Department of Psychology, Palo Alto University, Palo Alto, USA.
New York State Psychiatric Institute, Columbia University Medical Center, New York, USA.
J Psychopharmacol. 2021 Feb;35(2):150-158. doi: 10.1177/0269881120970879. Epub 2020 Dec 13.
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.
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.
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.
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.
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.
亚麻醉剂量的氯胺酮给药可能对物质使用障碍有帮助。越来越多的证据表明，氯胺酮对某些疾病的疗效可能暗示其部分致幻作用。
本分析的目的是评估氯胺酮的神秘体验样效应是否对酒精依赖个体的临床疗效至关重要。在这项二次分析中，我们确定了氯胺酮的部分致幻作用（所谓的神秘体验样效应）是否在与动机增强治疗联合使用时，对有治疗意向的酒精依赖个体的高危饮酒行为产生影响。
40 名酒精依赖成年人被随机分配到氯胺酮或咪达唑仑组，他们在为期五周的动机增强治疗方案的第二周的指定戒酒日接受 52 分钟的输注。输注后评估致幻效应，并在随后的 3 周内，在每个两次每周的就诊时监测酒精使用情况。
我们发现，与活性对照相比，氯胺酮导致明显更大的神秘体验样效应（通过 Hood 神秘主义量表）和分离（通过临床管理的分离状态量表）。氯胺酮还导致高危饮酒显著减少。发现 Hood 神秘主义量表，但不是临床管理的分离状态量表评分，介导了氯胺酮对饮酒行为的影响。
这项试验为成瘾治疗中神秘体验样效应的重要性提供了更多的文献证据。未来的研究应继续调查迷幻治疗的致幻作用与其他物质使用和心理健康障碍的临床结果之间的关系。
