Grabski, Meryem and McAndrew, Amy and Lawn, Will and Marsh, Beth and Raymen, Laura and Stevens, Tobias and Hardy, Lorna and Warren, Fiona and Bloomfield, Michael and Borissova, Anya and Maschauer, Emily and Broomby, Rupert and Price, Robert and Coathup, Rachel and Gilhooly, David and Palmer, Edward and Gordon-Williams, Richard and Hill, Robert and Harris, Jen and Mollaahmetoglu, O Merve and Curran, H Valerie and Brandner, Brigitta and Lingford-Hughes, Anne and Morgan, Celia J A (2022) Adjunctive ketamine with relapse prevention-based psychological therapy in the treatment of alcohol use disorder. The American Journal of Psychiatry, appiajp202121030277. doi: 10.1176/appi.ajp.2021.21030277.
External website: https://ajp.psychiatryonline.org/doi/full/10.1176/...
OBJECTIVE: Early evidence suggests that ketamine may be an effective treatment to sustain abstinence from alcohol. The authors investigated the safety and efficacy of ketamine compared with placebo in increasing abstinence in patients with alcohol use disorder. An additional aim was to pilot ketamine combined with mindfulness-based relapse prevention therapy compared with ketamine and alcohol education as a therapy control.
METHODS: In a double-blind placebo-controlled phase 2 clinical trial, 96 patients with severe alcohol use disorder were randomly assigned to one of four conditions: 1) three weekly ketamine infusions (0.8 mg/kg i.v. over 40 minutes) plus psychological therapy, 2) three saline infusions plus psychological therapy, 3) three ketamine infusions plus alcohol education, or 4) three saline infusions plus alcohol education. The primary outcomes were self-reported percentage of days abstinent and confirmed alcohol relapse at 6-month follow-up.
RESULTS: Ninety-six participants (35 women; mean age, 44.07 years [SD=10.59]) were included in the intention-to-treat analysis. The treatment was well tolerated, and no serious adverse events were associated with the study drug. Although confidence intervals were wide, consistent with a proof-of-concept study, there were a significantly greater number of days abstinent from alcohol in the ketamine group compared with the placebo group at 6-month follow-up (mean difference=10.1%, 95% CI=1.1, 19.0), with the greatest reduction in the ketamine plus therapy group compared with the saline plus education group (15.9%, 95% CI=3.8, 28.1). There was no significant difference in relapse rate between the ketamine and placebo groups.
CONCLUSIONS: This study demonstrated that treatment with three infusions of ketamine was well tolerated in patients with alcohol use disorder and was associated with more days of abstinence from alcohol at 6-month follow-up. The findings suggest a possible beneficial effect of adding psychological therapy alongside ketamine treatment.
B Substances > Alcohol
B Substances > New (novel) psychoactive substances > Aminoindanes / Arylalkylamines / Arylcyclohexylamines > Ketamine
G Health and disease > Substance use disorder (addiction) > Alcohol use disorder
HJ Treatment or recovery method > Substance disorder treatment method > Substance disorder drug therapy (pharmacological treatment)
HJ Treatment or recovery method > Psychosocial treatment method
J Health care, prevention, harm reduction and treatment > Treatment and maintenance > Treatment factors
VA Geographic area > Europe > United Kingdom
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