Ketamine for reduction of Alcoholic Relapse (KARE)
This clinical trial explores the combined use of psychological therapy and a low dose of ketamine as a possible treatment for alcoholism. KARE is a multi-site project running in both the South West of England as well as London. The project is supported by the University of Exeter, University College London (UCL), and the Medical Research Council (MRC).
Severe alcohol use disorder affects nearly 4 million people in the UK, with devastating consequences to lives. Staying sober is key to reducing the harm that alcohol can do to physical and mental health. Unfortunately, treatments to help people stop drinking alcohol have been shown to be limited in their effectiveness, and people often return to drinking after only a short time of being sober.
A follow-up trial, multi-centre investigation of increasing alcohol abstinence with ketamine-assisted psychological therapy in severe alcohol use disorder (MORE-KARE), is sponsored by the University of Exeter and is currently taking place.
What is ketamine?
Ketamine is an anaesthetic widely used across the world in hospitals. The dose of ketamine administered in this trial is substantially less than that used in hospitals, and repeat high doses of ketamine are commonly given to patients. In the low dose which will be used in this study, ketamine has been shown to lead to short term improvements in mood, lasting up to 7 days, in individuals with depression which has not responded to treatment.
People sometimes abuse ketamine because of the effects it can have at a high dose. However, the dose chosen for this study is well tolerated in humans. Patients may experience some changes in vision and hearing and other senses like touch while having the infusion of ketamine. Patients do sometimes report having hallucinations. Any changes experienced should resolve quickly.
The treatment administered in this trial does involve having a needle put into a vein on the back of the hand as the ketamine is infused over 40 minutes. There is therefore a chance of temporary bruising in this location.
Frequently asked questions (FAQs)
Isn’t ketamine a horse tranquiliser?
While ketamine is perhaps best known for its use in veterinary medicine, it was initially developed for use in humans as an anaesthetic. Ketamine is widely used in general hospitals across the world for this purpose. It is important to note that it is not uncommon for medicines to be effective and safe in both animals and humans: alongside ketamine, a number of antibiotics, anti-hypertensives and pain medications are used in both veterinary and human medicine.
Why ketamine?
Studies have shown that ketamine has an acute antidepressant effect and may improve learning of new information, both of which may promote continued abstinence in alcohol dependent individuals. Pilot work conducted in the 1980s found promising reductions in relapse rates in alcohol dependent individuals following ketamine treatment. However, this has not yet been tested robustly, and this is the purpose of the present trial.
Is it safe?
Ketamine is safe and well tolerated in humans at the doses chosen for this study. Like all medicines, ketamine can cause side effects. Common side effects include hallucinations, increased blood pressure and increased heart rate. Not everyone will experience side effects, however, and any effects experienced will resolve quickly after the infusion of the medication has finished. All participants in this study will be supervised while the drug is administered and in the short term after administration.
Aren’t you just swapping one addiction for another?
Since ketamine can be abused recreationally, one concern is that participants may become dependent on ketamine instead of alcohol. This trial involves only three, low-dose infusions of ketamine, with no scope for further treatment once participation ends. We have shown that the doses of ketamine used in this study are not in themselves rewarding, and recently alcohol-detoxified individuals given ketamine were not more likely to go on to abuse this drug. The risk of an individual becoming dependent on ketamine as a result of this trial is therefore low.
Important information for taking part in the trial
If you decide to participate your alcohol use will be monitored over a six month period. Participants will be required to wear an ankle monitoring bracelet during the active treatment phase (approximately 4-6 weeks), and complete alcohol diaries for the remaining five months.
The trial is a multi-site trial with the two main study centres being in London and Exeter. However, we welcome people from outside of these regions to get in touch if they are interested in participating. We are able to provide transport and/or reasonable expenses for those travelling long distances to participate.
Participants will be required to attend 10 sessions over the course of 6 months.
Meet the project team
| Name | Role |
|---|---|
| Dr Brigitta Brandner | Chief Investigator |
| Professor Celia Morgan | Principal Investigator |
| Professor Anne Lingford-Hughes | Co-Investigator |
| Professor Val Curran | Co-Investigator |
| Dr Rob Price | Exeter Site Principal Investigator |
| Dr Amy McAndrew | Southwest-based researcher |
| Dr Will Lawn | Research Associate |
| Dr Rob Hill | Consultant Clinical Psychologist |
| Dr Jen Harris | Consultant Clinical Psychologist |
| Dr Fiona Warren | Statistician |
| Dr Tobias Stevens | Exeter-based researcher |
| Laura Raymen | Research Assistant |
| Bethan Marsh | Trial Co-ordinator |
| Meryem Grabski | Postdoctoral Researcher |
| Rachel Hannon | Medical Sciences Undergraduate |
| Dr Lorna Hardy | Postdoctoral Researcher |
