt this destructive downward spiral. The sooner intervention occurs, the better the prognosis.


Ketamine Statistics and Facts

  • Up to 5 million Americans have tried ketamine recreationally, with around 2 million using annually

  • Approximately 20% of regular ketamine users become addicted

  • Adolescents and young adults have the highest rates of ketamine misuse

  • ER visits due to ketamine increased 3-fold from 2008 to 2018

  • At high doses, ketamine carries overdose risks comparable to opioids

  • Long-term urological damage occurs in 30% of chronic ketamine abusers

  • Cognitive impairment is detectable after only a few months of frequent use

  • Ketamine is emerging as a date rape drug due to its ability to rapidly immobilize and sedate victims when added to drinks unknowingly

Getting Treatment for Ketamine Addiction


Seeking professional addiction treatment provides the best chance for overcoming ketamine dependence. Many options exist:


Inpatient Rehabilitation Centers

Residential rehab facilities offer 24/7 medical monitoring, counseling, group therapy, activities, and amenities during an extended stay.


Outpatient Programs

Outpatient addiction treatment ranges from intensive day programs to weekly therapy sessions. Care is delivered while living at home.


Individual Therapy

Counselors specializing in addiction medicine provide psychological support and relapse prevention skills.


Group Counseling

Group meetings allow sharing struggles and successes in beating addiction with peers facing similar challenges.


12-Step Programs

Free mutual aid groups like Narcotics Anonymous use 12-step principles, fellowship, and sobriety support.


Sober Living Homes

Sober living provides structured, supervised housing to transition back to independent living in recovery. Residents receive peer support.


Alumni Programs

Many treatment facilities offer ongoing aftercare services and alumni programs for graduates. This extends the benefits of treatment.


Online Support Groups

Virtual meetings are available when in-person groups are inaccessible. Digital recovery communities share tips and motivation.


Community Reinforcement

Counselors help rebuild rewarding social, occupational, and recreational activities supporting sobriety.


Cognitive Behavioral Therapy (CBT)

CBT helps modify addictive thoughts and behaviors that perpetuate substance abuse.


Therapy for Ketamine Addiction


Behavioral therapies empower people to overcome addiction:


Contingency Management - Provides tangible reinforcement for abstinence through vouchers or prizes


Motivational Enhancement Therapy - Elicits internal motivation and commitment to change drug use


Cognitive Behavioral Therapy - Develops coping skills and addresses distorted thoughts promoting substance use


Relapse Prevention - Identifies high-risk situations for relapse and implements coping strategies


Mindfulness Meditation - Promotes awareness of cravings and triggers so they can be managed constructively


Family Therapy - Improves family relations and enlists support for recovery


12-Step Facilitation - Introduces principles of 12-step programs like surrender and spiritual connection


An individualized combination of therapies is used to treat all aspects fueling addiction


Medications Used to Treat Ketamine Addiction


Certain medications can help manage withdrawal, and cravings, and support abstinence:


Naltrexone - Blocks opioid receptors involved in ketamine’s effects to reduce cravings and reward


Acamprosate - Reduces symptoms of protracted withdrawal such as insomnia, anxiety, restlessness, and dysphoria


Disulfiram - Causes unpleasant reactions if alcohol is consumed; helps enforce sobriety. Used in those with concurrent alcohol abuse.


Clonidine - Lowers increased heart rate and blood pressure during ketamine intoxication.


Anticonvulsants - Gabapentin, pregabalin, and topiramate help relieve pain, anxiety, and sleep disruption


Antidepressants - Some reduce depressive symptoms during withdrawal and recovery

Medication-assisted treatment enhances the benefits of counseling and behavioral interventions.


Aftercare Following Ketamine Addiction Treatment


Continuing care after residential or outpatient rehab improves long-term recovery success by addressing issues that may lead to relapse:


Sober Housing

Transitional living provides a structured, supportive environment among peers in recovery.


12-Step Meeting Attendance

Groups like Narcotics Anonymous offer readily available fellowship anywhere.


Outpatient Counseling

Ongoing therapy helps process underlying issues and high-risk situations.


Case Management

Case managers coordinate care resources, services, appointments, and community referrals.


Family Support

Family therapy repairs damaged relationships and builds a recovery-oriented home environment.


Coaching and Mentoring

Sponsors and coaches provide individualized guidance and motivation.


Recovery Apps

Digital tools deliver motivational content, peer chat forums, and remote counseling.


Vocational Assistance

Academic tutoring or job training removes occupational barriers.


Holistic Health Services

Nutrition, exercise, mindfulness meditation, yoga, or acupuncture sustain wellbeing.

A strong continuum of aftercare provides support through all stages of recovery.


How Family and Friends Can Support Ketamine Addiction Recovery


The support of loved ones is vital to overcoming addiction. Family and friends should:

  • Express care, concern, and willingness to help

  • Educate themselves about ketamine addiction

  • Encourage getting professional treatment and lead by example

  • Provide transportation to therapy appointments

  • Participate in family education and counseling

  • Refrain from enabling or making it easy to continue substance use

  • Help identify triggers and develop healthier coping strategies

  • Ask how to support recovery goals

  • Plan social activities that do not involve drug use

  • Be patient - recovery is a long process

  • Celebrate and reinforce progress

  • Hold them accountable

I am Here to Help


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practically all who call 918-518-1636. I am waiting for your call.


Conclusion and Key Takeaways

  • Ketamine addiction is a growing issue requiring greater awareness of its dangers. Prolonged abuse leads to severe adverse effects.

  • Medical treatment combined with behavioral counseling maximizes recovery success. Peer support provides accountability.

  • Total abstinence from ketamine and avoidance of associated triggers prevents relapse. Developing new rewarding activities is key.

  • Recognizing the signs of ketamine addiction early and getting help quickly leads to better outcomes. Prevention is always best.

Understanding the use of non-medical ketamine is dangerous. Spreading greater public knowledge about ketamine addiction can hopefully reduce its abuse and improve lives.


About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.


This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.





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