Drug and Alcohol Dependence
January 15, 2014
E. Dakwar, C. Anerella, Carl L. Hart et al.
125 citations
In a small study of eight cocaine-dependent individuals, ketamine infusions produced mystical-type experiences that helped explain increased motivation to quit cocaine a day later. Participants received two doses of ketamine (0.41 mg/kg and 0.71 mg/kg) and a control drug lorazepam (2 mg) in random order. Ketamine, especially the higher dose, caused significantly stronger mystical-type effects than lorazepam. The intensity of those mystical effects, but not dissociative symptoms, predicted greater motivation to stop using cocaine 24 hours after infusion. The findings suggest that psychological experiences during ketamine treatment may contribute to its anti-addiction benefits, though larger studies are needed.
Harv Rev Psychiatry
January 1, 2009
Elias Dakwar, Frances R. Levin
53 citations
Meditation has become increasingly common in clinical settings over the past 30 years and may offer psychiatric benefits, particularly for substance use disorders. This review critically examines three widely studied meditation modalities—transcendental meditation, Buddhist meditation, and mindfulness-based meditation—describing their backgrounds, techniques, mechanisms of action, and evidence-based clinical applications, with a focus on their emerging role in treating substance use disorders. The review also addresses unique methodological challenges in studying meditation and suggests that meditation may help with substance use disorders through specific mechanisms, though further research is needed.
JAMA Psychiatry
January 1, 2023
Brian D Kiluk, Bethea A Kleykamp, Sandra D Comer et al.
22 citations
A review sponsored by a public-private partnership addresses clinical trial design for new opioid use disorder (OUD) treatments that target systems other than the μ-opioid receptor. The authors present consensus recommendations for evaluating novel therapies such as cannabinoids, psychedelics, sedative-hypnotics, and immunotherapeutics. Key design elements include specifying the treatment stage (e.g., early abstinence, long-term recovery), defining the treatment's role (adjunctive or independent), selecting patient-informed primary outcomes that assess opioid use patterns, retention, and quality of life, and monitoring adverse events like relapse or overdose, especially when patients are not on maintenance opioid agonist or antagonist medications. Incorporating input from people with lived experience is urged to accelerate development and uptake of effective therapeutics.
American Journal of Psychiatry
October 9, 2024
Caesar G. Imperio, Frances R. Levin, Diana Martínez
9 citations
Substance use disorder is common among psychiatric patients and often goes untreated, negatively affecting health. This review provides a neuroscience-based framework for psychiatrists to address SUD. It describes how pharmacotherapy can target craving, intoxication, and withdrawal to interrupt the substance use cycle. The neuroscience of stress is reviewed, including medications that act on neurotransmitter systems involved in alarm and fear. Treatments that promote neuroplasticity, such as ketamine, psilocybin, and transcranial magnetic stimulation, are discussed. The review concludes with resources and practice guidelines for physicians.