Ketamine is classified as a dissociative anesthetic. It was developed in the 1960s to replace the drug phencyclidine (PCP). The primary function of ketamine is to block the action of the neurotransmitter N-methyl-d-aspartate (NDMA), an excitatory neurotransmitter in the brain. However, the full effects of ketamine are not fully understood, and it most likely affects other neurotransmitters as well.
Ketamine is primarily used as an anesthetic by veterinarians. It is still used for humans in burn therapy as an analgesic, for the treatment of injuries on the battlefield, and for the treatment of pain for individuals who have allergic reactions to other narcotic medications. It does not produce deep sedation at lower doses, making it useful as a pain reliever in these instances.
The effects of ketamine include:
- A hypnotic state, which produces confusion and hallucinations (psychotomimetic effects) at low dosages, and sedation at higher dosages
- Anti-nociception or pain relief
- Increased activity of the sympathetic nervous system (the part of the nervous system that results in a speeding up processes, including increased heart rate, temperature, respiration, etc.)
- Effects occur without a significant decrease in breathing
The effects of the drug increase with the dosage, and higher dosages lead to more sedation and even to unconsciousness. Individuals who use the drug will also experience issues with memory surrounding the events occurring when under the influence of the drug. This is because the drug decreases the activity of the neurons in the brain, and memories in the brain are formed by increased neural activities. There are also some new potential uses for ketamine being investigated.
There is a large body of relatively recent research that has been investigating the use of ketamine in the treatment of depression. Most of this research appears to be positive. However, ketamine is listed by the United States Drug Enforcement Administration as a Schedule III drug, indicating that it has a high potential for abuse and dependence. As a result, its use in the treatment of depression may be limited to special cases, such as suicidal individuals and in inpatient units. Currently, ketamine is not formally approved for the treatment of depression.
It appears that the earliest recorded evidence of ketamine abuse occurred on the West Coast in the 1970s. The hallucinogenic properties of the drug made it popular among certain subcultures, and new forms of the drug were introduced. Ketamine is typically sold as an injectable liquid for medicinal purposes, but individuals who obtained the drug were able to transform it into crystals, tablets, powder, and other forms.
In the 1980s ketamine was used in conjunction with ecstasy on the dance club scene. Most sources are unable to determine the prevalence of its use but it is still used, mostly by young adults in the club scene and high school students for its hallucinogenic and euphoric effects. Street names for ketamine include:
- Special K
- Kit kat
- Cat valium
As a drug of abuse ketamine is often used by taking it orally in pill form or snorting it in powder form. When ketamine is snorted, the effects usually begin to appear within 5-15 minutes, whereas with oral ingestion, the effects usually appear within 5-30 minutes. The hallucinogenic effects of ketamine typically last about an hour; however, amnesia, confusion, and other cognitive effects may last for up to 24 hours. Other effects of ketamine include:
- Impaired motor functioning
- Rigid muscles
- Loss of coordination
- Loss of touch with reality
- Sense of extreme vulnerability
- Aggressive or violent behavior
- Increased heart rate
- Liver damage from chronic use
- Potential brain damage
- Potential death from overdose
Individuals who abuse ketamine may exhibit the following signs:
- Being unusually mellow
- Depression or sluggishness
- Difficulty with learning or general thinking
- Dilated pupils
- Complaints that things are not real or of floating sensations
- Exhibits evidence of hallucinations
- Dilated pupils
- Increased blood pressure
- Violent or aggressive behavior
- Delirium (confusion, unaware of the date, unaware of friends’ names, etc.).
- Secretive behavior or suddenly seems to spend lots of time alone
- Appears to be preoccupied with meeting friends out of the house, going to clubs, etc.
- Alternating periods of insomnia and drowsiness
- Suddenly appears to be acting paranoid and suspicious of others
Someone with an abuse issue or addiction to ketamine will continue to use the drug, despite usage leading to negative consequences that can affect health, relationships, work, or other important areas of functioning.
Treatment for Ketamine Abuse
Individuals who use ketamine will develop a tolerance to the drug, where they need more of the drug to achieve the same effects they initially experienced. It is unclear if halting the use of ketamine results in physical withdrawal symptoms; however, individuals who suddenly stop using ketamine will undoubtedly experience psychological symptoms associated with the discontinuation of the drug that can include:
- Strong cravings for the drug
Some individuals may initially benefit from attending a residential treatment program to separate them from the influence of an environment that is conducive to relapse. However, this is not necessary for every case, and the choice of residential treatment should be made on a case-by-case basis. Treatment can be undertaken in an individual or group format. Treatment options for ketamine abuse include:
Individual therapy where the person spends the entire therapeutic session with the therapist, and the two work to resolve the individual’s issues with substance abuse.
Group therapy where the person is a part of a group of individuals who share similar issues, and the group works together to address abuse/addiction issues along with a certified therapist. Family therapy is a type of group therapy that is especially useful for treating substance abuse in adolescents, for individuals who have family members that affect and are affected by addictive behavior, couples who need to resolve problems related to addiction, etc.
Twelve-Step groups or other support groups are groups composed primarily of one’s peers who work together to achieve recovery. There is no formal professional therapist leading these groups; therefore, they are not technically forms of therapy, but they can be crucial forms of ongoing support during the aftercare process.
The types of therapy or treatment that can be used to treat ketamine abuse and addiction include:
- Cognitive Behavioral Therapy: The therapist and the client work together to identify the client’s dysfunctional belief system, challenge those beliefs, and work on changing them as well as changing the addictive behavior.
- Relapse prevention: This is a targeted approach to help the individual identify triggers and other instances where there is a high probability of relapse. The therapist and the client work together to develop coping strategies to avoid, deal with, and change these situations.
- Medication management: For ketamine addiction, this may involve the use of antidepressants, anti-anxiety medications, and other medications that may help reduce cravings. Medication management alone will not prepare the individual for long-term recovery; it should be used in conjunction with therapy.
- Anger management therapy: This can be useful for individuals who have substance abuse issues that are triggered by feelings of hostility, anger, being treated unfairly, etc.
- Dialectical Behavior Therapy: This type of Cognitive Behavioral Therapy can be useful in the treatment of individuals with substance abuse problems who have personality disorders or suicidal thoughts.
- Hypnotherapy: This involves the use of hypnosis to address issues like substance abuse by helping the client to deal with cravings and triggers, and to develop skills to maintain sobriety.
Any individual who uses a drug like ketamine will respond best to some type of formal treatment, as opposed to attempting to control the substance abuse alone. This is important for parents of young people who are suspected of abusing ketamine to understand. Simply chastising the person and attempting to control the substance abuse will often result in reactive behaviors that lead to more complicated issues.
Getting the individual into a treatment program is only the first step to recovery. Substance abuse therapists and other professionals who are involved in the treatment process understand that motivation to change is often a big obstacle in the early stages of recovery. These individuals can apply specific strategies to help the person see the need for change and to go on to actively participate in recovery. Moreover, research has indicated that even forced substance abuse treatment, such as court-mandated treatment, is as effective as treatment given to individuals who voluntarily enter treatment. Thus, the goal is to get the person into a structured treatment program as soon as possible.