The effects of subanesthetic ketamine infusions on motivation to quit and
cue-induced craving in cocaine-dependent research volunteers.
Author(s): Dakwar E(1), Levin F(2), Foltin RW(2), Nunes EV(2), Hart CL(3).
Affiliation(s): Author information:
(1)New York State Psychiatric Institute/Columbia University College of Physicians
and Surgeons, New York, New York. Electronic address: dakware@nyspi.columbia.edu.
(2)New York State Psychiatric Institute/Columbia University College of Physicians
and Surgeons, New York, New York. (3)New York State Psychiatric
Institute/Columbia University College of Physicians and Surgeons, New York, New
York; Department of Psychology, Columbia University, New York, New York.
Publication date & source: 2014, Biol Psychiatry. , 76(1):40-6
BACKGROUND: Cocaine dependence involves problematic neuroadaptations that might
be responsive to modulation of glutamatergic circuits. This investigation
examined the effects of subanesthetic ketamine infusions on motivation for
quitting cocaine and on cue-induced craving in cocaine-dependent participants, 24
hours postinfusion.
METHODS: Eight volunteers with active DSM-IV cocaine dependence not seeking
treatment or abstinence were entered into this crossover, double-blind trial.
Three 52-min intravenous infusions were administered: ketamine (.41 mg/kg or .71
mg/kg) or lorazepam 2 mg, counterbalanced into three orderings in which ketamine
.41 mg/kg always preceded the .71 mg/kg dose. Infusions were separated by 48
hours, and assessments occurred at baseline and at 24 hours postinfusion.
Outcomes were change between postinfusion and preinfusion values for: 1)
motivation to quit cocaine scores with the University of Rhode Island Change
Assessment; and 2) sums of visual analogue scale craving ratings administered
during cue exposure.
RESULTS: Compared with the active control lorazepam, a single ketamine infusion
(.41 mg/kg) led to a mean 3.9-point gain in University of Rhode Island Change
Assessment (p = .012), which corresponds to an approximately 60% increase over
preceding values. There was a reduction of comparable magnitude in cue-induced
craving (p = .012). A subsequent ketamine infusion (.71 mg/kg) led to further
reductions in cue-induced craving compared with the control. Infusions were
well-tolerated.
CONCLUSIONS: Subanesthetic ketamine demonstrated promising effects on motivation
to quit cocaine and on cue-induced craving, 24 hours postinfusion. Research is
needed to expand on these preliminary results and to evaluate the efficacy of
this intervention in clinical settings.
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