Mystical-type experiences occasioned by ketamine mediate its impact on at-risk drinking: Results from a randomized, controlled trial

Rebecca L. Rothberg · Nour Azhari · Nancy A. Haug · Elias Dakwar

97 citations0/0 files storedJournal of Psychopharmacology

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Psychedelics and Drug Studies Substance Abuse Treatment and Outcomes Treatment of Major Depression

Abstract

BACKGROUND: Sub-anesthetic ketamine administration may be helpful for substance use disorders. Converging evidence suggests that the efficacy of ketamine for certain conditions may implicate a subset of its psychoactive effects. AIMS: The aim of this analysis is to evaluate whether the mystical-type effects of ketamine are critical for clinical efficacy in alcohol-dependent individuals. In this secondary analysis, we determine if a subset of the psychoactive effects of ketamine, the so-called mystical-type experience, mediates the effect of ketamine, when combined with motivational enhancement therapy, on at-risk drinking behavior in alcohol-dependent individuals interested in treatment. METHODS: Forty alcohol dependent adults were randomized to either a 52-minute infusion of ketamine or midazolam, which they received on a designated quit-day during the second week of a five-week motivational enhancement therapy regimen. Psychoactive effects were assessed following the infusion, and alcohol use was monitored for the subsequent 3 weeks at each twice-weekly visit. RESULTS: We found that ketamine leads to significantly greater mystical-type effects (by Hood Mysticism Scale) and dissociation (by Clinician Administered Dissociative States Scale) compared to the active control. Ketamine also led to significant reduction in at-risk drinking. The Hood Mysticism Scale, but not Clinician Administered Dissociative States Scale score, was found to mediate the effect of ketamine on drinking behavior. CONCLUSIONS: This trial adds evidence to the literature on the importance of mystical-type experiences in addiction treatment. Future research should continue to investigate the relationship between the psychoactive effects of psychedelic therapeutics and clinical outcomes for other substance use and mental health disorders.

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References

1902The varieties of religious experience: A study in human nature.2016Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial 2004Motivational Interviewing 2006Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance 2008Human hallucinogen research: guidelines for safety 2015Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study 2008Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later 2011Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness

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