Ketamine is classed as a dissociative anaesthetic drug and is predominantly used in medical and veterinary practice for aiding with the general anaesthesia process during medical procedures.
Ketamine contains chemical properties that make people who consume the drug feel detached from their pain. (1)
Being a dissociative anaesthetic means that ketamine can produce strong psychoactive effects that lead to the user experiencing distortions to their perceptual system (namely with vision and sound).
This leads to them experiencing a disconnection from the world around them along with a lack of control. (1)
Ketamine also elicits a sedative effect making the user feel relaxed and at peace and there is also the chance that ketamine users will experience memory loss relating to events that occurred while they were under the influence of the drug. (4)
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Ketamine is a very fast-acting drug and people who take it will feel its effects very quickly when taken. Ketamine has a short half-life (the time it takes half the drug to be removed from the body) of around 3 hours.
This potentially makes it a highly addictive drug as the quicker the drug passes through the human body the quicker a person will build up a tolerance to the drug. (7)
It is important for anyone considering taking ketamine to be aware of the high overdose risk associated with ketamine use when compared with other drugs and regular, heavy use can lead to the respiratory process in the human body breaking down. (2,7)
There are several ways in which ketamine can be ingested, these include inhalation, and injection into the bloodstream, and some recreational users prefer to smoke ketamine when combined with other drugs such as marijuana. (2,7)
Because the chemicals in ketamine affect the human perceptual system (visual and auditory) recreational users are keen to explore the strong hallucinatory experiences that ketamine elicits.
These hallucinogenic effects are short-lived however only lasting for 30 minutes to one hour only rather than several hours. (2,7)
People taking lower doses of ketamine will experience a state of euphoria, dissociation, detachment and mild to moderate hallucinations which are referred to as “K land”.
However, higher doses will tend to immobilize the user and provide them with a more intense, hallucinogenic experience and sensations equivalent to out-of-the-body, near-death experiences.
This may include a feeling of being detached from time and feeling separated from their body, which can be quite frightening which is probably why it is referred to by man users as “K hole”.
This is because when taken in lower doses the stimulant qualities of the drug will become more apparent but after taking high doses users will experience more psychotropic effects. (1,7)
These sensations are very appealing to recreational users who are keen to seek new experiences or have experienced these feelings and sensations before and have a strong desire to repeat the experience. (2)
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There can be serious physical health consequences for recreational drug users who regularly take ketamine, including:
All of the above consequences can be exacerbated by accompanying alcohol use. (1,7)
Regular consumption of ketamine may lead to the user experiencing:
There are several types of behavioural patterns that doctors and psychiatrists look for that are associated with addictive behaviour that are set out in the DSM5.
The following behaviours can indicate that someone taking ketamine is on the path to becoming addicted:
According to the Diagnostic and Statistical Manual for Mental Disorders (DSM5) if a ketamine user exhibits at least 2 of the behaviours above then it is likely they are addicted to ketamine.
The more of the above symptoms they exhibit the more severe their addiction is likely to be. (1a,1)
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Other indications of ketamine addiction to look out for include:
Any recreational user of ketamine will quickly build up a tolerance to the substance if they take it regularly. This is because as soon as a substance is ingested into the body the central nervous system triggers biological mechanisms that will begin to break down the drug to eliminate it quickly from the body.
As the body begins to adapt to the drug its effects will lessen meaning the user will need to take a higher dose of ketamine to retain the initial effects they experienced.
If upon stopping their intake of ketamine they experience withdrawal symptoms it is highly likely that they have become physically dependent on ketamine and require specialist medical treatment.
Overall, Ketamine addiction tends to be more psychological in nature than physical but this is very much dependent on i (1,1a)
Ketamine withdrawal symptoms are unpleasant to experience but are not considered to be harmful or life-threatening and do pass within time.
The range of symptoms that patients experience could include any of the following:
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All psychoactive drugs can lead to physical dependence if continuously used and ketamine is no different, although ketamine dependence is not as severe or as harmful as alcohol or opioid drugs.
However, because of the powerful positive experiences users obtain when taking the drug, ketamine is considered a drug with a high potential for psychological dependence.
The more powerful the experience a user has after taking ketamine the more likely it is that they will be motivated to take the drug again. The fact that users obtain several profound experiences after taking the drug means that the likelihood of continued use of ketamine has been positively reinforced.
This means that the user has become psychologically reliant on ketamine to offer them psychological relief or a rewarding experience that they will need to receive again.
It is preferable to treat patients with ketamine addiction in a residential setting for 1-2 weeks to help monitor their progress and the way they respond to the early stages of withdrawal.
This can be achieved more successfully in an inpatient (residential) setting where clients can be monitored and cared for around the clock and support can be close at hand should any physical or psychiatric emergencies arise.
This would be difficult to manage for patients on an outpatient programme as any slight delay in treating the patient could have negative consequences.
It is strongly recommended that patients with moderate to severe ketamine addiction or patients living in chaotic domestic environments should have their treatment in a residential setting.
The first stage of treatment for ketamine addiction is the detoxification stage, which is common practice in all drug rehabilitation programmes.
Detox treatment stabilises the patient as they go through the early stages of withdrawal as all patients are potentially vulnerable at this stage.
This is because there is always a great deal of uncertainty about how any one patient will react physically and mentally as medical practitioners start the process of removing the toxic elements of ketamine from their bodies. (1,4,7)
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The physical withdrawal symptoms associated with ketamine withdrawal are not as debilitating as opioid drugs or alcohol for the majority of people.
These can be managed very effectively in a residential setting by an experienced medical team who will be available to provide emotional support, encouragement and guidance on how to manage the symptoms.
They will also if necessary, provide appropriate medication for each symptom the patient is struggling with. (3)
However, it must be added that as ketamine is a powerful, fast-acting drug that offers many sought-after experiences patients may experience strong and challenging psychological withdrawal symptoms that need to be constantly reviewed and managed.
Withdrawal symptoms always tend to be opposite to the main effects of the drug so in ketamine’s case patients’ mental health is at risk of crashing to a very low level leading them to severe depression, which despite only lasting a few days can still leave the patient very low. (7,8)
It is not uncommon for patients to appear emotionally vulnerable and experience mental turmoil during the first 1-3 days of withdrawal due to the unpredictable nature of ketamine withdrawal.
Heavy users of ketamine may exhibit psychotic characteristics, and depressive symptoms and experience flashbacks. Due to the vast individual differences in the noticeable reactions between people withdrawing from ketamine, all patients need to be monitored carefully by doctors with specialist knowledge in the addiction field.
This ensures that all patient’s responses to withdrawal can be monitored and if necessary, offered the appropriate medication to deal with each symptom, For example, this may involve prescribing medication to treat depression, low mood and anxiety. (2,6)
Detox treatment is only one component of a patient’s treatment plan for ketamine addiction, most centres advocate a holistic approach to treating a drug addiction of any kind and ketamine addiction is no different. (6)
There are therefore several psychological therapies that addiction treatment managers draw up to help patients recover from their ketamine addiction.
All clients in rehab will go through a minimum of 10-12 sessions of personal counselling to help them understand the emotional, social and psychological factors behind their substance use.
Talking with a trained therapist enables clients to talk through their feelings about the challenging circumstances and traumatic experiences in their lives that have caused them psychological distress and poor mental health. (3)
These experiences may be related to a difficult upbringing, family discord and insecure attachment style, job loss, relationship break ups, bereavement or difficulties with life transitions, all of which can act as a catalyst for addictive behaviour.
At Rehab 4 Addiction, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
For more information, simply reach out to our 24/7, confidential hotline on 0800 140 4690.
Both Cognitive Behavioural Therapy (CBT) and Dialectical Behavioural Therapy (DBT) are used to help patients reduce the psychological distress caused by their ketamine addiction.
CBT helps clients recognise the inaccurate and unhelpful thought patterns that cause them to have low self-esteem and debilitating anxiety and distress. CBT therapists then seek to re-train the client to think in more positive and helpful ways which can help them to see themselves in a different light and enable them to positively interpret the events that happen to them. (3,6)
DBT is a skill acquisition-based therapy where the therapist will teach the client several techniques to help them deal with the strong emotions they experience, which are sometimes so powerful that substance use is the only way that they know how to react. This pattern of behaviour has become so habitual that patients need the training to help them override these automatic responses.
Helping clients gain control over their thought and feelings plays a huge role in enabling them to make significant strides in their recovery as they now have the cognitive and emotional skills to change their thought patterns and deal with strong emotions. (3,6)
As well as CBT many patients find techniques such as mindfulness useful for shutting out negative thoughts and achieving a calm state.
By focusing on breathing and being in the present moment clients can avoid negative thoughts and feelings which often act as a prelude to mental discomfort and a need to engage in drug use. (3,6)
Engaging in motivational interviewing sessions with drug rehab therapists enables clients to maintain the necessary motivation and focus required to complete their rehab programme. All clients in rehab face many obstacles whilst working through their personal programme and it is common for many clients to experience a drop in motivation at some stage.
By building a strong and trusting relationship with clients and showing empathy at all times therapists can help clients identify the psychological reasons for their disengagement with treatment.
Once this has been established they can help them find the necessary motivation to work through their difficulties and cotinine their treatment. (5)
Attending therapy in a group setting with other people with substance use addictions can provide many benefits for clients in recovery.
Group therapy has been found to:
Most addiction treatment programmes contain a 12-step programme which is based on the AA’s renowned 12 steps to the recovery model. The 12 steps are seen as providing clients with the opportunity to engage in important reflections about themselves and their ketamine use.
The steps include exercises related to powerlessness, personal character flaws, spirituality and recognising people they may have harmed, all of which are considered necessary to work through to achieve abstinence. (6)
Depending on the patient’s case history, rehab programme managers may recommend the following:
The final consideration in any treatment programme for ketamine addiction is the aftercare process which seeks to integrate several essential components into one individual plan designed to maximise the patient’s chances of remaining abstinent.
Aftercare plans usually include:
(1a) Black, D., Grant, J. (2013) DSM5 Guidebook: The Essential Companion to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. APP. London.
(1) Department of Justice / Drug Enforcement Agency (2022) Ketamine Fact Sheet. available@Drug Fact Sheet: Ketamine (dea.gov)
(2) Ghodse, H. (2002) Drugs and Addictive Behaviour: A guide to treatment Cambridge University Press.
(3) Herie, A. & Skinner, W. (ed) (2014) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.
(4) Kahan, M. (2014) Physical Effects of Alcohol and Other Drugs. In Herie, M. & Skinner, W. (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.
(5) Miller, W., Rose, G. (2009) Towards a theory of motivational interviewing. American Psychologist. Vol 64 No 6 p527-537.
(6) Moss, A, Dyer, K (2010) The Psychology of Addictive Behaviour. Palgrave McMillan. New York.
(7) Orhurhu, V. et al (2022) Ketamine Toxicity. available@Ketamine Toxicity – StatPearls – NCBI Bookshelf (nih.gov)
(8) Rassool, G.H. (2011) Understanding Addictive Behaviours. Palgrave MacMillan. New York.
(9) Tavistock and Portman NHS (2022) Family Therapy. available@Family therapy (tavistockandportman.nhs.uk).
(10) Wills, S. (2005) Drugs of Abuse. Pharmaceutical Press. London.
(11) Yalom, I.D. (1995) The Theory and Practice of Group Psychotherapy. Basic Books. New York.
