Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence

This open-label longitudinal study (n=59) investigated the efficacy of a single versus three sessions of ketamine-assisted psychotherapy (140mg/70kg/session) for people with heroin dependence and found that the three-session program is more than twice as effective (abstinence 50% vs. 22.2%) one year after treatment.

Abstract

Introduction: A prior study found that one ketamine-assisted psychotherapy session was significantly more effective than active placebo in promoting abstinence (Krupitsky et al. 2002).

Methods: In this study of the efficacy of single versus repeated sessions of ketamine-assisted psychotherapy in promoting abstinence in people with heroin dependence, 59 detoxified in patients with heroin dependence received a ketamine assisted psychotherapy (KPT) session prior to their discharge from an addiction treatment hospital, and were then randomized into two treatment groups. Participants in the first group received two addiction counseling sessions followed by two KPT sessions, with sessions scheduled on a monthly interval (multiple KPT group). Participants in the second group received two addiction counseling sessions on a monthly interval, but no additional ketamine therapy sessions (single KPT group).

Results: At one-year follow-up, survival analysis demonstrated a significantly higher rate of abstinence in the multiple KPT group. Thirteen out of 26 subjects (50%) in the multiple KPT group remained abstinent. compared to 6 out of 27 subjects (22.2%) in the single KPT group (p < 0.05). No differences between groups were found in depression, anxiety, craving for heroin, or their understanding of the meaning of their lives.

Discussion: It was concluded that three sessions of ketamine-assisted psychotherapy are more effective than a single session for the treatment of heroin addiction.”

Authors: Evgeny M. Krupitsky, Andrei M. Burakov, Igor V. Dunaevsky, Tatyana N. Romanova, Tatyana Y. Slavina & Alexander Y. Grinenko

Summary

A psychedelic afterglow is a positive post-hallucinogen state occurring in subjects after they have a transcendent psychedelic peak experience. This afterglow is often very pronounced within several days or weeks after a treatment session, but then these effects quickly decline.

Ketamine produces profound transformative experiences that share many elements with some near-death experiences. These experiences can help people accept a new meaning of life.

Recent studies have demonstrated that ketamine psychotherapy (KPT) is an effective treatment in promoting abstinence in alcohol and heroin addicts.

The authors sought to determine whether administering multiple ketamine-assisted psychotherapy sessions over one-month intervals would improve the efficacy of a single ketamine-assisted psychotherapy session in treating heroin dependence.

Material and Methods

Design

After detoxification, 59 heroin-dependent participants were assigned to one of two groups on a random selection basis. The multiple KPT group received three KPT sessions with a psychedelic dose of ketamine, with one-month intervals between sessions.

The single KPT group received one KPT session with the same dose of ketamine and the same psychotherapeutic technique and environment as the multiple KPT group. All participants were treated alike and received the same preparation for KPT.

Participants

Out of 73 heroin-dependent patients screened, 59 met inclusion criteria and were included in the study. Informed consent was obtained from all participants prior to acceptance into the study.

Psychotherapist

We are looking for people aged 18 to 35 with current heroin dependence present for at least one year, with at least high school education, with at least one relative willing to assist in follow-up and provide outcome data, and with competency to give informed consent and otherw ise participate.

Participant’s Evaluation

The participant underwent a formal psychiatric and clinical examination, which included a standard medical examination.

The psychological assessment consisted of two parts, psychiatric assessments and psychological assessments. The purpose-in-life test was used to assess the participant’s understanding of the meaning of his/her life.

Treatment Assessment, Outcome and Follow-Up

The investigators performed urine drug testing before the first KPT session in both groups, before each KPT and counseling session in the multiple KPT group, and before each addiction counseling session in the single KPT group.

Participants completed a follow-up interview in person with a research assistant, underwent a physical examination, and a urine sample was collected for drug testing. Psychiatrists blind to condition collected follow-up data on a monthly basis for up to 12 months after the end of the treatment phase.

Treatment Procedure

Participants received five hours of psychotherapy before the first ketamine session, five hours after the first ketamine session, and one hour of addiction counseling before the second and third ketamine sessions.

Ketamine was injected intramuscularly at the dose of 2 mglkg, and the participant listened to music throughout the session. A psychotherapist provided MAN OVA within-subjects repeated measures of analysis with Tukey test for post-hoc comparisons.

Retention in Treatment and Abstinence Rate

Six out of 59 participants relapsed and dropped out of treatment within the first month after the initial KVf session. The remaining 53 participants were randomized into two treatment groups and received two KVf sessions, including addiction counseling sessions before KVf, separated by one-month intervals.

In the multiple KVf group, 15.4% of participants relapsed, whereas in the single KVf group, 25.9% of participants relapsed. However, the multiple KVf group had a significantly greater follow-up abstinence rate than the single KVf group.

Psychometrics

All measures of depression, anxiety, and craving for heroin were significantly reduced after the first KVf session in both groups, and the understanding of the meaning of life improved in both groups.

Side Effects

No complications were noted after ketamine psychotherapy. The only side effect was an acute increase in blood pressure.

Discussion

Results showed that a three session KVf program was more effective than a single KVf session followed by two counsel ing sessions in promoting abstinence from heroin addiction. In clinical studies with psychedelics, the longer follow-up, the less improvement was observed across the single dose studies. This was the rationale for the multiple session approach used in this study.

This study does not compare ketamine-assisted therapy with placebo, but a previous study found that ketamine-assisted therapy produced a greater rate of abstinence from heroin than psychotherapy conducted with active placebo.

Study details

Compounds studied
Ketamine

Topics studied
Addiction

Study characteristics
Open-Label Longitudinal Randomized

Participants
59 Humans

Compound Details

The psychedelics given at which dose and how many times

Ketamine 140 - 140
mg | 3x

PDF of Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence