The therapeutic use and efficacy of ketamine in alcohol use disorder and alcohol withdrawal syndrome: a scoping review
Charlotte Goldfine, Jeremiah J. Tom, Dana D. Im, Benjamin Yudkoff, Amit Anand, Joseph J. Taylor, Peter R. Chai, Joji Suzuki
Frontiers in Psychiatry April 27, 2023 DOI: 10.3389/fpsyt.2023.1141836 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Scoping review Peer reviewed |
|---|---|
| Population | Humans with alcohol use disorder or alcohol withdrawal syndrome |
| Intervention | Ketamine |
| Dose | sub-dissociative doses |
| Topics | Addiction Esketamine Ketamine |
| Citations | 30 |
| Key findings | Across 10 human studies, ketamine was reported to reduce cravings, alcohol consumption, and increase abstinence duration in alcohol use disorder relative to treatment as usual, and as an adjunct to benzodiazepines in severe alcohol withdrawal it was associated with faster resolution of delirium tremens and withdrawal, shorter ICU stays, and lower intubation likelihood. The authors conclude efficacy and safety remain promising but not yet definitive enough to recommend broader clinical use. |
Abstract
Introduction: Alcohol use disorder (AUD) is the most prevalent substance use disorder (SUD) globally. In 2019, AUD affected 14.5 million Americans and contributed to 95,000 deaths, with an annual cost exceeding 250 billion dollars. Current treatment options for AUD have moderate therapeutic effects and high relapse rates. Recent investigations have demonstrated the potential efficacy of intravenous ketamine infusions to increase alcohol abstinence and may be a safe adjunct to the existing alcohol withdrawal syndrome (AWS) management strategies.
Methods: We followed Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines to conduct a scoping review of two databases (PubMed and Google Scholar) for peer-reviewed manuscripts describing the use of ketamine in AUD and AWS. Studies that evaluated the use of ketamine in AUD and AWS in humans were included. We excluded studies that examined laboratory animals, described alternative uses of ketamine, or discussed other treatments of AUD and AWS.
Results: We identified 204 research studies in our database search. Of these, 10 articles demonstrated the use of ketamine in AUD or AWS in humans. Seven studies investigated the use of ketamine in AUD and three studies described its use in AWS. Ketamine used in AUD was beneficial in reducing cravings, alcohol consumption and longer abstinence rates when compared to treatment as usual. In AWS, ketamine was used as an adjunct to standard benzodiazepine therapy during severe refractory AWS and at signs of delirium tremens. Adjunctive use of ketamine demonstrated earlier resolution of delirium tremens and AWS, reduced ICU stay, and lowered likelihood of intubation. Oversedation, headache, hypertension, and euphoria were the documented adverse effects after ketamine administration for AUD and AWS.
Conclusion: The use of sub-dissociative doses of ketamine for the treatment of AUD and AWS is promising but more definitive evidence of its efficacy and safety is required before recommending it for broader clinical use.