Research Update: Ketamine for the Treatment of Alcohol Use Disorder
June 18, 2021
Alcohol Use Disorder is a major issue in the US and throughout the world. Recent data shows that 14% of US adults met criteria for the disease. The World Health Organization estimates that 5% of people worldwide suffer from alcoholism. Alcohol use contributes to many diseases such as cirrhosis of the liver, pancreatitis, cancer of the esophagus, depression, and anxiety.
Dr. Celia Morgan recently presented the results of the KARE study: Ketamine for Reduction of Alcoholic Relapse. Dr. Morgan is a Professor of Psychopharmacology and the Head of Psychology at the University of Exeter in the United Kingdom.
Her presentation, entitled “Ketamine for the Treatment of Addiction”, was part of an International Conference hosted by the Department of Psychiatry at Oxford University.
Dr. Morgan stated that the purpose of the KARE study was to address 2 questions. First, does ketamine reduce drinking in patients with alcohol use disorder. Second, does psychological therapy enhance ketamine’s effects in addiction treatment.
A total of 96 patients with moderate to severe Alcohol Use Disorder were enrolled in the study. Half of the patients received weekly intravenous ketamine infusions and the other half received placebo infusions for 3 weeks. The groups were further subdivided to receive either psychotherapy or alcohol education for a total of 7 sessions. The participants were followed for a total of 6 months. The study was funded by the Medical Research Council in the UK.
There were multiple exclusion criteria for the study, including a history of psychosis, currently taking an anti-depressant medication, liver function tests of greater than three times normal, currently taking any medications that are contraindicated with ketamine, and a diagnosis of any substance use disorder other than alcohol.
The primary endpoint of the study was the percentage of days of abstinence during the 6-month trial. The participants receiving ketamine and psychotherapy had significantly more days of abstinence than any other group. The group receiving ketamine plus alcohol education had significantly more days of abstinence than the group receiving placebo and psychotherapy. Overall, ketamine significantly increased days of abstinence during the 6-month trial period.
Another important finding of the study was the improvement in liver function noted in the ketamine groups. Alcohol causes a range of diseases in the liver. One of the earliest signs of liver damage is an elevation in the enzymes known as liver function tests. Patients receiving ketamine in the KARE study had significant improvement in the liver function tests that was maintained throughout the 6-month trial.
Another potentially important observation was the correlation between out of body experiences and percentage of days of abstinence. Dr. Morgan noted that this is a preliminary finding and will need to be confirmed with further research. There has been conflicting evidence on the correlation between out of body experiences during ketamine infusions and improvement in depression symptoms in other studies. In the KARE study, there was very strong correlation between out of body experiences during the ketamine infusion and improvement in alcohol use as measured by percentage of days of abstinence.