The KARE Trials Test Ketamine as a Treatment for Alcohol Use Disorder

Alcohol Addiction is an American Epidemic

Alcohol addiction ranks high on the list of medical crises in the United States. Alcohol addiction is more accurately referred to as Alcohol Use Disorder (AUD) or Alcohol Dependence Syndrome.  Alcohol Use Disorder is a condition in which an individual shows a physical or psychological dependence on alcohol. This excessive drinking of alcohol results in the development of physical or mental health problems.

Traditional Addiction Treatment Routes

According to NYC Health, “Alcohol plays a significant role in many chronic diseases, violence, and accidental injury. Each year, more than 1700 New Yorkers die of alcohol-related causes.”

New York City goes to great lengths and invests millions to combat alcohol use disorder. Their Drug and Alcohol Use Services are a helpful resource available to anyone struggling. It is a website specific to New York City where people can learn about the types of care and services available for problematic alcohol or drug use. They list many traditional interventions including the use of relapse prevention, support groups, psychotherapy, and psychopharmacology. In 2018, ketamine is being discussed as an unanticipated new treatment option for AUD that is giving people renewed hope. I wanted to take a moment to describe what we are seeing so far with respect to research supporting the use of ketamine for alcohol addiction.

The KARE Trials May Offer New Treatment Possibilities

A Russian study first indicated that ketamine could be used to treat addiction back in the 1980’s. Buoyed by the potentials of the test conducted in Russia efforts are now focused on the KARE trials – an acronym for Ketamine for Reduction of Alcoholic Relapse. The trials are taking place at the University of Exeter and University College London. The official study description reads:

96 recently detoxified alcoholics will be randomized to receive either 3 sessions ketamine (0.8 mg/kg IV over 45 minutes) or placebo plus manualised psychological therapy, or 3 sessions of ketamine or placebo plus simple psychoeducation. Patients will be assessed at 3 and 6 months on a range of psychological and biological variables. Primary endpoints will be % days abstinent at 3 and 6 months and relapse rates at 6 months. Secondary endpoints include depressive symptoms, craving, quality of life.”

The study is evaluating for efficacy of Ketamine and psychotherapy (so two comparator arms will be run, with one providing psychoeduaction in place of psychotherapy, and another providing Normal saline instead of Ketamine). What is most important here is that Ketamine is being evaluated as an adjunct to psychotherapy in patients post-detox. The study began in January 2016 and the estimated completion date is January 2019 and we eagerly await the results.

How Could Ketamine Help People Stay Sober?

A study out of Biological Psychiatry: A Journal of Psychiatric Neuroscience and Therapeutics indicates that the first step in examining how Ketamine works when used to treat alcohol addiction centers on one of the major hurdles of abstaining from alcohol for someone with AUD: depression. These symptoms of depression have been identified as the chief causes of relapse. Ketamine possesses proven anti-depressant properties. So doctors help patients achieve a long and sustained period of abstinence from alcohol consumption, by keeping depression at bay with ketamine.

Further tests from Upsala Journal of Medical Sciences reveal that Ketamine may enhance the growth of new nerve cells and tissues in the brain. The learning of new habits and in particular memory are effected by both depression and alcohol. By introducing ketamine, the hope is that an environment in the brain will be created where new nerve cells will have the chance to learn to wean the body off alcohol, unhindered by the withdrawal symptom of depression. This particular property may find practical application in psychotherapy sessions for individuals with AUD.

We do not yet know whether these ketamine trials for the treatment of AUD will be successful, but there is hope. Well-designed research studies like the KARE trials will help shed light on what could be a remarkable new treatment for Alcohol Use Disorder.

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