Ketamine Psychedelic Therapy (KPT): A Review of the Results of Ten Years of Research
E.M. Krupitsky, M.D., Ph.D.* & A.Y. Grinenko, M.D., Ph.D.**
The authors wish to thank the staff of the Research Laboratory of Leningrad Regional Center for Alcoholism and Drug Addiction Therapy who took part in their studies during the last 10 years. We are particularly grateful to Drs. A. Paley, A. Burakov. G. Karandashova. V. Ivanov, T. Romanova, T. Berkaliev, and to many others who contributed a great deal to their work. Also, the authors' deep appreciation goes to the research fellows and physicians of the various scientific research institutes involved in their studies, particularly Drs. I. Dunaevsky, I. Kungurtsev. O. Luchakova and L. Priputina. Finally, we are very thankful to the Multidisciplinary Association for Psychedelic Studies (MAPS) and to Rick Doblin, MAPS president, for his assistance and support of the research we were doing. In addition, Dr. Krupitsky would especially like to express his deep appreciation to Jon Frederick and Sylvia Thyssen for their crucial assistance in editing this paper, and to Dr. Rick Strassman for the inspiration and guidance that he has provided.
*Chief of the Research Laboratory, Leningrad
Regional Center for Alcoholism and Drug Addiction Therapy, Novo-Deviatkino,
**Minister of Health Care, Leningrad Region.
Please address correspondence and reprint requests to E.M. Krupitsky,
M.D., Ph.D.. Research Laboratory, Leningrad Regional Center for
Alcoholism and Drug Addiction Therapy, Novo-Deviatkino 19/1. Leningrad
Region, 188661. Russia.
Abstract – Ketamine
is a prescription drug used for general anesthesia. In subanesthetic
doses. it induces profound psychedelic experiences and hallucinations.
The subanesthetic effect of ketamine was the hypothesized therapeutic
mechanism in the authors' use of ketamine-assisted psychotherapy
for alcoholism. The results of a controlled clinical trial demonstrated
a considerable increase in efficacy of the authors' standard alcoholism
treatment when supplemented by ketamine psychedelic therapy (KPT).
Total abstinence for more than one year was observed in 73 out of
111 (65.8%) alcoholic patients in the KPT group, compared to 24%
(24 out of 100 patients) of the conventional treatment control group
(p<0.01). The authors' studies of the underlying psychological
mechanisms of KPT have indicated that ketamine-assisted psychedelic
therapy of alcoholic patients induces a harmonization of the Minnesota
Multiphasic Personality Inventory (MMPI) personality profile, positive
transformation of nonverbalized (mostly unconscious) self-concept
and emotional attitudes to various aspects of self and other people,
positive changes in life values and purposes, important insights
into the meaning of life and an increase in the level of spiritual
development. Most importantly, these psychological changes were
shown to favor a sober lifestyle. The data from biochemical investigations
showed that the pharmacological action of KPT affects both monoaminergic
and opioidergic neurotransmitter metabolism. i.e., those neurochemical
systems which are involved in the pathogenesis of alcohol dependence.
The data from EEG computer-assisted analysis demonstrated that ketamine
increases theta activity in cerebrocortical regions of alcoholic
patients. This is evidence of the reinforcement of limbic cortex
interaction during the KPT session.
Keywords – alcoholism,
hallucinogen, ketamine, psychedelics, psychotherapy, Russia
A review of the literature suggests that the psychedelic experience
may have beneficial effects in many ways: contributing to the cathartic
process, stabilizing positive psychological changes, enhancing personal
growth and self-awareness, catalyzing insights into existential
problems, increasing creative activities, broadening spiritual horizons,
and harmonizing relationships with the world and other people (Strassman
1995; Krupitskv & Grinenko 1992; Grinspoon and Bakalar 1979).
All these effects can be auspicious for a sober life.
Many studies in the 1950s and 1960s suggested that psychedelic psychotherapy
might be an effective treatment for alcoholism (Grinspoon &
Bakalar 1979), but use of differing methodologies made it difficult
to generalize across studies. The requisite development of appropriate
sophistication of these studies was not possible after psychedelics
were scheduled in 1970 and their use in research was strictly limited.
However, at about this time, ketamine and ketamine-like anesthetic
agents were being shown to elicit “psychedelic” emergent
phenomena in patients (Stafford 1983; Khorramzadeh & Lofty 1976;
Loh et a1. 1972). This property of ketamine was utilized for therapeutic
purposes in ketamine-assisted therapy for alcoholism because ketamine
induced a profound psychedelic experience in doses about one-sixth
to one-tenth of that usually used in surgery for general anesthesia.
Ketamine has some advantages over other psychedelics as an adjunct
to psychotherapy. It is safe and short acting (the psychoactive
effects last about an hour). In addition, ketamine is not on Schedule
I as are other psychedelics and is already a prescription drug.
Three main stages in the authors' method of ketamine psychedelic
therapy (KPT) can be distinguished (Krupitsky et a1. 1992). The
first stage is preparation. In this stage, preliminary psychotherapy
is carried out with patients. During these psychotherapeutic sessions,
it is explained to the patients that relief from their dependence
on alcohol will be induced in a special state of consciousness.
In this state, they will have deep experiences that will help them
realize the negative effects of alcohol abuse and the positive
aspects of sobriety. Patients are told that the psychedelic session
may induce important insights concerning their personal problems,
their systems of values, their notions of self and the world around
them, and the meaning of their lives. All of these insights may
entail positive changes in their personalities, which will be important
for their shift to a sober lifestyle. During the ketamine sessions,
patients often experience separation of consciousness from the
body and dissolving of the ego; as a result, it is very important
to prepare them carefully for such unusual experiences. The patients
are told that they will enter some unusual states of consciousness
and are instructed to surrender fully to the experience.
During several preparatory sessions, it is emphasized that personally
significant mental concepts concerning the negative aspects of
the patient's alcoholism have been repressed into the unconscious.
The patient is told that during the session these concepts will
manifest themselves into consciousness in peculiar symbolic forms
in emotionally saturated visions (hallucinations), allowing the
patient to see and sense the unconscious roots of his alcohol problems.
This experience will help the patient to understand that alcohol
problems are directly related to more deeply rooted personality
problems and are often the consequence of the latter. The conscious
recognition of these concepts, along with the painful experience
of the negative aspects of alcoholism, will result in the patient's
psychological rejection of alcohol abuse and the establishment
of a stable orientation towards sobriety.
This information is not presented to the patient in the form of
a didactic monologue from a psychotherapist. The abstract “psychotherapeutic
myth” is not simply explained to the patient; it is discussed
with him or her and embroidered with specific concrete content
during a dialogue. The therapist pays close attention to issues
such as the patient's personal motives for treatment and sobriety,
goals for a sober life, ideas concerning the cause of the disease
and its consequences, opinions as to what hinders sobriety and
what favors it, and so on. An individually tailored “psychotherapeutic
myth” is formed during this dialogue. It becomes the most
important therapeutic factor responsible for the psychological
content of the second stage of the KPT. It is also very important
to create an atmosphere of confidence and mutual understanding
between the psychotherapist and the patient during the first stage
The second stage is the ketamine session itself. During this procedure
aethimizol (1.5% 3 ml, i.m.) is injected into the patient; after
this bemegride (0.5% 10 ml, i.v.) is injected, and then ketamine
(Krupitsky 1992). Ketamine doses of 2.5 mg/kg, i.m. were used.
The intramuscular route is preferred because the effect is more
gradual and the psychedelic experience lasts longer. With an intravenous
injection, the effect lasts only about 15 to 20 minutes, but after
an intramuscular injection, it lasts from about 45 minutes to an
hour. Bemegride enhances the emotional experiences and visions
produced by ketamine (Krupitsky 1995), and aethimizol promotes
the storage of experiences in long-term memory (Smirnov & Borodkin
1979). Moreover, both of these drugs (aethimizol and bemegride)
are analeptic drugs which enhance cortical activity and thus widen
the opportunities for psychotherapeutic dialogue with the patient
during the ketamine session. In the last several years, the authors
have also begun to prescribe a central calcium channel antagonist
(nimodipine, 60 mg. a day, orally) before the KPT session to improve
the patient's memory about his or her psychedelic experience, because
it was shown that calcium channel antagonists reverse memory disturbances
produced by ketamine in rats (Saha et al. 1990). A previous study
has shown that nimodipine improves memory of the ketamine session,
specifically about psychotherapeutic suggestions and the psychedelic
experience (Krupitsky et al. 1995).
With a background of specially chosen music (generally, New Age
composers such as Kitaro and Jean Michel Jarre) the patient having
a KPT session is exposed to psychotherapeutic influences. The content
of these influences is based on the concrete data of the patient's
case history and is directed toward the resolution of the patient's
personality problems and toward the formation of a stable orientation
towards sobriety. The goal is to help patients create a new meaning
and purpose in life during this session. The specific character
of this KPT method allows one to carry out a special psychotherapeutic
dialogue with the patient undergoing the psychedelic experience.
The positive values and meaning of a sober life style and the negative
aspects of alcohol abuse are emphasized during this dialogue, which
has a specific personal orientation for each patient. It is very
important to carefully direct the patient's psychedelic experiences
by verbal influences and by establishing a musical background that
supports the symbolic resolution of personality conflicts and facilitates
cathartic peak experiences. Moreover, at certain moments in the
psychedelic session, usually at moments of highly intense hallucinatory
experiences, the patient is given an opportunity to smell alcohol.
The introduction of the smell of alcohol serves to enhance the
negative emotional coloring of the alcoholic themes in the patient's
psychedelic experience, thus forming in the patient an aversion
towards alcohol and an alcoholic lifestyle.
The second stage of KPT is conducted by two physicians, a psychiatrist
and an anesthesiologist, because some complications and side-effects
— such as increased blood pressure, convulsions and depression
of breath — are possible, though exceedingly rare. After
45 minutes to an hour, the patient slowly comes back from the experience.
During the recovery period, which takes about one or two hours,
the patient begins to feel ordinary reality returning. At this
point in the session, the patient usually begins to describe his
or her experience and some discussion and interpretation is begun.
After the session, the patient goes to rest. Patients are asked
to write down a detailed self-report of their experiences that
The third stage is group psychotherapy, which is carried out the
day after the KPT session. Patients are gathered in a group the
day after treatment, because when they all share the experience,
it is usually more powerful. During this session the patients,
with the aid of the psychiatrist, discuss and interpret the personal
significance of the symbolic content of their experiences. This
discussion is directed toward helping the patients make a correlation
between their psychedelic experience and their intra- and interpersonal
problems (primarily those connected with alcohol abuse), and thereby
to solidify their desire for a sober life. The therapist tries
to assist the patients in the psychological integration of the
spiritual transformation which can result from the psychedelic
experience. This uniquely profound and powerful experience often
helps them to generate new insights that enable them to integrate
new, often unexpected meanings, values and attitudes about the
self and the world.
CLINICAL STUDY OF THE EFFICACY OF KPT IN THE TREATMENT OF ALCOHOLISM
One hundred eleven male alcoholic patients were treated following
the KPT method. All participants in the KPT procedure gave voluntary
written consent. These patients were chronic alcoholics who could
not control their drinking. Their age ranged from 23 to 56 with
an average age of 36.5±7 years. Alcohol withdrawal syndrome, one
of the major diagnostic criteria for alcoholism, had been present
for an average of 5.3±0.5 years. The KPT procedure followed the
standardized three-month treatment course at the Leningrad Regional
Center for Alcoholism and Drug Addiction Therapy. These three months
constituted the first phase of therapy. During this first phase,
the patients' alcohol withdrawal syndrome and any related anxiety
or affective disorders and somatic disorders were treated. Then,
rational, cognitive individual and group psychotherapy was begun
in order to establish a mental set of sobriety and a negative attitude
to alcohol. Broader issues than the problem of alcohol abuse were
explored, including the patient's life history, relationships,
and world view. Later, patients in the ketamine program were told
that they would undergo a new treatment which would allow them
to see and feel the deep unconscious roots of their problems. Patients
were helped to understand that their alcohol problem was perhaps
only a superficial symptom of these problems.
The control group was composed of a corresponding set of 100 male
alcoholics. Their average age was 38.4±.81 years, and their alcohol
withdrawal syndrome had been present for an average of 6.8±0.54
years. These patients underwent the same three-month treatment
course at the same hospital, but received only conventional, standard
methods of treatment. A t test for values was used, and there were
no significant differences between the experimental and control
groups either in the patients' age or in their severity of alcoholism.
It is possible that the requirement that patients volunteer for
KPT may have introduced some selection bias into the data, in that
the KPT group may have been more motivated to obtain sobriety than
the control group. A more rigorous design would have been random
assignment to either the KPT treatment or the control group from
among a group of patients who had expressed a willingness to experience
KPT. Nevertheless, all patients in both the control group and the
experimental group carne to the hospital voluntarily for treatment
In addition, all patients willingly participated in some form of
psychotherapy to complete their course of treatment, with the control
group choosing conventional psychotherapy and the experimental
group choosing KPT. While it is not possible to conclude that the
motivational dynamics were exactly the same in the subjects in
the experimental and the control group, it is quite likely that
the motivation for treatment was somewhat similar in both groups.
To determine the efficacy of the treatment, follow-up information
was collected about all the patients who had taken part in this
study a year after their release. According to the data, abstinence
of more than one year was observed in 73 out of 111 people (65.8%)
who had undergone KPT. Thirty people (27.0%) had relapsed. Data
could not be obtained on eight patients (7.2%). In the control
group of 100 patients whose treatment consisted only of conventional
methods, only 24 patients (24%) remained sober for more than one
year. Sixty-nine patients (69%) had relapsed. We could not obtain
data for seven (7%) of the control patients. These data suggest
that ketamine-assisted psychedelic therapy increases the efficacy
of conventional alcoholism treatment.
The 111 patients were treated sequentially over a four-year period.
Monthly evaluations were conducted on each patient. Two- and three-year
follow-up statistics were collected at only one time, one year
after the last patient was treated. Two years had elapsed for only
81 of the original 111 patients at the time of the final follow-up
study. Abstinence of more than two years was observed in 33 out
of these 81 patients (40.7%). Thirty-eight patients (46.9%) had
relapsed. Two-year follow-up data on 10 patients (12.4%) could
not be obtained.
Three-year follow-up data were collected for all 42 patients who
had undergone KPT within the previous three years (three years
had elapsed for only 42 of the original 111 patients at the time
of the follow-up study). According to the data, abstinence of more
than three years was observed in 14 out of these 42 patients (33.3%);
24 patients (57.2%) had relapsed. Three-year follow-up data on
four patients (9.5%) could not be obtained.
Unfortunately, two- and three-year follow-up data on the control
group could not be collected because of financial limitations.
The difficulty was due in part to the huge catchment area for these
patients, as big as most states in the United States. The most
that can be said is that the two- and three-year follow-up data
for the experimental group compare favorably Witll tile two- and
three-year follow-up data from conventional treatment in the region,
which, according to official but unpublished statistics, found
between 5 to 15% of the patients remaining sober two to three years
after treatment (Leningrad Region Ministry of Health 1995).
Several months after being released from the hospital, most of
the patients treated by KPT stated that it had contributed significantly
to their sobriety. For instance, seven months after he was released,
patient A.C. reported, “The experience related with the KPT
session is vividly imprinted in my mind and is a kind of 'taboo'
on drinking. . . .”
STUDY OF THE UNDERLYING MECHANISMS OF KPT
All patients for these particular studies were randomly selected
from among those patients who gave their consent to undergo KPT.
Selection was made by medical staff who were blind to the purpose
of the studies. The randomization was done informally. Technically,
patients who were conveniently available at the time were referred
by medical staff of the clinical area of the hospital (which includes
five departments for alcoholism and drug addiction therapy with
50 beds each). Everybody was accepted except those with contraindications,
such as severe cardiovascular disorders, family and/or personal
history of major psychiatric disorders, organic brain damage or
severe neurological disorders.
Underlying Psychological Mechanisms
Content Analysis Data. Content analysis of the psychedelic
experiences written down by our patients after their KPT sessions
was carried out These descriptions (see Appendix I) often had common
plots: violent movement in various types of tunnels and corridors,
experience of the separation of consciousness from the body, symbolic
experience of death and rebirth, identification with inanimate
objects, fear of an apocalyptic end to the world, the sensation
of losing one's self image, deep suffering from loneliness, rupture
of relations with the family, a feeling of being lost in the universe,
a sensation of lack of self-control, feeling dependent upon the
frightening chaotic movement, falling through space, a terror of
closed spaces and no exit, an unexpected exit and rebirth associated
with an oceanic feeling and becoming part of the universe, a feeling
of being connected with a Supreme Power or God, and a perceived
awareness of the reality of other dimensions or worlds no less
real than ours. Ketamine produced diverse experiences ranging from
spiritual rapture to fear and even horror, sometimes all in the
same person. All of these experiences were extremely intense, clear
and compelling. Many people reported great difficulty in expressing
their experiences in words.
It should be noted that, despite the common topics in the patients'
experiences, themes were almost always individually specific and
reflected in symbolic form the individuals' case histories and
personality problems (Appendix I). Supported by group psychotherapy,
patients were able to interpret more clearly what they had experienced,
initially in symbolic form, during their session and to address
the personal psychological problems that were uncovered during
the ketamine session. These problems in particular were associated
with alcohol dependence and the positive prospects for a sober
life; patients attributed the negative aspects of the ketamine
session to alcohol and beneficial effects of the ketamine session
to the idea of a sober life. This provided favorable psychological
conditions for the patients to feel, reflect upon and accept the
personal implications of a sober lifestyle. Moreover, after KPT
the patients reported a sensation of “catharsis” and
“resolution” of a whole series of psychological problems,
especially those associated with alcohol dependence (Patient V.S.:
“What has accumulated in me, that is, everything associated
with drinking, burst out of my consciousness, my soul. I feel relieved.
. . .”). The reflection upon and processing of patients'
psychedelic experiences is undoubtedly an important mechanism in
preventing relapse and in forming and solidifying attitudes and
behaviors conducive to sobriety.
It is of interest to note that a content analysis of the written
self-reports of 108 male alcoholic patients whose personality characteristics
were defined by the Minnesota Multiphasic Personality Inventory
(MMPI), adapted in Russian (Sobchik 1990), demonstrated a number
of statistically significant correlations between some MMPI scales
assessed before KPT and the content of the psychedelic experience
described in self-reports. For example, the scores of the hypochondria
scale (Hs) were significantly correlated with such characteristics
of patients' self-reports as “feeling of separation of consciousness
from the body,” “fear,” “rapid movement
in labyrinths,” “memories about friends,” “positive
attitude to the psychotherapist,” “feeling of flight,”
etc. The scores of the psychopathic deviation scale (Pd) were significantly
correlated with such characteristics of self-reports as “feeling
of separation of consciousness from the body,” “curiosity,”
“depersonalization experience” (losing ego), “cosmic
experiences,” etc. The scale of hypomania (Ma) was significantly
correlated with 14 characteristics of patient self-reports, psychopathic
deviation scale (Pd) with 10 characteristics, hypochondria (Hs)
with eight, depression scale (D) with six, hysteria scale (Hy)
with five, social introversion scale (Si) with five, masculinity
scale (Mf-m) with three, schizophrenia scale (Sc) with three, psychastenia
scale (Pt) with three, and paranoia scale (Pa) with one. Thus,
one may conclude that the ketamine psychedelic experiences were
to a certain extent determined by the personality characteristics
of the patients.
In addition, the relationship between the content of the ketamine
session experiences and the MMPI profile changes caused by KPT was
examined and statistically significant correlations were found,
suggesting that the content of the ketamine session experiences
to a certain extent determined the personality changes caused by
The correlation between the intensity of the negative experiences
during the ketamine session and the length of remission was also
studied. The “negative experiences” were considered
to be the experiences associated with fear, horror, anxiety and
other negative emotions (which often involved alcohol-related themes
in the plot of the hallucinations). The intensity of the negative
experiences was assessed quantitatively (from a score of 0 for
no negative experiences, to 3 for severe negative experiences),
according to the data of the patients' self-reports, by a specially
trained psychologist who did not participate in the treatment procedure.
It was found that the more negative experiences during the ketamine
session, the longer remission was observed (correlation coefficient5.1,p<0.01).
This underscored the importance of addressing the negative aspects
of alcoholism directly at the deep levels of the mind during the
ketamine session. The enhanced recollection of negative effects
may have prevented the psychological defenses of information suppression
in consciousness deemed important in alcoholism (Gaboyev 1989).
In this case, a patient either denies his or her illness, or the
internal representation of his or her disease has no emotional
component to it. Thus, the role of the therapist is to help release
suppressed ideas regarding the disease, which the authors believe
KPT is successful in doing.
Influence of KPT on Personality. All patients in the
experimental group were examined with the MMPI before and after
KPT. Analysis of psychological changes in the experimental group
shown in the MMPI data indicated a dynamic shift in patient MMPI
profiles (see Table 1).
The Influence of KPT on MMPI Personality Profiles
MMPI Filling Time
| MMPI Scales (T-marks)
| Lie (L)
| Validity (F)
| Correction (K)
| Hypochondriasis (Hs)
| Depression (D)
| Conversion hysteria (Hy)
| Psychopathic deviate (Pd)
| Masculinity-femininity male (Mf-m)
| Paranoia (Pa)
| Psychasthenia (Pt)
| Schizophrenia (Sc)
| Hypomania (Ma)
| Social introvertion (Si)
| Iowa manifest anxiety (Taylor) (At)
| Sensitivity-repression (S-R)
| Ego strength (Es)
| Aging (Ag)
| Ego overcontrol (Eo)
| Need for affection (Hy2)
|*Statistical significance of differences between
MMPI marks before and after KPT (Student's t-test = p<0.05).
**Statistica1 significance of differences between MMPI marks
before and after KPT (Student's t-test = p<0.01).
***Statistica1 significance of differences between MMPI marks
before and after KPT (Student's t-test = p<0.001).
After KPT, the indices were decreased for the majority of the
main MMPI scales. The most statistically significant decreases
in the profile were in the scales for hypochondria, depression,
hysteria, psychastenia, schizophrenia, sensitivity-repression,
and in Taylor's scale of anxiety. At the same time, the score in
the ego strength scale increased. On the whole, such favorable
psychological dynamics testify to the fact that the patients became
more sure of themselves, their possibilities and their futures,
less anxious and neurotic and more emotionally open after KPT.
Against the background of these general tendencies, in the majority
of cases some essential individual variations (changes in such
scales as masculinity-femininity, paranoia, hypomania, and sensitivity-repression)
appeared that reflected a certain harmonizing of the patients'
Thirty-seven randomly selected patients treated by KPT were also
examined with Plutchik's Life Style Index (LSI) (Plutchik &
Conte 1989) to assess changes in the structure of psychological
ego defenses. It was established that a decrease in the regression
defense mechanism occurred after KPT (from 28.6±3.1 to 20.6±2.2;
p<0.01). This means that patients became more mature and responsible
for themselves after KPT. Other ego defense mechanisms (suppression,
substitution, etc.) were not significantly changed.
Thirty randomly selected alcoholic patients (age 40.±1.8) treated
with KPT were examined with the Locus of Control Scale (LCS) developed
by J. Rotter (Phares 1976) and adapted in Russia by Bazhin, Golynkina
and Etkind (1993). All patients were assessed with LCS twice: before
and after KPT.
It was established that the locus of control in the personality
of alcoholic patients became significantly more internal after
KPT (from lI.1±4.8 to 30.3±5.3; p<0.01). This means that patients
became more sure about their ability to control and manage different
situations in their lives. They became more responsible for their
lives and futures after KPT. It is important to note that changes
in all of the personality tests (MMPI, LSI and LCS) were in agreement
with each other and that all these changes were very positive and
auspicious for a sober life.
Psychosemantic Changes. We also studied changes in
the psychosemantic domain induced by KPT. The study used the data
from 69 randomly selected alcoholic inpatients treated by KPT (age
37.2±1.04). All patients were examined using the personality differential
(PD) test (Bazhin & Etkind 1983) and the color test of attitudes
(CTA) (Etkind 1980) before treatment and after (the PD is a personality-oriented
version of Osgood's semantic differential — see Osgood, Susi
& Tannenbaum 1957).
Both PD and CTA were organized in such a way that one could
define peculiarities of the alcoholic patients' personality attitude
systems. The combination of PD and CTA allowed, to a certain extent,
assessment of changes of attitude which occurred both at the conscious
(PD) and unconscious (CTA) levels after KPT. Using these tests
allowed analysis of the following spheres of a personality's attitudes:
attitude to oneself, to one's close relatives, to the ideal image
of self, to the psychotherapist and one's own alcoholism, to the
images “me sober,” “me drunk,” “me
in the future,” “a man completely abstaining from alcohol,”
and to “a man who is able to control his drinking.”
In order to conduct the CTA, the patient was first requested
to arrange eight colors of Luscher's test in order of correspondence
(similarity) to each of the above-mentioned images, from the “most
similar, suitable” to the “most different, unsuitable.”
After the first task, the patient was asked to arrange the same
colors in order of preference for the colors themselves, not in
reference to any specific image. Then the order of the two arrangements
was compared to assess quantitatively the patient's attitude toward
the defined images. By comparing the resemblance of these two arrangements
(one regarding the images and one in order of preference) it is
possible to assess the patient's nonverbal/unconscious attitude
towards each of the images. The arrangement of Luscher's eight
colors in order of correspondence (similarity) to each specific
image reflects the patient's emotional perception of that image;
the allotment of the same eight colors in order of preference (from
the most preferable to the least preferable) reflects the patient's
preference for that color (i.e., how much the patient likes these
colors). Thus, a quantitative comparison of these two allotments
(comparing the respective order of colors) demonstrates the patient's
emotional, nonverbal/unconscious attitude to the image.
Analysis of the CTA results (Table 2) revealed that after KPT
significant positive changes occurred in the patients' nonverbal
emotional attitudes toward the psychotherapist, close relatives,
the ideal image of self, and to the image “me sober.”
At the same time, attitudes toward the image “me drunk”
became more negative. According to the PD data, significant positive
changes occurred after KPT only in respect to the attitude of the
patient toward himself (Table 2).
» Click here to open Table 2
After KPT a considerable decrease occurred
in the differences between the specific indices of CTA and those
of PD in respect to the same images (Table 2). This decrease evidenced
a reduction of the difference between the verbal/conscious and
nonverbal/unconscious assessments of personal attitudes. Such reduction
was mainly related to the change in the CTA indices and appeared
to be strongest for the sphere of attitudes to the psychotherapist,
relatives, the image “me sober” and the ideal image of
Thus, KPT produced considerable and significant positive changes
in the domain of patient attitudes, which took place due to the
transformation of nonverbal/unconscious emotional attitudes. KPT
resulted in a decreased level of dissonance between isosemantic
indices as measured by CTA and PD. This could be interpreted as
a reduction of dissonance between verbal/conscious and nonverbal/unconscious
thoughts and feelings regarding alcohol use and personality characteristics
According to the CTA data, strong positive changes occurred in
patients' nonverbal/unconscious assessments of their attitudes
to the psychotherapist, close relatives, to the image “me
sober,” and to the ideal image of self. This means that the
patients had internally grown to accept emotionally these images
and, in turn, the attitudes to sobriety connected with them. Thus,
KPT may be of benefit in the treatment of alcoholism because it
transforms unconscious attitudes, particularly those related to
sobriety. The enhancement of the relationship to the therapist
might also have had a therapeutic effect by improving transference.
A special note should be made of the discrepancies between the
verbal and nonverbal estimates of a patient's personal attitudes
registered before KPT. These discrepancies reflect the presence
of an essential discord between the conscious and unconscious estimates
of the patient's attitudes. This discord reflects a peculiar difference
between the subject's unconscious and conscious mind. This possibly
characterizes the ambivalence of the patient's position and the
disagreement between what is declared at the verbal level and what
takes place at the level of the immediate emotional experience.
Such discord may give rise to psychological discomfort, internal
tension, and difficulties in communication with the environment.
These in turn erode a person's adaptive capacity, which may ultimately
lead to relapse. Therefore, the reduction of discord resulting
from KPT should be considered a development in a patient's psychological
status which favors sobriety. It is important to note that the
reduction of differences in verbal and nonverbal assessments of
the patient's attitudes resulting from KPT (as well as the harmonization
of the MMPI profile resulting from KPT) may be the result of the
awareness (often in some symbolic form) and partial resolution
of important internal conflicts and personality problems that are
connected with alcohol abuse and its consequences. This is confirmed
both by the patients' statements during the psychedelic session
and by their self-reports written after the session. One might
suggest that in so far as the discord between conscious and unconscious
attitudes is decreased, as suggested by PD and CTA scores, internal
conflicts are resolved. This resolution may therefore reduce the
pathological need to drink.
In summary, this research shows that KPT results in a correction
of tile personality of alcoholic patients, that this correction
promotes sobriety, and that processes occurring at the unconscious
level play a considerable role in promoting sobriety.
A study with repertory grids (Kelly matrices) was carried out with
10 randomly selected alcoholic patients treated with KPT. The repertory
grid technique allowed assessment of subtle changes in a patient's
self-concept (self-identification) caused by KPT. The technique
of “assessment repertory grids” or Kelly matrices (Fransella
& Bannister 1977) was employed for this purpose. The grids
were arranged so that their 11 elements were replaced by various
aspects of the patient's ego as well as other persons significant
to the patient, such as “me in the present,” “me
in the past,” “me in the future,” “ideal image
of self.” “wife,” “mother,” “father,”
“recovering alcoholic,” “drunkard,” “psychotherapist,”
and “a man who is well-adjusted.” For the constructs,
12 pairs of categories (construct poles) were preset to describe
characteristics of the patient's personality and value orientations
such as “responsible-irresponsible,” “self-controlled-impulsive,”
“self-confident-lacking in self-confidence,” and so on
for “independent,” “striving for health,” “striving
for high living standards,” “striving for social recognition,”
“striving for self-perfection,” “striving for family
life,” and “wise.” Two techniques for filling the
repertory grids were used. In the first (conventional) one, the
patient placed each of the elements at a certain point on the calibrated
scales preset by the construct poles (assessed each element with
all construct scales). The second technique was specially developed
by the authors' to measure changes in nonverbal (and in this sense,
less reflexive) psychosemantics. This involved the following procedures:
first, the patient arranged eight colors of the Luscher test in
the order of correspondence (similarity) to each of the grid elements,
from the most similar, suitable color to the most different, unsuitable
one. Then, the patient arranged the same colors in the order of
correspondence to the poles of each of the constructs. Comparing
the positions of the colors in the two arrangements, by the correspondence
to a certain element and by the correspondence to the poles of
a certain construct, the authors quantitatively estimated the closeness
of this element to the poles of the given construct. The more similar
the order of the eight colors in the two allotments, the closer
the element to one of the construct poles. For example, when arranging
eight colors according to similarity (correspondence) to the element
“me in the future,” one patient may choose the first
color to be green, the second yellow and so on until the seventh
and eighth are gray and black. For the construct “active-passive,”
the same patient may locate yellow closest to active, then green
and so on with black and then gray being closest to passive. It
is then possible to compare quantitatively the similarity of these
two allotments. By this method an element can be located between
the poles of a given construct. For the hypothetical patient mentioned
above, the element “me in the future” is clearly closer
to active than to passive.
The second (color) technique allowed us to obtain nonverbal (and,
to a considerable extent, unconscious emotional) estimates of the
elements in terms of the categories of given constructs. All 10
alcoholic patients were tested with verbal and color repertory
grids before and after KPT. Then mean verbal repertory grid (MVRG)
and mean color (nonverbal) repertory grid (MCRG) were calculated
for all 10 patients together. Finally, four MVRG and MCRG (two
before KPT and two after) were processed by the standard programs
of repertory grid computer-assisted analysis (Fransella & Bannister
1977), and then semantic spaces of the personality (spatial representation
of a semantic personality structure) were constructed (Figures
1 and 2). The semantic space of the personality (constructed on
the basis of multidimensional assessments of elements with constructs)
shows semantic interrelationships and interconnections between
elements and/or constructs of the repertory grid.
» Click here to open Figure 1
The results of this study (see Figure 1) demonstrated positive
changes in the semantic space of the personality of alcoholic patients,
particularly in the space of personality characteristics of the
color repertory grids. The image “me now” was close
to the image “drunkard” and far from the group of such
positive images as “recovering alcoholic,” “ideal
image of self,” “wife,” “a man who is well
adjusted” and others in the semantic space of the MCRG before
KPT. After KPT the image “me now” became close to the
group of positive images described above and far from the image
“drunkard” in the space of MCRG. At the same time,
the image “drunkard” became closer to the image “me
in the past.” These data show that alcoholic patients emotionally
perceived (identified) themselves as drunkards before KPT. After
KPT their emotional perception of themselves had changed: they
emotionally identified themselves with “recovering alcoholic”
and other positive images in the semantic space of personality
characteristics and value orientations, and identified themselves
as drunkards only in the past.
The changes in the verbal repertory grids were not as significant
as those in the color repertory grids (Figure 2). Only the image
“drunkard” became a little bit more distant from the
group of positive images and closer to the image “me in the
past.” It is interesting to note that patients already identified
themselves with the positive images at the level of verbal self-identification
in the semantic space of personality characteristics and value
orientations before KPT, whereas they identified themselves in
the same way at the level of nonverbal/unconscious (mostly emotional)
perception only after KPT. That means, first, that KPT created
a profound nonverbal self-concept associated with sobriety, and
second, that KPT brought about a correspondence of verbal/conscious
and nonverbal/unconscious perceptions of the self and the world.
here to open Figure 2
These data demonstrate that KPT positively transformed mostly
the nonverbal (unconscious, mainly emotional) perceptions by alcoholic
patients of their individual selves. Thus, it is possible to conclude
that KPT positively transformed primarily the emotional self-identification
(self-concept) of alcoholic patients.
Effect on Life Values. All 30 patients assessed with
LCS were also examined with the Questionnaire of Terminal Life
Values (QTLV) developed by Senin (1991) and based on Rokeach's
approach to human values and beliefs (Rokeach 1973, 1972). Patients
were examined with QTLV twice: before and after KPT.
» Click here to open Table 3
This study demonstrated a number of significant positive changes
in patients' values as a result of KPT (Table 3). KPT enhanced
the importance of the life values of creativity, self-perfection,
spiritual contentment, social recognition, achievement of life
purposes and individual independence. These changes were mostly
expressed in such areas of life values actualization as family,
education and social life (Table 3). It is evident that such a
positive transformation of patients' life values system brings
about an enhanced motivation for a sober life and favors sobriety.
Effect on Understanding the Meaning and Purpose of One's Own
Life. Ten randomly selected alcoholic patients (age 41.l±2.4)
were studied before and after KPT with the Purpose-in-Life Test
(PLT) elaborated by Crumbaugh (1968) and based on Frankl's (1978)
concept of the individual's aspiration for meaning in life. The
PLT was adapted in Russia by Leontiev (1992) in the Department
of Psychology of Moscow State University. This study has shown
that KPT in alcoholic patients causes a significant increase in
the index measuring the understanding of the meaning of life (from
89.7±5.7 to 115.3±3.2; p<0.01). Before KPT, the
index for the understanding of the meaning of life was below the
average normal level. After KPT, it was higher than that level.
These changes mean that after KPT patients were better able to
understand the meaning of their lives, their life purposes and
perspectives. After KPT, their lives became more interesting, emotionally
deeper and filled with meaning. They felt themselves better able
to live in accordance with their concept of the meaning of life
and life purposes as a result of KPT. Such changes favor sober
life, particularly from the standpoint of Frankl's approach, which
considers alcoholism as an “existential neurosis,” consequent
to losing the meaning of life and the appearance of a specific
“existential void” (Frankl 1978), which we believe KPT
is able to fill in at least to some extent.
Effect on Spirituality. The influence of a profound
mystical (transformative) experience during KPT on the level of
spiritual development was studied. For the assessment of changes
in spirituality, the authors developed a Spirituality Scale based
on the combination of the Spirituality Self-Assessment Scale developed
by Charles Whitfield, who studied the importance of spirituality
in alcoholism therapy in Alcoholics Anonymous (Whitfield 1984),
and the Life Changes Inventory developed by Ken Ring to estimate
changes in values and purposes of life produced by near-death experiences
(Ring 1984). Three randomly selected groups of people were assessed
with this Spirituality Scale: (1) 25 alcoholic patients before
and after KPT (average age 37.8±1.3); (2) 21 alcoholic patients
before and after a 15-day course of autogenic training, a technique
of deep relaxation and self-hypnosis (average age 40.9 ±.7);
(3) 35 healthy volunteers before and after a four-month course
of studying meditation (average age 37.9±1.6).
The Spirituality Scale demonstrated that the increase in the level
of spiritual development of alcoholic patients who had undergone
KPT was comparable with the increase induced in healthy volunteers
by a special course of meditation, and was much greater than the
changes in spiritual development induced in alcoholics by a training
program of relaxation techniques and self-hypnosis (Table 4). The
increased spiritual development induced by KPT in alcoholic patients
may be very favorable for sobriety. Moreover, the results of the
study of KPT’s influence on spirituality indicate that KPT
does much more than simply create an attitude to a sober life.
These results suggest that KPT brings about profound positive changes
in life values and purposes, in attitudes to the different aspects
of life and death, and, in turn, in the alcoholics' world views.
The Influence of KPT on Spirituality
(in Comparison with Other Influences)
According to the Spirituality Scale Meditation
Autogenic Training (Self-Hypnosis) Group
| The number of answers testifying to: spiritual growth
| the absence of spiritual growth
Many reports suggest that religious or spiritual conversion
is an important factor in “spontaneous” recovery from
drug abuse. Indeed, Alcoholics Anonymous programs have a distinctly
spiritual/religious orientation (Grof 1990; Corrington 1989; Whitfield
1984). A therapy that enhances the likelihood of a conversion experience
therefore might have utility in the treatment of substance abuse.
Psychedelic-assisted psychotherapy may represent one method of
eliciting religious or spiritual experiences in patients with chemical
The enhanced spirituality in patients after KPT may be an important
element of its therapeutic action. Many patients who had never
thought about spirituality or the meaning of life reported having
profound religious transformative experiences. During the ketamine
session, people often experienced the separation of consciousness
from the body and the dissolving of the ego. For many patients,
it was a profound insight to think that they could exist without
their bodies as pure consciousness or pure spirit. Some of them
said that as a result of their experience, they understood the
Christian notion of the separation of soul and body. Some people
reported contact with God. After coming back to ordinary consciousness,
they felt sure that they had contact with a higher power. Many
patients reported the existence of other dimensions or other worlds
that are parallel to ours and seem as real as or even more real
than our own. Some patients experienced the expansion of consciousness
to encompass the whole universe, whole cosmos, etc. They often
said: “I ceased to exist, I disappeared, yet still just my
consciousness existed. It was like I became the whole universe
or the whole cosmos” (see Appendix I).
It seems ironic that so many of these patients, through their experiences,
were converted to a more spiritual approach to life, despite living
in a country where people have been brought up for generations
with atheism. The authors believe that these positive clinical
results in maintaining sobriety were not achieved simply because
they were more successful in establishing a motivation for sobriety
and a deeper negative attitude to alcohol but also because of changes
in the values, relationships, and world view of these patients.
Patients began to see other purposes, other values, other meaning
and pleasures in their lives, and this was an important reason
for their sobriety.
The changes in the results from the battery of psychological tests
show that the patients grew more self-confident, surer in their
abilities and their futures, less anxious and neurotic, more balanced,
emotionally open and self-sufficient, and more responsible for
their lives and futures. A transformation of patients' emotional
attitudes, a decrease in the level of inner discord, anxiety, internal
tension, discomfort, and emotional isolation, and an improved self-assessment
and the appearance of a tendency to overcome the passive aspects
of their personalities were all observed. A positive transformation
of the patients' system of life values and meaning and even changes
in world view were also noted. All these changes favor sober life.
In conclusion, the authors believe that the efficacy of KPT can
be interpreted from psychodynamic, hypnotherapeutic/suggestive
and spiritual perspectives.
Underlying Biochemical Mechanisms
Biochemical investigations of the underlying mechanisms of KPT
were also carried out. Blood was taken from 21 randomly selected
male alcoholic patients a day before the KPT and during the ketamine
session. Dopamine, GABA and serotonin concentrations in blood,
monoamine oxidase type A (MAO-A) activities in blood serum and
MAO type B (MAO-B) in blood platelets, ceruloplasmin activity and
B-endorphin content were determined. The dopamine concentration
was determined by Kogan's method (Kogan & Netchayev 1979);
GABA by the method of Sutton and Simmonds (1974); serotonin by
the method of Laboda and Makarov (Kolb & Kamyshnikov 1976);
MAO-A activity was determined by the method of Stroyev and Gusak
(1983): and ceruloplasmin activity by Moshkov's method (Moshkov
et al. 1986). Blood platelets were extracted by the usual method
(Baluda et a1. 1980) and then MAO-B activity with benzylamine as
substrate was determined (Voloshina & Moskvitina 1985). B-endorphin
levels in blood serum were determined by radioimmunoassay (Ayrapetov
et al. 1985).
The results of the biochemical investigations (Table 5) show that
during the ketamine session a real decrease in, the activity of
MAO-A in blood serum and MAO-B in blood platelets occurred, and
there were increased dopamine levels in the blood. Serotonin and
GABA concentrations were not altered significantly. Increase of
ceruloplasmin activity was statistically significant and the B-endorphin
level increased during the KPT session (Krupitsky et al. 1990).
These changes in the metabolism of neurotransmitters allow some
opinions to be formed about the underlying neurochemical mechanisms
of ketamine's psychedelic action (Krupitsky et al. 1990). For example,
an increase of ceruloplasmin activity causes a corresponding increase
in the conversion of monoamines into adrenochromes, which have
hallucinogenic activity (Nalbandyan 1986; Anokhina 1975). This
particularly takes place under the conditions of inhibited MAO
activity and increased dopamine levels. This is of interest because
such conditions are typical for the action of many hallucinogens
(Hamox 1984; McKenney, Towers & Abbots 1984).
The fact that the pharmacological action of KPT affected both monoaminergic
and opioidergic systems, i.e., those neurochemical brain systems
which are involved in the development (pathogenesis) of alcohol
dependence, is an important result of this biochemical investigation;
it is possible that this action contributes to the efficacy of
» Click here to open Table 5
Underlying Neurophysiological Mechanisms
Another component of the authors' research was EEG computer-assisted
analysis of the underlying mechanisms of KPT for alcoholism. EEG
recordings were taken of seven randomly selected male alcoholic
patients (average age 35.0±4.4) before, during and after the ketamine
session by placing 16 electrodes according to the international
10/20% scheme. Ear electrodes were used as the reference. After
analog-digital conversion, standard programs of computerassisted
spectral EEG analysis (fast Fourier transformation) and topographic
mapping of EEG (EEG topography) were employed. According to the
data of EEG computer-assisted analysis, it was discovered that
ketamine increases delta activity (1.5-2X) and particularly theta-activity
(3-4X) in all regions of the cerebral cortex (Table 6 and Figure
3). This is evidence of limbic system activation during the ketamine
session as well as evidence of the reinforcement of the limbic
cortex interaction (Pribram 1971). These findings can also be considered
to a certain extent as indirect evidence of the strengthening of
the interactions between the conscious and unconscious levels of
the mind during the KPT (Simonov 1987).
» Click here to open Table 6
There is also a substantial body of evidence demonstrating that ketamine's major underlying mechanism of action on the brain is the blockade of the N-methyl-D-asparate (NMDA) receptors, which are mostly located in the cortex and hippocampus and are involved in processes of integration and transmission into the cortex of incoming signals from all sensory modalities (Krystal et al) 1994; Oye, Paulsen & Maurset 1992). Thus a significant reduction of sensory transmission and activation of autonomous cortex-limbic interactions may be important underlying mechanisms of the psychedelic action of ketamine.
» Click here to open Figure 4
There are also some data that indicate that the interaction
between the frontal cortex and the limbic system are particularly
important for the action of ketamine on the brain. For example,
it has been demonstrated in positron emission tomography (PET)
studies that ketamine results in a specific hyperfrontal metabolic
pattern in the human brain, associated with psychedelic experiences
(hallucinations and ego-dissolution) (Vollenweider et at. 1994).
Also, frontal lobotomy reduces the psychedelic response to phencyclidin
(which is very similar to ketamine) in schizophrenic patients (Itil
et al. 1967). Ketamine activates the interaction between brain
structures associated with cognitive processing of information
(frontal cortex) and structures involved in the processes of emotions,
motivations, memory, and subconscious experiences and perceptions
(limbic structures). Such enhanced interaction may be an important
neurophysiological mechanism underlying the phenomenology of ketamine
psychedelic experiences and the dramatic psychological changes
caused by those experiences.
KPT turned out to be effective for the treatment of personality
disorders in alcoholic patients (Ivanov et al. 1995). Sixty-four
alcoholic patients with different personality disorders (avoidant,
N=20; histrionic, N=21; borderline, N=23) were treated with KPT.
Data of clinical (Bekhterev Psychoneurological Research Institute
rating scales) and psychological studies (MMPI, Spielberger State-Trait
Anxiety Scale, and Timothy Leary Test of Interpersonal Relationships)
showed the differential efficacy of ketamine psychedelic psychotherapy
in distinct groups of patients. KPT turned out to be very effective
in patients with avoidant personality disorders, less effective
in patients with histrionic personality disorders and minimally
effective in patients with borderline personality disorders. It
should be noted that KPT positively influenced the personality
characteristics assessed by MMPI in all groups of alcoholic patients
with personality disorders (Figure 4).
The potential of KPT is not restricted to the treatment of addiction.
According to data from the authors' pilot study (20 patients, seven
male and 13 female), KPT is also quite effective in treating neurotic
disorders. This research has demonstrated that the efficacy of
KPT differed witl1 various forms of neuroses: KPT turned out to
be most effective in treating neurotic (reactive) depression and
posttraumatic stress disorders, and least effective in treating
obsessive/compulsive and phobic neuroses. Hysterical neurosis appeared
to be most resistant to KPT.
Psychosemantic Fields of Patients with Neurotic Disorders
The authors carried out special research into the influence of
KPT on the psychosemantic fields of 14 patients with neurotic disorders.
Employed for this purpose was the technique of “assessment
repertory grids” (Kelly matrices) (Fransella & Bannister
1977) as previously described but with substitutions of elements
and constructs in the grids relevant to neurotics rather than alcoholics.
All 14 neurotic patients were tested with verbal and color repertory
grids before and after KPT. Then mean verbal repertory grid (MVRG)
and mean color (nonverbal) repertory grid (MCRG) were calculated
for all 14 patients together. Finally, four MVRG and MCRG (two
before KPT and two after) were processed by the standard programs
of repertory grid computer-assisted analysis (Fransella & Bannister
1997), and then semantic spaces of the personality were constructed
(Figures 5 and 6).
» Click here to open Figure 5
The results of this research demonstrated that after
KPT, the neurotic patients showed, in general, positive changes
in the estimates of their individual selves. These changes concern
both verbal and nonverbal estimates and suggest a reduction of
neurotic symptoms (Figures 5 and 6). For example, before KPT in
the semantic space of MCRG the image “me now” was far
from the images “ideal image of self,” “me in the
past,” “me in the future,” and “healthy man,”
and close to the “neurotic patient” (Figure 5). At the
same time such images as “ideal image of self,” “me
in the past,” and “healthy man,” were close to each
other. This means that patients before KPT felt they were healthy
in the past, not in the present. After KPT, the semantic space
of the MCRG image “me in the past,” was close to the
image “neurotic patient,” and these two images were far
from the group of images “ideal image of self,” “me
in the future,” “me now,” and “healthy man”
(the last four images were close to each other). Patients after
KPT felt they were neurotic in the past, are healthy now and will
be healthy in the future. Similar positive tendencies took place
in MVRG after KPT (Figure 6).
These data are evidence of significant positive changes after KPT
both in verbal/conscious and nonverbal/unconscious (mostly emotional)
perception by neurotic patients of their individual selves. It
is possible to conclude that KPT positively transformed the self-concept
of neurotic patients both at the level of verbal reflection and
» Click here to open Figure 6
APPENDIX 1: PATIENT SELF-REPORTS
The process by which therapeutic interventions during the KPT session
induce therapeutic attitudes can best be illustrated by several
self-reports from patients describing and interpreting their experiences.
These self-reports were written down by the patients the day after
the ketamine session, and then were discussed during the final
group session, several days after the patients'
Patient P.Kh.: “I found myself inside
a gigantic tunnel whose mouth reached a terrifying
height, and there, on the top, was nothing. . . . A red
capsule spiraled rapidly to the top along the surface of the tunnel.
And I was in this capsule — or even this capsule was myself and
it was me who was rushing towards nothing. But at the same time,
I regarded myself in a detached spirit, as if I were split apart.
. . . Abruptly, I found myself on the top of the tunnel. What I
saw made me shudder with horror. A horrible, dark and cold abyss
gaped in front of me. It was as if I were in an open space, infinite
and impossible to perceive. Each cell of my body felt the horror
of this abyss. One more turn and I would find myself in this obscurity
and drop and drop endlessly. . . . Even after the procedure, when
I remembered this, it made me feel uneasy. . . . But there was
no other turn. Everything got mixed up, went round, and this whirl
took me upward. . . . I felt that I was rushing at a high speed
along some glass tunnel; through the glass I could see somebody's
face and somebody asked me if I would drink. I answered that no,
I wouldn't. . . . I came to understand that this gaping abyss where
I would be completely alone would be my fate, if I would not give
Patient A.S.: “Sticky masses began to attack my body, to melt
it. Fear invaded me. Everything around was in a whirl. One thing
overlapped another. I felt the odor of alcohol. I felt excruciating
aversion, fear, presentiment of death. Bright objects replaced
one another at a crazy speed, everything went round, and I went
round, too. It seemed to me that I would never get out of this
nightmare; that I was slowly and painfully dying; that I, my entire
self, would melt in this black mass, but my brain would go on working.
That I would feel, think, not live, but suffer. .. . Some voice
was talking about alcohol; I felt a strong aversion. . . . Everything
I saw resulted from my hopeless life, my alcoholism. It was as
if the trash accumulated in me during years and years went out
of me during an hour. I do not want it to repeat; I am afraid of
this nightmare. . . . I would never forget it . . . . ”
Often the negative experiences and visions induced by KPT were
immediately associated with alcohol.
Patient V.Z.: I lost myself. I felt bewilderment because I lost
myself, my body. Then it was death. Death, a calm flight down-ward
through dense gray-and-white clouds. And suddenly rebirth. At somebody's
command I saw a series of terrifying pictures on a red background.
They moved horizontally, picture by picture, independently of each
other. They depicted the sad scenes of the alcoholic life. Filth,
broken bottles, corpses, horrible faces, drunk grimaces. It was
absolutely clear that this would be my future, the future of people
like me (if we did not give up drinking). The desire to tell everybody
as soon as possible where this would lead us was also horrible
to feel. Fast movement by some strange vehicle, a kind of train.
And here the disgusting smell of alcohol, then the oath of sobriety.
Dissatisfaction. As if everything should be done some other way.
People must know about my oath and hear it. . . .
A piece of cotton moistened in alcohol always induced in patients
pronounced negative experiences and strong aversions. Patient G.G.: “...Everything around me started rotating. I felt weightless and
cold. I heard the doctor's voice: 'Your fear is a result of vodka.
It is vodka that has led you to the edge of the abyss.' And I felt
the disgusting odor of vodka that constantly accompanied the whole
procedure....” Patient A.K.: “I got to feel the smell
of vodka. The aversion was so strong that it would be impossible
to describe it. . . . ” Patient D.F: “When I was allowed
to smell a piece of cotton moistened in alcohol. . . . I felt a
fear for myself, my future, children. I felt I would go crazy or
die of vodka. . . . ”
Often, the hallucinatory experiences of the patients concerned
their relatives, their wives and children. Patient S.L.: “Then
I was asked several times: 'Your daughter’s name is Inna?
Do you love her?' Then my daughter and I started flying over whitish-green
rocks. There were strange creatures all around us. They were dreadful,
vague. Again I was allowed to smell and taste vodka. My body fell
to pieces; one of its parts flew with my daughter and the creatures.
So, I lost my daughter and found myself in blood. I was choking;
spitting the blood out. Again I heard the voice; it told me that
it all was due to vodka, that it was me who had let it be so. .
. I would not see my daughter, 1 lost her. . .” Patient
S.Ya., who was afraid of losing his family: “I saw my parents,
wife and children. They didn't approach me, they passed by, paying
no attention to me. . . . ”
The psychedelic experiences often involved the psychotherapist
who tried to help the patient to reach something desirable or get
out of the nightmare. Patient A.K.: “I could see that the
doctor helped me to get out of these flows. . . . Again, thinking
of my family. Certitude that I would find my way to my people if
I gave up drinking. . .” For this reason, the patients attached
great importance to the specific contact with the psychotherapist
established during the procedure. Patient V.G.: “I remember
the beginning of our talk with the doctor, when he asked me not
to lose the contact with him. I've got such a feeling that the
contact was there during the whole procedure and it was positive
and favorable. . . .” Many patients mentioned that the words
of the psychotherapist pronounced during KPT were somewhat unusual,
and were very ponderable and significant. Some words differed from
their usual sound, and induced, a pronounced emotional reaction.
Patient V.K.: “Most of all, 1 was annoyed by the word 'vodka,'
more exactly, two letters 'dk.' A very inconvenient combination,
this 'dk.' And just this combination almost physically tortured
It is of interest that the psychotherapist somehow helped the patients
to go from the horrible visions of their hallucinatory experiences
to clearer and calmer ones. Patient S.L.: “They made me smell
alcohol; it induced aversion. I remember crying: 'I don't want
it, I won't drink.' Then I began to dissolve in time and space;
only my brain remained and it rushed about some narrow labyrinth.
Bright flashes of light, dead ends, whenever you go. I felt a desire,
an urge to get out of this space. . . . Then, something like blackout,
stop, flash, and a door to a new world. . . . In the doorway, I
saw a doctor and somebody else. . . .”
The patients' experiences induced by KPT were not always negative.
Sometimes, they had a positive emotional coloring; moreover, they
were often associated with the sober life. Patient V.Z.: “Fast
flight somewhere downwards. And at once I was going by some vehicle
to a new, rose-colored world. Calm movement; warm, bright yellow
and pink colors. Pleasant feelings, interest, curiosity. It is
probably that sober world where everything is all right, where
there is no room but for smiles, calm movements and the joys of
life.” By the presentation of alcohol and appropriate verbal
influence, the therapist could generally turn such positive emotional
experiences into negative ones.
Patients of higher intellectual level and sensitivity generally
had more vivid, colorful, diverse, and personality-relevant experiences,
which profoundly impressed them. The following are examples of
such patients' reports:
Patient P.F.: “In my whole body music starts playing in synchrony
with the switched-on tape-recorder. I've got an irresistible feeling
of being carried away. I try to resist it with all my forces, but
can't. It's as if a train disappears in the tunnel and you are
flying after it into this black abyss and can't resist it. The
music is deafening; your whole body obeys it. It is as if your
body is pulsating in unison with the music. And you are flying
in pitch-darkness, and at the same time you are hearing the doctor's
voice telling you about aversion to alcohol, about the sober life
and so on. Then, a flash of light. You are always moving and feel
as if you are a ball among other balls rolling along a corridor
lined with similar balls. Always dead ends, turns, flights and
drops; turning into a cube with smoothed edges. The illumination
and color of the corridor where you are rolling also changes. Or
suddenly everything is ruined by a wave, and you are going with
the wave along the corridor. Then, everything bumps into something.
The splash reaches the sky and you become a brilliant white point
flying in space. Then you burst into thousands of splashes, and
again turns, nooks, flights and drops, but always in a rush and
always ahead, ahead. . . . Abruptly, everything starts going round,
becomes a small point. This point turns into a gold hair and the
whole universe turns out to be hanging by it. You see it clearly.
You are feeling the responsibility for everything alive and this
depresses you. Then everything turns into silvery stars forming
a dome, and you are one of the stars. Then the whole dome collapses
and turns into one dot. A gold splash appears against the blue
background. It turns into a flower. The flower opens and there,
in the flower. I see my son, and somebody's voice is saying: 'That
is most important.'”
Patient S.K.: “I felt that my legs did not move, and my body
started stretching and falling down at a crazy speed. My consciousness
concentrated at one point and became a part of the scene. I was
flying to infinity along something like channels that interlaced
and joined one another (everything was brightly colored: orange,
red). Gradually, this crazy dance grew slower. I found myself in
some closed space. At that moment an unconscious fear invaded me.
Fear that I would never get out of this state - the state of being
a part of something and not myself. The space where I was started
filling with a solid foam. I was cornered. At the last moment,
when I saw that I couldn't get away, that the space I occupied
was the only free spot, I heard something splash and felt myself
free. Everything around became understandable (I thought that it
was impossible to live the way I had lived). My family came distinctly
to my mind. . . . Now it was as if my consciousness was over the
things that were under me. Everything below looked like some brown
layers: as if a clot of brown dough scattered in the air and came
down to the earth and covered it all over. It seemed to be my past
life. Again, a strong fear overwhelmed me as I was pulled to this
brown mess. All my self rose against it. I deeply desired to live,
to live as everybody else, and never see this nightmare again.
And my desire won. At this point, I felt as if I opened my eyes
and regained my sight. I saw a window, a green tree and the blue
sky. . . .”
Everything the patient had seen and felt in this case (as in all
other cases) was discussed and interpreted by him with the help
of the psychotherapist in order to work out and solidify the positive
attitude towards a sober life.
Patient V.K.: “As soon as I had been brought to the state
of unconsciousness, I started sliding in a curve of the vertical
plane. The latter was distinct and represented a blue line against
the clearly visible and illuminated background. The thought: somewhere
there is a point which is important for you, which you should not
miss, since it is a matter of life or death. I slid for a quite
a long time, but I never met this point. Abruptly I found myself
in a cave on the top of a high granite rock .... The rock rose
high above the ocean that exactly resembled the thinking ocean
of (Stanislaus) Lem's 'Solaris.' The ocean was brownish-crimson,
swirling, and looked like the upper parts of cumulus clouds, as
seen from an airplane before the sunset. The cave had an entry
which without any reason seemed black. The ocean was several hundred
meters below the cave, and I could distinctly imagine that sooner
or later I would fall down and it would swallow me up. I didn't
feel my body, but in the cave some ellipse-shaped, orange concentrate
of thoughts, my thoughts, was pulsating. The thoughts were: the
universe is infinite in space and time; we are all mortal; the
space, the ocean will always be, but thoughts will die and nonexistence
will come. . . . I felt hopeless and was surprised only at one thing:
why the thought to live persists, to live endlessly. Several scenes
of my life passed before my eyes. They were from my childhood and
youth, everything in sad, reddish-brown colors. Several times the
thought. but not the body, appeared at the exit of the cave and
I could understand that I was about to fall down into the ocean,
but I would not fall down and again would return into the cave.
And again hopelessness and the sense of doom. . . . All this went
on for a very long time. . . . Gradually, I began to come back
to reality. . . . It was not a dream and I didn't want to sleep;
it was simply a desire to lie calmly. I was thinking of my experience
and gloomily analyzing it. I also thought about the questions I
had been asked during the procedure. . . . In my opinion, I had
heard everything, about alcohol, the attitude towards it, its consequences
and about 'the finale' and my feelings. . . . My general condition:
perfect physical state, strangely depressed psychological state
(without any reason), a desire to somehow analyze my past life,
some dull ache at the thought about past years, and some sharpened
homesickness. . . . The attitude towards alcohol or anything similar:
fear, a vague fear of everything that could disturb my distinct
and clear consciousness and return it to something like what I
had previously experienced. Be it some drink or injection or pills,
it made no difference. If only the sober state were not disturbed,
not even a little. . . .”
Many patients, like V.K., stressed that KPT induced in them a pronounced
negative attitude towards everything that could change their state
of consciousness (be it alcohol or something else), and a desire
to maintain this state of clear consciousness, sobriety, serenity
Some reports revealed the fact that, although the patients' experiences
during their ketamine sessions were not immediately associated
with their alcoholism problems, their experiences still catalyzed
some changes in their attitudes towards their ego and the world,
changes that might result in a sober life. For instance, the report
of patient M.B. (courtesy Dr. O.V. Goncharov):
Now I know why both the head and the earth have the form of a ball.
. . . The bends of the cerebral hemispheres look like mountains
and rivers, basins and seas. There, inside me, are the zones of
warmness and coldness, coolness (indifference?) and heat (passion?);
and there are also (as in the cosmos) the zones of exhausted atmosphere.
I felt it physically; I lived through it. I made a voyage around
the world and, at the same time, rolled down the mountains of my
own unconscious. Sometimes you feel at ease, but sometimes spaces
suddenly fall down on you and you risk choking under their weight.
The voyage, it is the insight into your ego; it is when you feel
that you are the universe; it is the impossibility of turning away,
of going away, because all this is you yourself and you are given
nothing else. The voyage is, on the one hand, your confinement
to yourself but, on the other hand, is a step into the cosmos which
is in you yourself, whenever you find it paradoxical. If not the
voyage, I would be always a can swollen with my own emotions, these
aggressors eager to blow you and the whole world up.
During the voyage and especially during the recovery period, I
got the feeling that the world was flexible, plastic, ready to
interact. And it was only up to you what you would build of its
soft materials responding to the glistening flow of your sensations.
The voyage, it is at once a dream and the reality. It is the work
of feelings and intellect. You are astonished at your own mediocrity
and narrow-mindedness and at the cosmos that is also inside you.
You want to become different, spiritually richer, brighter, in
order that your further voyage could bring you new impressions,
could reveal new worlds. You'd like to penetrate further, deeper
into yourself and the universe, to test yourself once again. . . .
Only after the voyage, you begin to discover with surprise that
there are people who “know” everything as it is to be;
you begin to be indulgent to those who will never know, to sympathize
with them. You are learning to distinguish many things and get
surprised at how you could live without this knowledge. . . . After
some time, you are able to quietly enjoy the fact that you are,
though a little, a bit different and that at any moment you can
stop, look inside yourself and recall. . . .”
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