Can Ketamine Help Heavy Drinkers

Ketamine decreases alcohol cravings

A single dose of the active ingredient ketamine apparently helps people who drink a lot of alcohol to reduce their consumption. This could help alcohol addicts fight their addiction. British scientists from London examined this effect in an experimental study that they published in "Nature Communications" (see primary source).

People become addicted to drugs because the positive experience of being high stimulates the brain's reward system. With multiple experience, the feeling of intoxication manifests itself as a memory in the memory and a strong desire arises to use the drug again. Every time any memory is recalled, the brain goes through an active process - reconsolidation. The memory can be changed during this process and is saved anew every time. It is precisely this storage of the good feeling of addiction that the active ingredient ketamine can apparently prevent. It blocks an important receptor in the brain that plays a role in reconsolidating memories.

In the study on the effects of ketamine, the scientists included 90 people who had not officially diagnosed any alcohol dependence, but who drink more than 40 (men) or 30 units (women) of alcohol per week, especially beer. Ten units are the equivalent of 2.5 liters of beer (3.8 percent) [I]. The test group were presented with pictures of beer, which reactivated the memory of consumption. However, they did not receive the expected reward afterwards, but an intravenous infusion of ketamine. Participants reported that their urge to drink beer had decreased significantly over the next ten days. This effect persisted over a nine-month follow-up period.

Ketamine is widely used clinically as a sedative or pain reliever. However, the active ingredient is also used as a party drug, which has a negative effect on memory performance when used in high doses and can lead to depression.

 

Statement

Prof. Dr. Ben Becker

Professor at the Clinical Hospital of the Chengdu Brain Science Institute, Key Laboratory for Neuroinformation, University of Electronic Science and Technology, Chengdu, China

“Learning and memory processes play a very important role in the development of addiction and relapse. Animal models and an increasing number of human imaging studies have provided consistent evidence that repeated and long-term drug use leads to the development of strong reward-induced memory stains. This 'addiction memory' promotes automatic and compulsive behaviors which can hardly be influenced by will or therapy. From general memory research we know that (1) these memory traces after reactivation, i.e. for example remembering, are consolidated again in the memory, (2) the memory traces can be modified more easily at this point in time, and (3) certain messenger substances in the brain (neurotransmitters ) play an important role in reconsolidation. This mechanism has long been discussed as a possible treatment target to influence addiction memory. The elegant study by Das and colleagues was able to show for the first time that this mechanism can indeed be influenced by means of ketamine. The findings therefore open up completely new treatment options for addiction and also represent important neurobiological points of attack for the development of new drugs to treat addiction. "

“For the first time, the study was able to show a clear effect on the self-reported alcohol consumption of the study participants. This variable is certainly suitable for the study of a non-addict group of test persons with heavy alcohol consumption, but it could lead to a bias of the results in studies with addiction patients. For example, previous studies reported a distorted perception of their own consumption among patients. In the study by Das and colleagues, this effect could be partially controlled by including additional control groups. In the context of future studies, it will therefore certainly make sense to collect additional parameters, such as biological markers of consumption. "

“In the context of initial treatment evaluation studies, working with risk groups who do not yet meet the full diagnosis offers a number of important advantages. For example, alcohol addiction often shows other comorbid conditions (additional clinical picture; editor's note) Diagnoses such as anxiety or depression, which would make it difficult to investigate a clear addiction mechanism. From animal and some human studies, however, we know that the transition to addiction also leads to fundamental changes in the memory processes involved, which promote compulsive consumption - a core symptom of addiction diagnosis. The success of the new treatment method in addictive populations must therefore be further evaluated in subsequent studies. The mechanisms influenced by the authors play an important role across various addictions - including gambling addiction - and thus open up new treatment methods beyond alcohol addiction. "

“In the context of the high prevalence of alcohol abuse and the moderate success of the treatment of alcohol addiction with the previously established treatment approaches, new treatment approaches are urgently needed. Although ketamine per se has an addictive potential, the addictive potential in the context of a single administration in the context of a therapeutic session is to be assessed as very low. This is also shown in the study by Das and colleagues, which observed the participants over several months. The essence of the study is the elegance of the long-term influence of memory mechanisms, which play a central role in addiction, through a single administration of ketamine. Compared to other pharmacological treatment methods - for example the daily administration of other drugs with sometimes considerable side effects over a period of months - this is revolutionary. "

“Similar doses of ketamine have been used repeatedly in scientific experiments and a positive effect on depression has been shown in an increasing number of studies. In these studies as well as in our own studies in healthy people, no long-term undesirable side effects, for example in the area of ​​memory, were observed. On the other hand, an increase in the use of ketamine as a party drug has been observed in recent years - negative consequences cannot be ruled out with heavy or long-term consumption in this context. "

Information on possible conflicts of interest

None specified.

Primary source

The RK et al. (2019): Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories. Nature Communications. DOI: 10.1038 / s41467-019-13162-w.

References cited by the SMC

[I] National Health Service (NHS) (2018): Alcohol units.