Ketamine Addiction and Abuse: A 2023 Comprehensive Review
Updated: 8 hours ago
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?
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
Fatigue and low energy
Psychological withdrawal symptoms:
Powerful cravings for ketamine
Irritability and restlessness
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?
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
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:
ideas of reference
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:
Ulcerative cystitis - Severe inflammation of the bladder wall causing pain and bleeding
Reduced bladder capacity - Frequent painful urination
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.
Liver function impairment
Biliary duct dilation
The mechanism involves reduced smooth muscle contraction in the biliary tract and stimulation of dopamine receptors causing nausea.
Reduced attention span
Slower thinking speed
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.
Regular, escalating ketamine use causes addiction in up to 20% of users. Psychological cravings and compulsive use develops.
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.
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.
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 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.
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
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 addiction treatment ranges from intensive day programs to weekly therapy sessions. Care is delivered while living at home.
Counselors specializing in addiction medicine provide psychological support and relapse prevention skills.
Group meetings allow sharing struggles and successes in beating addiction with peers facing similar challenges.
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.
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.
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:
Transitional living provides a structured, supportive environment among peers in recovery.
12-Step Meeting Attendance
Groups like Narcotics Anonymous offer readily available fellowship anywhere.
Ongoing therapy helps process underlying issues and high-risk situations.
Case managers coordinate care resources, services, appointments, and community referrals.
Family therapy repairs damaged relationships and builds a recovery-oriented home environment.
Coaching and Mentoring
Sponsors and coaches provide individualized guidance and motivation.
Digital tools deliver motivational content, peer chat forums, and remote counseling.
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
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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.