Beyond 28-Day Detox Programs

Why ketamine-assisted psychotherapy deserves a place in the addiction toolkit.

By Jon Stevens M.D., MPH

Psych Insights

Posted June 27, 2025

KEY POINTS

  • Ketamine-assisted psychotherapy offers a pharmacologic-psychologic intervention to prevent addiction relapse.

  • We can no longer accept the status quo of high relapse rates and revolving-door detox.

  • During KAP, patients can install new, healthier associations that counteract memories linked to drug cues.

  • KAP reduces symptoms of trauma, depression, and hopelessness, thus diminishing the urge for substances.

I just returned from the West Coast Symposium on Addictive Disorders, where I spoke about “Harnessing Ketamine: A New Frontier in Addiction Therapy.” My goal—then and now—is not to dethrone 12-step programs, inpatient detox, or life-saving medications like buprenorphine. It is to show why ketamine-assisted psychotherapy (KAP) may fill stubborn gaps for people who ricochet through standard care yet continue to relapse. When the revolving door keeps spinning, it’s time to add another hinge.

The Relapse Problem We Still Haven’t Solved

Whether we are talking about alcohol, cocaine, or opioids, the numbers tell a sobering story. More than half of individuals who finish alcohol detox return to drinking within six months. Two-thirds of people leaving a 28-day program for cocaine resume use within the first month, and nearly half of those on medication for opioid use discontinue treatment in the first year. These figures are not moral failures; they reflect how chronic exposure to addictive substances rewires reward circuits, priming the brain to leap toward familiar drug cues even after prolonged abstinence. Trauma, depression, and hopelessness often compound the problem, making substances feel less like a party and more like the only reliable anesthetic in reach.

What Makes Ketamine Different?

Ketamine’s value begins at the synapse. By blocking NMDA receptors, it unleashes a surge of glutamate that stimulates brain-derived neurotrophic factor (BDNF), jump-starting synaptogenesis and giving the brain a brief window of increased neuroplasticity. Clinically, that translates to two advantages. First, mood lifts within hours, cutting through the despair and suicidality that so often drive relapse. Second, memories connected to drug cues become temporarily malleable. With the skilled guidance of a therapist, patients can revisit these memories, weaken their emotional grip, and install new, healthier associations.

Source: Jon Stevens, MD

Inside a KAP Series

Preparation, dosing, and integration form the backbone of a successful ketamine-assisted psychotherapy session. In one or two preparatory visits, the therapist and physician work in tandem to set intentions and screen for medical issues such as uncontrolled hypertension or active psychosis. On dosing days, patients sit or recline in a quiet room, eyeshades on, therapeutic music playing, and a clinician monitoring vital signs. The infusion itself—usually 0.5 to 1.0 mg/kg over forty minutes—induces a floating, mildly dissociative state lasting about an hour. Integration takes place within the next couple of days, while the neural “wet cement” is still setting; this is where insights crystallize into concrete relapse-prevention strategies. A typical course involves four to eight infusions spread across two or four weeks, though protocols vary.

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Who Is (and Isn’t) a Good Candidate?

Ketamine-Assisted Psychotherapy is reserved for individuals who have failed evidence-based care or whose recovery is treacherous because of severe depression, suicidality, or trauma. It is not for people with uncontrolled cardiovascular disease, active mania or psychosis, or those seeking a purely recreational experience. Screening and a commitment to ongoing therapy are essential. Ketamine is an adjunct, not a silver bullet.

Common Concerns

The question I hear most often is whether we are trading one addiction for another. At clinical doses, administered under supervision and accompanied by psychotherapy, the risk of ketamine misuse is low. Another worry is that dissociation might block therapeutic work; in practice, mild dissociation often loosens entrenched beliefs, allowing new perspectives to emerge, provided integration follows promptly. Logistics also matter: sub-anesthetic dosing falls well within the skill set of psychiatrists and other physicians trained in Advanced Cardiac Life Support, and clinics without infusion capability can partner with medical colleagues who do.

Looking Forward

Research momentum is building. Multi-site phase-II trials for alcohol and opioid use disorders are under way, and federal agencies have begun funding mechanistic studies. Meanwhile, real-world programs are tracking outcomes to refine best practices. As clinicians and as a society, we can no longer accept the status quo of revolving-door detox. Ketamine-assisted psychotherapy is not intended to replace the community and hope provided by 12-step recovery, but it offers a pharmacologic-psychologic bridge for those left behind by our current system. When combined with careful screening, skilled integration, and community supports, KAP offers hope grounded in neuroscience and that, for many patients, is the missing piece.

About the Author

Jon Stevens, M.D., MPH, is triple board-certified in child and adolescent psychiatry, adult psychiatry, and obesity medicine. He blends interventional psychiatry, psychopharmacology, and medication management to help patients live healthfully.

Online:

JonStevensMD.com, LinkedIn, Instagram