Ketamine for Alcohol Use Disorder with Steven Mandel, MD

In this episode of the Psychedelic Medicine Podcast, Dr. Steven Mandel returns to discuss ketamine treatments for alcohol use disorder. Dr. Mandel is an internationally recognized expert and pioneer in the use of ketamine-infusion therapy to treat mental health disorders and chronic pain. He is a board-certified anesthesiologist with a masters in psychology and over 40 years of experience working with ketamine. He is the founder and president of Ketamine Clinics Los Angeles and also the Founder and first president of American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3).

In this conversation, Dr. Mandel explores the topic of using ketamine to address alcohol use disorder, discussing findings from research and sharing his professional experience with this treatment protocol. He begins by unpacking the specifics of alcohol use disorder before relaying an incredible success story from a client who was able to conquer a very significant alcohol addiction due to ketamine therapy treatment.

However, Dr. Mandel notes that actual scientific research for this particular therapeutic use of ketamine is still in the early days, though he notes that the first non-anesthetic use of ketamine was for treating alcoholism in Moscow, and this intervention appeared to be quite effective. He also shares results from animal studies, noting that one study found outcomes of ketamine treatment for alcohol dependent mice was significantly mediated by sex, with the female mice being less responsive to the treatment. However, Dr. Mandel notes that it is too early to know if these same patterns appear in humans.

In terms of the theoretical basis for this treatment protocol, Dr. Mandel discusses glutamatergic transmission and the nucleus accumbens as being important in both alcohol use disorder and ketamine treatment. He also mentions that ketamine potentiates the NMDA receptors which are desensitized in the case of chronic alcohol use.

But Dr. Mandel insists that these pharmacological mechanisms are not the whole story when it comes to the efficacy of ketamine therapy for alcohol use disorder. At his clinics, treatment consists of a five point model which also addresses things like sleep hygiene and diet to provide a more holistic approach to wellness. He also stresses the importance of including talk therapy in the treatment protocol, as patients are primed for effective therapy following infusions. This is due to the improved neuroplasticity resulting from the neurological effects of ketamine, but since this does not last forever Dr. Mandel maintains there is a sweet spot where therapy will be most effective, which is between a few hours after the ketamine treatment and a few days later.

In combination with therapy and other interventions to promote patient wellness, Dr. Mandel is confident ketamine therapy presents a promising treatment option for those struggling with alcohol use disorder, and he thinks it may even be a helpful support for those who've shaken their addictions but still struggle with cravings in abstinence.

Ketamine Clinics Los Angeles phone number: (310) 270-0625

In this episode:

• What is alcohol use disorder?
• Patient success stories from Dr. Mandel's ketamine treatments
• The research on ketamine for alcohol use disorder
• How set and setting differentiates alcohol and ketamine use in important ways
• The importance of the experiential aspect of ketamine for its clinical efficacy
• Why Dr. Mandel's clinic focuses on sleep hygiene and diet alongside ketamine therapy to help achieve the best patient outcomes
• Dr. Mandel's protocol for ketamine infusions
• The history of AA and psychedelic therapies

Quotes:

"[Ketamine's] first major use… outside of the operating room for anesthesia was by Krupitsky in Moscow in a government program treating chronic alcoholism. That was the first behavioral use of ketamine! And it was profoundly effective." [9:25]

"We're really at a frontier here. Just getting ketamine in people and seeing the transformation is amazing. And trying to sort out how to optimize it—we're not there yet." [20:41]

"There's a whole other population of people who are successfully abstinent, but are beginning to have cravings. And those people are so helped by a little experience with ketamine. Ketamine is amazing at helping people to resist cravings." [24:08]

Links:

Ketamine Clinics Los Angeles

American Society of Ketamine Physicians, Psychotherapists & Practitioner

Previous Episode: Ketamine Practitioner Methods with Dr. Steven Mandel

Psychedelic Medicine Association

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