8 . Ten Year Study of Ketamine Psychedelic Therapy ( KPT ) of Alcohol Dependence

Psychedelic psychotherapy was shown to be a potential benefit for alcoholism treatment in the "60s," but different methodologies made it difficult to generalize across studies. The requisite development of appropriate sophistication for these studies was not possible to do after they were scheduled in 1970 and their use was strictly limited. However, at about this time, ketamine was being shown to elicit "psychedelic" emergent phenomena in patients. This property of ketamine was exploited by our use of ketamine-assisted therapy of alcoholism. Ketamine has some advantages over other psychedelics as an adjunct to psychotherapy. It is safe and short acting (the psychoactive effects lasting about an hour). In addition, ketamine is not scheduled like other psychedelics. In lower doses (about one sixth to one tenth of that usually used in surgery for a general anaesthesia) it induces a profound psychedelic experience. Psychotherapy in our model consists of the preparation of patients for the psychedelic session, the psychotherapeutic facilitation of the session and special post-session psychotherapy (Krupitsky, 1992). This post-session work is intended to help the patient integrate insights from the psychedelic experience to the everyday life and relate the experience to his life and personality problems. Moreover, psychotherapy in this manner acquires a special quality. It is considered here not only as a process of resolution of certain psychological problems, but also as an important stage in spiritual maturation. The uniquely profound and powerful psychedelic experience often helps our patients to generate new insights that enable them to integrate new, often unexpected meanings, values and attitudes about their individual selves and the world. We carried out a controlled clinical trial of the efficacy of KPT. To determine the efficiency of the treatment, we collected follow-up information about all the patients who had taken part in this study a year after their release. According to the data, abstinence of more than 1 year was observed in 73 out of 111 people (65.8%) who had undergone the KPT. Thirty people (27.0%) had relapsed. We could not obtain data on eight patients (7.2%). In the control group of 100 patients whose treatment consisted only of conventional methods, only 24 patients (24%) remained sober for more than 1 year (p < 0.01). Thus, the data from the follow-up study demonstrated that ketamine-assisted psychedelic therapy increases the efficacy of conventional alcoholism treatment. Two-year follow-up data had been collected for the 81 patients who had undergone the KPT (because at the moment of the follow-up study only 81 out of 111 patients had a two-year follow-up period after KPT). According to the data, abstinence of more than 2 years was observed in 33 out of these 81 patients (40.7%). Thirty-eight patients (46.9%) had relapsed. We could not obtain two-year follow-up data on 10 patients (12.4%). Three-year follow-up data had been collected for the 42 patients who had undergone KPT. According to the data, abstinence of more than 3 years was observed in 14 out of these 42 patients (33.3%). Twenty-four patients (57.2%) had relapsed. We could not obtain three-year follow-up data on four patients (9.5%). These twoand threeyear follow-up data are also evidence of the high efficacy of KPT. We also carried out psychological, biochemical, and neurophysiological studies of the different possible underlying mechanisms of KPT.