Alcohol Use Disorder affects an estimated 28 million people ages 12 and older in the United States, yet only 7.6 percent of people with past-year AUD received alcohol use treatment in 2024. Even with evidence-based care, return to drinking remains a major challenge. The neurobiological grip of alcohol on the brain’s reward and stress systems is profound, and emerging research has begun to explore whether ketamine’s unique mechanism might offer a new foothold in disrupting the cycle of craving, relapse, and despair that can define severe AUD. At OC Ketamine Therapy in Newport Beach, we want to provide an honest, evidence-grounded overview of what the research currently supports and how we approach this application in our Orange County clinic. (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2026)
Understanding Alcohol Use Disorder
Alcohol Use Disorder is a chronic, relapsing medical condition characterized by compulsive alcohol use despite harmful consequences. The neurobiological changes it produces are profound and multilayered. Chronic heavy alcohol use can dysregulate GABA and glutamate systems—the two primary inhibitory and excitatory neurotransmitter systems in the brain—in ways that create a neurological dependency extending far beyond alcohol’s immediate pharmacological effects. Over time, stress circuits can become hyperactivated, reward circuits can become blunted to natural pleasures, and the prefrontal cortex—the brain’s governor of impulse control, long-term planning, and judgment—can lose some capacity to override the powerful pull of craving. This last point is critical: AUD is not a failure of willpower; it is a condition involving changes in the neural systems that support judgment, impulse control, and long-term planning. (Koob & Volkow, 2016; NIAAA, 2025a)
Standard FDA-approved pharmacological treatments for AUD—naltrexone, acamprosate, and disulfiram—work through distinct mechanisms and can be effective adjuncts to behavioral treatment. Naltrexone blocks opioid receptors involved in alcohol-related reward and can reduce craving; acamprosate may reduce some of the hyperexcitability associated with alcohol withdrawal; and disulfiram produces aversive physical reactions when alcohol is consumed. These medications may be used alongside evidence-based behavioral therapies, including motivational enhancement approaches, cognitive behavioral therapy, and 12-step facilitation. Yet many patients do not respond adequately to available options, and return to drinking remains common. (NIAAA, n.d.)
Why Ketamine Is Being Studied for AUD
The interest in ketamine for AUD emerges from multiple converging lines of evidence. First, ketamine is an NMDA receptor antagonist, and the NMDA glutamate receptor system is centrally implicated in neuroplastic changes associated with addiction. Specifically, the reconsolidation of alcohol-related memories—the neural mechanism by which cue-triggered cravings may be refreshed and strengthened each time they are activated—requires NMDA receptor activity. Ketamine, by blocking NMDA receptors during a memory-reconsolidation window, may disrupt this process and weaken the hold of alcohol-associated cues on behavior.
This is not merely theoretical. A randomized trial conducted by Ravi Das and colleagues at University College London found that ketamine administered following the retrieval of alcohol reward memories reduced alcohol use and craving in hazardous and harmful drinkers compared with ketamine alone or memory retrieval with placebo during follow-up. However, the participants did not have formal AUD diagnoses or seek treatment, so the findings should not be treated as a definitive AUD protocol. (Das et al., 2019)
Second, AUD is associated with high rates of co-occurring depression and anxiety. The co-occurrence is bidirectional: alcohol can worsen mood symptoms, while mood symptoms can increase vulnerability to alcohol use. For patients whose AUD is deeply intertwined with untreated depression or trauma, ketamine’s rapid antidepressant effects may be clinically relevant, but those effects do not establish ketamine as a standard treatment for AUD. (NIAAA, 2025b; Walsh et al., 2022)
Third, chronic alcohol use can compromise prefrontal systems involved in impulse control and future-oriented thinking. Ketamine’s effects on neuroplasticity have prompted interest in whether it could support those systems, but this remains an area of research rather than an established clinical effect in AUD. (Koob & Volkow, 2016; Walsh et al., 2022)
Where the Research Stands
We want to be clear about where this research stands. The UCL trial is compelling, but it represents one important study in a specific population. Small randomized trials involving people with AUD have also explored ketamine alongside motivational enhancement therapy or relapse-prevention-based psychological therapy. The broader evidence base is growing but is not yet at the level of established standard care. (Dakwar et al., 2020; Grabski et al., 2022)
IV ketamine for AUD is an off-label application, and we discuss this honestly with every patient. We do not offer ketamine as a replacement for the evidence-based behavioral treatments and social supports that are the foundation of AUD recovery—we discuss it as a potential neurobiological adjunct that may enhance the effectiveness of those treatments.
Addressing Concerns About Ketamine in Recovery
One barrier we encounter frequently is the concern that a patient in recovery from alcohol—or in the process of reducing use—should not receive a medication with psychoactive or dissociative properties. This concern is understandable and deserves a direct response. Ketamine does have psychoactive and dissociative effects, which is why careful screening and administration in a controlled clinical setting are essential. In the clinical trials for AUD, ketamine was administered in structured treatment settings alongside behavioral therapy rather than as a self-administered substitute for recovery care. (Dakwar et al., 2020; Grabski et al., 2022)
We evaluate each patient individually, with careful attention to psychiatric history, co-occurring conditions, alcohol use history, prior treatment attempts, and goals of care.
The second barrier is the stigma that still attaches to AUD and addiction broadly. Many patients who have been living with severe AUD carry profound shame—about the impact on their families, employment, and health—that makes seeking specialized care feel like one more acknowledgment of failure. We reject this framework entirely. AUD is a medical condition with identifiable neurobiological underpinnings, and the people who struggle with it are not morally deficient. We approach every patient with this understanding. (NIAAA, 2025a)
Our Approach at OC Ketamine Therapy
At OC Ketamine Therapy, a full consultation is required before any ketamine treatment is considered for AUD. This includes a careful psychiatric evaluation, review of medical history, alcohol use history, prior treatment attempts, and goals.
We also screen for medical and psychiatric factors that may affect whether ketamine is appropriate, including whether acute alcohol withdrawal management is needed before treatment decisions are made. Patients must not be in acute alcohol withdrawal when receiving ketamine, as alcohol withdrawal can require medical monitoring and, in some cases, dedicated treatment. (NIAAA, 2025a)
We encourage continued care with addiction medicine specialists and therapists as appropriate. Results vary by individual, and ketamine does not eliminate the underlying vulnerability to AUD. Discuss with your provider whether this treatment is appropriate for you.
Frequently Asked Questions
Is IV ketamine approved to treat alcohol use disorder?
No. IV ketamine is not FDA-approved for AUD or for any substance use disorder. Its consideration for AUD is off-label and based on emerging clinical trial evidence rather than an approved indication. We discuss this distinction clearly in every consultation. (Dakwar et al., 2020; Grabski et al., 2022; NIAAA, n.d.)
What is the research behind ketamine for alcohol cravings?
The most notable study is a randomized trial published by researchers at University College London, which found that ketamine administered following retrieval of alcohol reward memories reduced alcohol use and craving in hazardous and harmful drinkers over follow-up. This work draws on the concept of memory reconsolidation disruption, in which NMDA blockade may weaken the neural encoding of alcohol-related cue memories. (Das et al., 2019)
Can ketamine be given to someone who is currently drinking or in active AUD?
This requires careful evaluation. Patients must not be in acute alcohol withdrawal when receiving ketamine, and we assess medical stability before ketamine is considered. The specific protocol is individualized based on your situation. (NIAAA, 2025a)
Does receiving ketamine mean I do not need addiction counseling or other AUD treatments?
No. Ketamine is not a substitute for behavioral treatment, and we emphasize this strongly. Existing AUD studies have paired ketamine with active psychological work, including motivational enhancement therapy and relapse-prevention-based therapy. Our role is to provide potential neurobiological support for the recovery process, not to replace it. (Dakwar et al., 2020; Grabski et al., 2022)
How does ketamine’s effect on depression relate to AUD treatment?
AUD and depression commonly co-occur, and untreated depression can complicate recovery. Ketamine can have rapid antidepressant effects in depression studies, but that does not establish it as a treatment for AUD. We consider the full clinical picture when discussing whether ketamine may be appropriate. (NIAAA, 2025b; Walsh et al., 2022)
Key Takeaways
- Alcohol Use Disorder affected an estimated 28 million Americans ages 12 and older in 2024, while only 7.6 percent of people with past-year AUD received alcohol use treatment. (NIAAA, 2026)
- Ketamine acts on NMDA receptors and may disrupt the reconsolidation of alcohol reward memories, potentially weakening cue-triggered cravings. (Das et al., 2019)
- IV ketamine for AUD is an off-label application; evidence is promising but not yet at the level of established standard care. (Dakwar et al., 2020; Grabski et al., 2022)
- Ketamine’s rapid antidepressant effects may be relevant for patients with co-occurring depression, but they do not establish ketamine as a standard AUD treatment. (NIAAA, 2025b; Walsh et al., 2022)
- At OC Ketamine Therapy, ketamine for AUD is considered as part of a comprehensive plan that includes psychiatric evaluation and continued behavioral treatment.
Conclusion
Alcohol Use Disorder is one of the conditions we treat with the most respect for its biological complexity and the most awareness of how much judgment surrounds it. If you are in Orange County and are working toward recovery from AUD, or if conventional treatments have not provided the foothold you need, we invite you to explore what the emerging evidence suggests and discuss your specific situation with Dr. Seif. We bring clinical rigor, honesty about what we know and do not know, and genuine investment in your recovery.
About Dr. Dina Seif
Dina Seif, MD, believes that with the right mindset and support, every one of us has the potential to transform and heal our minds. She specializes in creating a personalized plan for each patient and is committed to providing a supportive healing environment for your journey. Dr. Seif is a member of the American Society of Ketamine Physicians and was recognized as a Physician of Excellence by the Orange County Medical Association. Dr. Seif has 15+ years of experience with ketamine in the emergency setting and founded one of the first ketamine practices in Orange County in 2019. She has administered thousands of infusions and cared for hundreds of patients from around the world. Dr. Seif is board-certified in Emergency Medicine and is a graduate of the University of California, Irvine, where she attended college, medical school, and business school. After an internship in Internal Medicine at St. Vincent’s Medical Center in New York, she returned to California for Emergency Medicine residency at LAC+USC Medical Center, where she also completed a fellowship in Emergency Ultrasound and was a Professor of Clinical Emergency Medicine at Keck School of Medicine of USC for five years.
References
Das, R. K., Gale, G., Walsh, K., Hennessy, V. E., Iskandar, G., Mordecai, L. A., Brandner, B., Kindt, M., Curran, H. V., & Kamboj, S. K. (2019). Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories. Nature Communications, 10, 5187. DOI: 10.1038/s41467-019-13162-w
Dakwar, E., Levin, F., Hart, C. L., Basaraba, C., Choi, J., Pavlicova, M., & Nunes, E. V. (2020). A single ketamine infusion combined with motivational enhancement therapy for alcohol use disorder: A randomized midazolam-controlled pilot trial. American Journal of Psychiatry, 177(2), 125–133. DOI: 10.1176/appi.ajp.2019.19070684
Grabski, M., McAndrew, A., Lawn, W., et al. (2022). Adjunctive ketamine with relapse prevention–based psychological therapy in the treatment of alcohol use disorder. American Journal of Psychiatry, 179(2), 152–162. DOI: 10.1176/appi.ajp.2021.21030277
Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760–773. DOI: 10.1016/S2215-0366(16)00104-8
National Institute on Alcohol Abuse and Alcoholism. (2025a, May 8). Alcohol use disorder: From risk to diagnosis to recovery. National Institutes of Health.
National Institute on Alcohol Abuse and Alcoholism. (2025b, May 8). Alcohol use disorder and common co-occurring conditions. National Institutes of Health.
National Institute on Alcohol Abuse and Alcoholism. (2026, March 12). Alcohol treatment in the United States. National Institutes of Health.
National Institute on Alcohol Abuse and Alcoholism. (n.d.). Treatment for alcohol problems: Finding and getting help. National Institutes of Health.
Walsh, Z., Mollaahmetoglu, O. M., Rootman, J., Golsof, S., Keeler, J., Marsh, B., Nutt, D. J., & Morgan, C. J. A. (2022). Ketamine for the treatment of mental health and substance use disorders: Comprehensive systematic review. BJPsych Open, 8(1), e19. DOI: 10.1192/bjo.2021.1061
Medical Disclaimer
The information provided in this blog is for educational purposes only and does not constitute medical advice. Treatment outcomes vary by individual. Results may vary. Please consult with a qualified healthcare provider before beginning any new treatment. Discuss with your provider whether this treatment is appropriate for you.