Treating addiction with an addictive drug: the ketamine paradox revisited - Scorecard - MDSpire

Treating addiction with an addictive drug: the ketamine paradox revisited

  • By

  • Alqassem Y. Hakami

  • July 9, 2026

  • 0 min

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Clinical Scorecard: Addressing Addiction Through a Controversial Approach: Reevaluating the Role of Ketamine

At a Glance

CategoryDetail
ConditionSubstance Use Disorders (SUDs)
Key MechanismsKetamine promotes synaptic plasticity via NMDA receptor antagonism and downstream glutamatergic signaling.
Target PopulationIndividuals with treatment-resistant depression and substance use disorders.
Care SettingClinical settings with structured delivery and supervision.

Key Highlights

  • Ketamine combined with psychotherapy has demonstrated reductions in cravings and increases in abstinent days in small-to-moderate Phase 2 trials.
  • Current pharmacological treatments for SUDs have limitations and gaps in effectiveness.
  • Ketamine's mechanism may disrupt maladaptive reward-related memories and neurocircuitry involved in addiction.
  • Acute adverse effects of ketamine are generally transient under clinical supervision.
  • There is a risk of misuse associated with ketamine, particularly in unsupervised settings.

Guideline-Based Recommendations

Diagnosis

  • Assessment of substance use disorders and treatment-resistant depression.

Management

  • Consider ketamine as an adjunctive treatment for selected SUDs in combination with psychotherapy.

Monitoring & Follow-up

  • Monitor for acute adverse effects and potential misuse during ketamine administration.

Risks

  • Risk of misuse, particularly in unsupervised or high-dose settings.

Patient & Prescribing Data

Patients with treatment-resistant depression and substance use disorders.

Larger-scale trials are needed to define ketamine's role in treatment.

Clinical Best Practices

  • Careful patient selection for ketamine therapy.
  • Integration of ketamine treatment with psychotherapy.
  • Structured delivery of ketamine in clinical settings.

Related Resources & Content

Original Source(s)

Treating addiction with an addictive drug: the ketamine paradox revisited

  • by Alqassem Y. Hakami

  • July 9, 2026

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