Alcohol Relapse
Alcohol Use Disorder
Alcohol use disorder is a medical condition that involves impaired ability to control or stop alcohol use despite active social, physical and occupational consequences. It can be mild, moderate or severe based on DSM-5 classification.
Risk factors
- Mental health conditions, such as depression, PTSD, childhood trauma, ADHD
- Genetics and family history of alcohol use disorder
- Early exposure to alcohol, particularly before the age of 15.
United States Relevant AUD Numbers
28 million
Affected with AUD, aged 12 and older
178K
Deaths annually
80-90%
Did not receive any treatment
2-3%
Received FDA approved medications
Traditional treatments
Traditional treatment follows a multi-step, evidence-based approach designed to help people stop drinking, manage withdrawal, avoid relapse, and build long-term recovery. Medical detox, behavioral therapy and counseling, peer support, and rehabilitation programs help many people, and they remain first-line care.
Even so, relapse is very common partially due to untreated underlying mental health conditions, unaddressed social or environmental triggers, and faded motivation over time.
Even so, relapse is very common partially due to untreated underlying mental health conditions, unaddressed social or environmental triggers, and faded motivation over time.
FDA-approved medications
Disulfiram
Causes nausea, headache and skin flushing after drinking alcohol, which deters further use.
Naltrexone
Available in pill form as well as a long-acting injection, it blocks opioid receptors in the brain and helps to diminish cravings for alcohol.
Acamprosate
This medication acts on multiple brain systems to help mitigate alcohol cravings during the sobriety phase.
Behavioral therapies & support
Behavioral therapies
Therapists help uncover the underlying feelings and situations that lead to excessive drinking, using cognitive behavioral therapy, motivational enhancement, brief interventions, and marital and family counseling.
Mutual Support Groups
Support groups such as Alcoholics Anonymous and other peer support networks assist individuals in confronting the social and emotional stigma associated with alcohol use disorder
Ketamine and AUD
Ketamine combined with psychotherapy is emerging as a fast-acting adjunct treatment during the sobriety phase.
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Calms glutamate
Chronic heavy drinking causes over-excitatory glutamate signaling. Ketamine blocks NMDA receptors and calms this state.
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Neuroplasticity
Ketamine disrupts stubborn alcoholic neural circuits by promoting synaptogenesis
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Alcohol Memory Disruption
Ketamine can interfere with the reconsolidation of alcohol-related memories, the entrenched emotional cues and habits that keep drinking always in action
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Improving Mental Health
Most people with AUD either have pre-existing mental health conditions or developed thmsuch as depression, PTSD or ADHD or encounter these conditions from chronic alcoholic use. Ketamine is. Shown to swiftly improve these conditions
Risks of non-prescribed ketamine and alcohol
MD supervised iv ketamine therapy can be safe and highly effective for AUD but unsupervised use of ketamine with ongoing alcohol consumption can introduce serious health risks.
Short-term use
Can cause extreme drowsiness, slowed breathing, and in severe cases unconsciousness. It can also cause nausea, confusion, and impaired coordination, raising the risk of blackouts, injury, or overdose.
Long-term use
Can cause liver and kidney damage, cardiovascular problems, gastrointestinal inflammation, cognitive decline and memory loss, and a higher risk of anxiety, depression, or psychotic episodes.
Relevant research
2026/27
MORE-KARE Trial
Ketamine plus therapy yielded 86% abstinence at 6 months.
2026
KARE Trial Secondary Analysis
King's College London News: Acute psychoactive effects, or "psychedelic" high, resulting from repeated iv Ketamine infusions do not predict the therapeutic success or long-term abstinence in treating AUD. The benefits are likely driven by deeper neural, functional, or psychological mechanisms rather than the intensity of the subjective experience.
2024
JAMA Psychiatry (Wilkinson et al.)
The authors raised severe safety risks and fatalities associated with the combined use of unsupervised ketamine and alcohol.
2023
Systemic Review (PMC10237681, May)
The combination of ketamine and psychotherapy produced the most promising rates of abstinence and reduced consumption.
2022
KARE Trial
Combining ketamine with therapy resulted in an 86% abstinence rate at six months and 78.5% of days abstinent during weeks 17 to 24, compared to 57.8% in the placebo plus education group.
2020
Columbia Trial
There was an 82% abstinence rate three weeks post-infusion, in contrast to 65% with midazolam, along with delayed relapse and fewer heavy drinking days.