Ketamine is a dissociative anesthetic used primarily in veterinary medicine. It’s also used in some surgical procedures in humans.
Ketamine is also a popular street drug, having gained popularity in the 1990s as a club drug. Most commonly referred to as Special K on the illegal market, its effects vary widely depending on the dosing, which is unpredictable in the highly unregulated illicit drug scene.
Generally, the drug produces trancelike effects and a feeling of being separate from one’s own body as well as the outside world. At high doses, ketamine can produce an out-of-body experience during which the user is on the verge of being completely “put under” the anesthetic — this is called a K-hole. A high dose can also create hallucinations, depressed heart rate, and vomiting.
Treatment for physiological dependence on dissociative drugs will likely include ongoing counseling and behavioral therapy with a licensed counselor or psychologist, preferably one experienced with dissociative drug and Ketamine abuse.
Users will have to learn coping methods for dealing with everyday stresses and examine why they so badly want to escape their own reality. Dealing with the underlying issues affecting the user’s emotional state could provide them with the true relief and mental freedom they are seeking.
With limited research on ketamine withdrawal available, information on detox and withdrawal is limited to the following indicators:
To many, even those seeking a recreational hallucinogenic high, the ketamine experience is too extreme. Being so out of touch with reality is frightening to most, especially when combined with the anesthetic effects of the drug, which may include muscle numbness, drowsiness, and memory loss.
To others, however, the ketamine high seems to be exactly what they’re looking for.
Research on ketamine is relatively slim, especially compared to the two drugs it is most often compared to – PCP (phencyclidine) and MDMA (3,4-Methylenedioxymethamphetamine). It’s not clear what makes some users of ketamine become dependent on it, while other users can use it only once or even on occasion recreationally. According to user accounts, for some, battling an addiction to ketamine can become a consuming struggle.
In a Psychology Today article on dissociative drugs, writer Marc Lewis, Ph.D., notes a ketamine user’s explanation of his continued use of the dissociative drugs ketamine and dextromethorphan (DXM): “They get him to a place he can’t seem to find without them.”
As a dissociative drug, ketamine allows users to experience reality in a way they likely haven’t before. Whether going to the brink of being completely subdued by the anesthetic in a high-dosage induced K-hole, or experiencing a milder out-of-body experience on a smaller dose, a user’s perceptions of their surroundings and moment-to-moment existence are greatly altered by the drug.
Dissociative drugs work, in part, by blocking NMDA receptors in the brain cortex — the part of the brain that thinks and plans. The NMDA receptors transmit information that helps the cortex make “sense” of the information being communicated to it. With this information, the cortex acts as a sort of reality check. It takes the information being given to it and fits that information into what it already knows, making sensible action plans for continuing life in a practical manner.
When dissociative drugs, including ketamine, interfere with NMDA receptors, these perceptions of reality go largely out the window. Rather than experiencing surroundings and perceptions through the lens of learned reality, users may experience perceptions only as they seem to be or as they want them to be.
Without being shaped by what is familiar, perceptions and meanings may become formed by different parts of the brain, allowing for a unique state of consciousness.
This altered state is unpredictable and dangerous. Users may find themselves in a very vulnerable state as their perceptions are so extremely altered. Remaining balanced and in control, both physically and mentally, may be impossible.
This altered state is alluring to many. Its hold can take grip, drawing users in to escape their reality in favor of experiencing a reality without learned boundaries and the stress of everyday life. This escape, and dealing with the aftereffects of ketamine use, which can include depression and memory loss, may result in a user’s withdrawal from society. Avoiding even family and friends, the user may become isolated and physiologically dependent on the dissociative effects of Special K.
In addition to generally or gradually retreating from normal relationships and activities, those struggling with a ketamine addiction may also go on binges. According to the Center for Substance Abuse Research (CESAR), these binges are a common feature of ketamine dependence. Users disappear from their normal life for days, repeatedly taking large doses of ketamine over a short period.
Treatment for physiological dependence on dissociative drugs likely will include ongoing counseling and behavioral therapy with a licensed counselor or psychologist, preferably one experienced with treating dissociative drug abuse.
Users will learn coping methods for dealing with everyday stresses and examine why they so badly want to escape their own reality. Dealing with the underlying issues affecting the user’s emotional state could provide them with the true relief and mental freedom they are seeking.
Ketamine binges are indicators that an individual has a serious problem with the drug. They have very possibly developed a higher tolerance for it and may experience serious cravings for the drug after they stop using it.
An inpatient treatment center may be the best option for a user with this level of dependence, providing an environment where they don’t have to worry about everyday stresses and can instead focus only on their recovery. Professionals familiar with dissociative drug addiction can address the common obstacles faced and provide needed medication, such as antidepressants, or additional therapy.
If inpatient treatment isn’t an option, outpatient programs that include cognitive behavioral therapy and peer support groups can be effective as well.
Research on physical addiction to Ketamine and other club drugs is slim, but user accounts indicate that users can become physically addicted to the drug.
In addition to reports of strong cravings for the drug during withdrawal, users report developing a tolerance to the drug rather quickly. Using higher doses to create the previous effects of the drug puts the user at a higher risk of developing effects of long-term ketamine abuse, which may include impaired motor skills, depression, and bladder and kidney problems.
Addressing these physical concerns is necessary to ensure the individual can live successfully in society and pursue a higher quality of life after addiction. The mode of treatment for these issues will depend on the severity of a user’s addiction and the physical effects they are experiencing as part of their recovery.
Impaired motor skills, for example, may require physical or speech therapy, while mood issues might be best treated with non-habit-forming drugs, like antidepressants or natural alternatives.
There is also debate about ketamine’s relationship to opioids, with a recent study indicating that ketamine may interact with opioid receptors in the brain.
This can cause users to become very addicted and dependent on the drug, mimicking the effects of opioids. This is new and ongoing research that could reveal much more about ketamine addiction and treatment
Because of the unique characteristics of ketamine and dissociative drug addiction, and the limited research available on the topic, those seeking treatment for ketamine addiction should choose a detox center where professionals are familiar with the drug and have helped others successfully overcome related addictions.
(October 2013) Ketamine. Center for Substance Abuse Research (CESAR). from http://www.cesar.umd.edu/cesar/drugs/ketamine.asp#7
(July 2014) The Sad Demise of Nancy Lee, One of Britain's Ketamine Casualties. Max Daly. Vice News. from https://www.vice.com/en_us/article/av4njj/ketamine-slowly-ruins-your-bladder-and-kills-you-863
(November 2011) The True Self: Unveiled by Dissociative Drugs? Part 1. Marc Lewis Ph.D. Psychology Today. from https://www.psychologytoday.com/us/blog/addicted-brains/201111/the-true-self-unveiled-dissociative-drugs-part-1
(October 2017) What are the Uses of Ketamine? Kathleen Davis, F.N.P. Medical News Today. from https://www.medicalnewstoday.com/articles/302663.php
(December 2014) Drug Facts: Club Drugs (GHB, Ketamine, and Rohypnol). National Institute on Drug Abuse. from https://www.drugabuse.gov/sites/default/files/drugfacts_clubdrugs_12_2014.pdf
(August 2018) Ketamine, A Promising Depression Treatment, Seems to Act Like an Opioid. Jon Hamilton. National Public Radio (NPR). from https://www.npr.org/sections/health-shots/2018/08/29/642700616/ketamine-a-promising-depression-treatment-seems-to-act-like-an-opioid
(February 2015) What Are the Effects of Common Dissociative Drugs on the Brain and Body? National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/research-reports/hallucinogens-dissociative-drugs/what-are-effects-common-dissociative-drugs-brain-body
(2017) Relapse on Ketamine Followed by Severe and Prolonged Withdrawal: A Cautionary Case and Review of Potential Medical Therapies. Matthew P. Prekupec. Journal of Nature and Science. from http://www.jnsci.org/files/html/2017/e450.htm
(January 2018) Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-2