|Krupitsky E.M., M.D., Ph.D. and Grinenko A.Ya., M.D.,Ph.D.
Research Laboratory, Leningrad Regional Dispensary of Narcology
Novo-Deviatkino 19/1, Leningrad Region, 188661, Russia
A review of the literature suggests that the psychedelic experience may contribute or may
have beneficial effects in the following ways: contributing to the cathartic process,
stabilizing positive psychological changes, enhancing personal growth and selfcognition,
insights into existential problems such as the meaning of self and the world around one,
and increase in creative activities, broadening of spiritual horizons, harmonization of
relationships with the world and other people (Grinspoon and Bakalar, 1979; Krupitsky
and Grinenko, 1992; Strassman, 1995). All these beneficial effects can be very auspicious
for a sober life.
Psychedelic psychotherapy was shown to be a potential benefit for alcoholism treatment
in the "60s", but different methodologies made it difficult to generalize across studies.
The requisite development of appropriate sophistication for these studies was not possible
to do after they were scheduled in 1970 and their use was strictly limited. However, at
about this time, ketamine and ketamine-like anaesthetic agents were being shown to elicit
"psychedelic" emergent phenomena in patients. This property of ketamine was exploited
by our use of ketamine-assisted therapy of alcoholism. Ketamine has some advantages
over other psychedelics as an adjunct to psychotherapy. It is safe and short acting (the
psychoactive effects lasting about an hour). In addition, ketamine is not scheduled like
other psychedelics. In lower doses (about one sixth to one tenth of that usually used in
surgery for a general anaesthesia) it induces profound psychedelic experience.
2.1. First Stage
Three main stages in our method of KPT can be distinguished (Krupitsky et al.,
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 patient
that the removal of their dependence from alcohol will be induced in a special state of
consciousness in which they will have deep experiences that will help them to realize the
negative sides and results of alcohol abuse, and the positive sides of sobriety. Such
realizations and sharp experiences of the negative aspects of alcoholism and the positive
sides of sobriety will cause a subsequent psychological unacceptability of alcohol abuse
and a stable orientation towards sobriety. We also explain to the patients that during the
psychedelic session important insights concerning the meaning and values of their life
and their personality's problems will take place which will be very auspicious for their
new sober life. We tell the patient that they will enter some unusual states of
consciousness and that they may feel detached from their body. We also instruct them to
surrender fully to the experience. At the ketamine sessions, people often experience the
separation of consciousness from the body and the dissolving of the body ego. So, it is
very important to prepare patients curefuly for a such unusual experience.
During this several preparatory psychotherapeutic sessions it is emphasized also that
personally significant mental concepts concerning the negative aspects and consequences
of patient's alcoholism have been forced out of his consciousness into his subconscious.
He is told that during the session these concepts will manifest themselves into his
consciousness in peculiar symbolic forms, in emotionally-saturated visions
(hallucinations). The conscious recognition of these concepts along with the painful
experience of the negative aspects of alcoholism will eventually result in the patient's
psychological rejection of alcohol abuse and the establishment of a stable set of sobriety.
We also try to explain to our patients that the psychedelic session will allow them to see
and sense the subconscious roots of their alcohol problems in colorful symbolic form. By
experiencing these forms, they will come to understand that the alcohol problems of their
life are directly related to deeply rooted personality problems and are often the
consequence of the latter. Moreover, we attempt to explain to the patients that the
psychedelic session may induce important insights concerning the resolution of their
problems and the reorientation of their system of values, their notions of self and the
world around them, and the meaning of their life. All this may entail profound positive
changes in their personality that will undoubtedly be important for their shift to a sober
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 and embroidered with specific concrete content during a
dialogue. The therapist pays close attention to such points as the patient's personal
motives for treatment and sobriety, his goals for his sober life, his idea of the cause of his
disease and its consequences, his suggestions as to what hinders sobriety and what favors
it, and so on. An individually concretized "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 a
specific atmosphere of confidence and mutual understanding between a psychotherapist
and a patient during the first stage of KPT.
2.2. Second stage
The second stage is ketamine session itself. During this procedure aethimisol (1,5% 3ml,
i.m.) is injected into the patient and after this bemegride (0,5% 10ml, i.v.) and then
ketamine (Krupitsky, 1992). We use ketamine doses from 2-3 mg/kg, i.m. We prefer the
intramuscular route because the effect is more gradual, and the psychedelic experience
lasts longer. With an intravenous injection, the effect lasts only about fifteen to twenty
minutes, but after an intramuscular injection, it lasts from about forty-five minutes to an
hour. Bemegride enhances the emotional experiences and visions produced by ketamine
(Krupitsky, 1995), and aethimizol promotes the stable fixing of experiences in long-term
memory (Smirnov and 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 we have 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 their psychedelic experience, because it was shown that calcium
channel antagonists reverse the memory disturbances produced by ketamine in rats (Saha
et al., 1990). In our special study we have also shown that nimodipine improves the
memory about ketamine session (about psychotherapeutic suggestions and psychedelic
experience) (Krupitsky et al., 1995).
With a background of special music, 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 anamnesis (case history) and is directed toward the resolution of the
patient's personality problems and toward the formation of a stable orientation towards
sobriety. We try to create a new meaning and purpose of life in our patients during this
The specific character of our KPT method allows us to carry out a special
psychotherapeutic dialogue with the patient undergoing their psychedelic experience. We
emphasize the positive values and meaning of a sober style of life and the negative
aspects of alcohol abuse during this dialog which has a specific personal orientation for
each patient. It is also very important to direct carefully the patient's psychedelic
experiences by the verbal influences and manipulating with a musical background
towards the simbolic resolution of the personality conflicts and final cathartic peak
Moreover, at certain moments in the psychedelic session (usually at moments of highly
intensive hallucinatory experiences), the patient is given an opportunity to smell alcohol.
The introduction of the smell of alcohol during the session is intended to bring alcohol-
related themes into patient's psychedelic experience and also to enhance the negative
psychedelic experiences, thus forming in the patient a profound aversion towards alcohol,
as well as enhancing the negative emotional coloring of the alcoholic themes in the
patient's psychedelic experience itself. Than it hopefully generalizes to a negative
affective state relating to any themes regarding alcohol.
The second stage of KPT is conducted by wo physicians, a psychotherapist and an
anaesthesiologist, because some complications and side-effects (such as: increased blood
pressure, convulsions, depression of breath) are possible though exceedingly rare. As
with other psychedelics, music also enhances the ketamine experience. So we used to
carry out ketamine session against the background of a special music conducive for
After forty-five 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 period of the session, the patient usually begins to
describe their experience, and we begin some discussion and interpretation. After the
session, the patient goes to rest, and we ask them to write down a detailed self-report of
their experience that evening.
2.3. Third stage
In the third stage, group psychotherapy is carried out with the patients taking KPT the
previous day. During this session the patients discuss and interpret the individual
personal significance of the symbolic content of their psychedelic experience with the
psychotherapist. This discussion is directed toward helping the patient make a correlation
between their psychedelic experience with their personality's problems and with the
problems of their life (first of all connected with alcohol abuse), and thereby to a
realization and solidification of their desire for a new sober life. We are also trying at this
stage to help our patients to accept new attitudes to one's self and the world around them,
new values, and a more spiritual world view produced by the ketamine psychedelic
experience. The uniquely profound and powerful psychedelic experience often helps
them to generate new insights that enable them to integrate new, often unexpected
meanings, values and attitudes about their individual selves and the world. We gather
these patients in a group the day before treatment and the day after, because when they all
share the experience, it is usually more powerful.
111 male alcoholic patients were treated by the KPT method. These patients were chronic
alcoholics who could not control their drinking. Their age ranged from 23 to 56 with an
average age of 36,50,7 years. Their alcohol withdrawal syndrome had been previously
formed for an average of 5.30.5 years. The KPT procedure followed the three-month
treatment course at a psychiatric hospital. These 3 months were a first phase of therapy.
During the first phase of therapy, we treat their alcohol withdrawal syndrome and any
related anxiety or affective disorders and also somatic disorders. Then, we start rational,
cognitive individual and group psychotherapy in order to establish a mental set of
sobriety and a negative attitude toward alcohol. However, we go beyond the problem of
alcohol abuse to explore broader issues including the patient's life history, relationships,
and world view. Later with patients included in the ketamine program, we tell them that
they will undergo a new treatment which will allow them to see and feel the deep
subconscious roots of their problems. We help our patients understand that their alcohol
problem is perhaps only a superficial symptom - the manifestation of more deeply rooted
problems. The patients were all voluntary and gave written consent for the KPT
The control group was composed of 100 male alcoholics who could not control their
drinking. The average age was 38.40.81, and their alcohol withdrawal syndrome had been
previously formed for an average of 6.80.54 years. These patients underwent the same
three-month treatment course at the same hospital, but received only conventional
standard methods of treatment. There were no significant differences between the
experimental and control groups either in the age or in the severity of alcoholism.
To determine the efficiency of the treatment, we collected follow-up information about
all the patients who had taken part in this study a year after their release. According to the
data, abstinence of more than 1 year was observed in 73 out of 111 people (65.8%) who
had undergone the KPT. Thirty people (27.0%) had relapsed. We could not obtain data
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 1
year. Thus, the data from the follow-up study demonstrated that ketamine-assisted
psychedelic therapy increases the efficacy of conventional alcoholism treatment.
Two-year follow-up data had been collected for the 81 patients who had undergone the
KPT (because at the moment of follow-up study only 81 out of 111 patients had two-
years follow-up period after KPT). According to the data, abstinence of more than 2 years
was observed in 33 out of these 81 patients (40,7%). 38 patients (46,9%) had relapsed.
We could not obtain two-years follow-up data on 10 patients (12,4%). Three-years
follow-up data had been collected for the 42 patients who had undergone the KPT.
According to the data, abstinence of more than 3 years was observed in 14 out of these 42
patients (33,3%). 24 patients (57,2%) had relapsed. We could not obtain three-years
follow-up data on 4 patients (9,5%). These two- and three-years follow-up data are also
evidences of the high efficacy of KPT.
Several months after they had been released from the hospital, most of the patients
treated by the KPT stated that it had contributed quite a lot to their sobriety. For instance,
seven months after he was released, patient Ch-ko reported, "the experience related with
the KPT session (very vivid) is imprinted in mind and is a kind of Ôtaboo' on drinking...".
4.1. Psychological Underlying Mechanisms
4.1.1. KPT influence on the personality
All patientes of experimental group were examined with Minnesota Multiphasic
Personality Inventory (MMPI) (adapted in Russia by Sobchik (1990)) before and after
KPT. According to MMPI data, our analysis of psychological changes in the exper
imental group testifies to a definite, rather expressed dynamics in the patient's MMPI
profiles (Table 1). Particularly, after the KPT the indices were decreased for the majority
of the main MMPI scales. The most expressed, statistically significant decrease in the
profile was in the scale "hypochondria", "depression", "hysteria","psychastenia",
"schizophrenia", "sensitivity-repression", and also in Taylor's scale of anxiety. At the
same time, the estimate in the Ego strength scale increased. On the whole, such favorable
psychological dynamics testifies to the fact that the patients became more sure of
themselves, their possibilities, their future, less anxious and neurotic and more
emotionally open after KPT. Against the background of these general tendencies, we saw
in the majority of cases some essential individual variations (e.g. concerning changes in
such scales as "masculinity-femininity", "paranoia", hypomania", "sensitivity-
repression") that reflected, as a rule, a certain harmonization of patient's personality
188.8.131.52. Ego Defence Mechanisms
37 patients of the experimental group were examined also with Plutchik's test "Life
Style Index" (LSI) (Plutchik and Conte, 1989) to assess the changes in the structure of
Ego psychological defences. It was established that there occured a decreasing of the
regression defence mechanism after KPT (from 28,63,1 to 20,62,2; P<0,01). It means
patients got more aged, mature and responsible for themselves after KPT. Other Ego
defence mechanisms (suppression, substitution, etc.) have not been significantly changed.
184.108.40.206. Locus of Control
30 alcoholic patients ( age 40,11,8 ) treated by KPT were examined with Locus of
Control Scale (LCS) developed by J.Rotter ( Phares, 1976 ) and adapted in Russia by
Bazhin et al. (1993). All patients were assessed with LCS twice: before and after KPT.
It was established that locus of control in the personality of alcoholic patients became
significantly more internal after KPT ( from 11,14,8 to 30,35,3; P<0,01 ). It means
patients became more sure about the ability to control and manage different situations of
their life, they got more responsible for their life and future after KPT. It is important to
note that changes of all personality tests (MMPI, LSI and LCS) were in a good agreement
with each other, and all these changes were very positive and auspicious for a sober life.
4.1.2. Psychosemantic Changes
220.127.116.11. A study with Color Test of Attitudes and Personality Differential
We studied also changes in the psychosemantic domain induced by KPT. The study used
the data from 69 alcoholic in-patients treated by KPT in our hospital (age 37,21,04). All
patients were examined by the personality differential test (PD) (Bazhin and Etkind,
1983) (a personality oriented version of Osgood's semantic differential (Osgood et al.,
1957)) and also by the color test of attitudes (CTA) (Etkind, 1980) before the treatment
and after it.
Both PD and CTA were organized in such a way so that one could define peculiarities of
the alcoholic patients' personality attitude systems. The combination of PD and CTA
allowed us to assess to a certain extent changes of attitude which occured both at the
conscious (PD) and subconscious (CTA) levels after KPT. Using these tests for the
above-mentioned purpose allowed us to analyze the following spheres of a personality's
attitudes: the attitude to oneself, to one's close relatives, to the ideal image of self, to a
psychotherapist and one's own alcoholic disease, to the images "Me sober" , "Me drunk",
"Me in the future", "a man completely abstained from alcohol", and to "a man who is
able to control his drinking". CTA was performed in the following way: at first a patient
was requested to arrange 8 colors of Luscher's test in order of correspondence
(similarity) to each of the above-mentioned images. In conclusion, he was requested to
arrange the same colors in order of preference (by the preference degree). After that, to
assess quantitatively the attitude to the definite image the resemblance of order of two
allotments were compared. In the first one the patient arranged 8 colors of Luscher's test
in the order of correspondence to the image: from the "most similar, suitable" to the
"most different, unsuitable"; as for the second allotment (the same for all images) the
patient arranged the same colors in the order of preference. By comparing the
resemblance of these two allotments (one regarding the image and one in order of
preference) it is possible to assess the nonverbal (unrealized) attitude towards each of the
The analysis of the CTA results (Table 2) revealed that after KPT there occurred
significant positive changes in the nonverbal emotional attitude to a psychotherapist,
close relatives, to the ideal image of self, and to the image "Me sober". At the same time,
the attitude to the image "Me drunk" became more negative. According to the PD data,
significant positive changes occurred after KPT only in respect to the attitude toward the
person himself (Table 2).
After KPT there occurred a considerable decrease in differences between the certain
indicies of CTA and that of PD in respect to the same images (Table 2). This decrease
evidenced the reduction of the difference between the verbal (realized) and nonverbal
(unrealized) assessments of personal attitudes. Such reduction was mainly related to the
change in the CTA indices and appeared to be the strongest for the sphere of attitudes to a
psychotherapist, relatives, the image "Me sober" and the ideal image of self.
Thus, the KPT produced considerable and significant positive changes in the domain of
personality attitudes, which took place due to the transformation of nonverbal
(unrealized) emotional attitudes. KPT resulted in a decreased level of dissonance between
isosemantic indices as measured by CTA and PD which could be interpreted as a
reduction of dissonance between verbal /conscious and non-verbal/unconscious thoughts
and feelings regarding alcohol use and personality characteristics and relationships.
One should also underline the fact, that according to the CTA data, there occurred strong
positive changes in patients' nonverbal (unrealized) assessments of the attitudes to a
psychotherapist, close relatives, to the image "Me sober", and to the ideal image of self.
This means that the patient has internally grown to emotionally accept these images and,
in its turn, the attitudes to sobriety connected with them. Thus KPT of alcoholism may be
of benefit by transforming unconscious attitudes particularly those related to sobriety.
Also the enhancement of the relationship to the therapist may have enhanced transference
issues which may also have had a therapeutic effect.
A special note should be made of the discrepancies between the verbal and nonverbal
estimates of a patients' personal attitudes registered before KPT. These discrepancies,
obviously, reflect the presence of an essential discord between the conscious and
unconscious estimates of a personality's attitudes. This discord reflects a peculiar
difference between the subject's unconscious and conscious mind, and 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, to difficulties in the communication with the environment, i.e. to the reduction of
a person's adaptation, which after all leads to the alcoholism relapse. Therefore, the
reduction of such discord due to KPT should be considered as an achievement of a
personality's psychologial status which favors sobriety.
It is important to note that the reduction of differences in verbal and nonverbal
assessments of a personality's attitudes which occurred due to KPT (as well as the
harmonization of MMPI profile owing to the KPT) may be considered to result from the
awareness (often in some symbolic form) and partial resolution of some 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 as far as
the discord between conscious and unconscious attitudes is decreased as suggested by PD
and CTA scores, internal conflicts are resolved. That may therefore reduce the
pathological need to drink.
Thus, this complex psychological research shows that KPT results in a correction of the
personality of alcoholic patients which promotes sobriety. Regarding that correction, the
processes occurring at the unconscious level play a considerable role in it.
18.104.22.168. A study with repertory grids (Kelly matrices)
This study was carried out in 10 alcoholic patients treated with KPT. Repertory grid
technique allowed as to assess subtle changes in patients' self-concept (self-
identification) caused by KPT.
We employed for this purpose the technique of so-called "assessement repertory grids"
(Kelly matrices) ( Fransella and Bannister, 1977 ). The grids were arranged in such a
manner that their 11 elements were replaced by various aspects of the patients "ego"
and other significant persons (such as "Me now (Me at present)", "Me in the past", "Me
in the future", "Ideal image of self", "Wife", "Mother", "Father", "Recovery alcoholic",
"Drunkard", "Psychotherapist", and "A man who gets on in life"). As for the constructs,
12 couples of categories (construct poles) were preset to describe characteristics of the
patient's personality and value orientations (such as "Responsible - Irresponsible", "Self-
controlled - Impulsive", "Strongwilled - Weakling", "Active - Passive", "Self-confident -
Laking in self-confidence", "Independent", "Striving for health", "Striving for high
living standards", "Striving fo social recognition", "Striving for self-perfection",
"Striving for family life", and "Aged"). We employed two techniques of filling the
repertory grids. According to the first (conventional) one, a patient placed each of the
elements at a certain point of the calibrated scales preset by the construct poles
(assessed each element with all construct scales). The second one was specially
developed to measure changes in nonverbal (and in this sense, less reflexive)
psychosemantics. This involved the following procedures: at first, a patient arranged 8
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 colors positions in the two allotments (by the
correspondence to a certain element and by the correspondence to the poles of a certain
construct), we quantitatively estimated the closeness of this element to the poles of the
given construct. The second ("color") technigue allowed us to obtain nonverbal (and to a
considerable extent, unrealized, based on the unawared emotional assessments)
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 KPT
and after it. Then we calculated mean verbal repertory grid (MVRG) and mean color
(nonverbal) repertory grid (MCRG) for all 10 patients together. Final four MVRG and
MCRG (2 before KPT and 2 after KPT) were processed by the standard programs of
repertory grid computer-assisted analysis (Fransella and Bannister, 1977), and then
semantic spaces of the personality were built (Fig.1 and 2). Semantic space of the
personality (built on the basis of multidimentional assessments of elements with
constructs) shows semantic interrelationships and interconnections between elements
and/or constructs of repertory grid.
The results of this study have demonstrated some 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 "Recovery alcoholic",
"Ideal image of self", "Wife", "A man who gets on in life" and others in the semantic
space of the MCRG before KPT (Fig.1A). 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 (Fig.1B). At the same time image "Drunkard" became more close to
the image "Me in the past". These data testify that alcoholic patients emotionally
perceived (identified) themselves as drunkards before KPT. After KPT their emotional
perception of themselves had been changed: they emotionally identified themselves with
recovery alcoholic and other positive images in the semantic space of personality
characteristics and value orientations, and identified themselves as drunkards only in the
The changes in the verbal repertory grids were not so significant as in the color repertory
grids (Fig.2A and 2B). Only image "Drunkard" became a little bit more distant from the
group of positive images and more close to the image "Me in the past". It is interesting to
note that patients identified themselves with the positive images at the level of verbal
self-identification in the semantic space of personality characteristics and value
orientations already before KPT, whereas they identified themselves in the same way at
the level of nonverbal ( unawared, mostly emotional ) perception only after KPT. That
means, first, that KPT creates a profound nonverbal associated with sobriety self-concept,
and second, that KPT brings about the attainment of similarity (resemblance) of verbal
(realized) and nonverbal (unawared) perception by the patients their individual self and
These data testify that KPT positively transformed mostly the nonverbal (unawared,
mainly emotional) perception by alcoholic patients their individual self. Thus, it is
possible to conclude that KPT positively transformed mostly emotional self-identification
(self-concept) of alcoholic patients.
4.1.3. Content Analysis Data
We also carried out content-analysis of psychedelic experiences written down by our
patients after their KPT sessions. These descriptions (see Appendix I) often had common
plots: a violent movement in various types of tunnels and corridors, experience of the
separation of consciousness from the body, a symbolic experience of death and rebirth,
identification with inanimate objects, a fear of an apocalyptic end to the world, a
sensation of losing one's self image, 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 space 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 the awareness of the reality of the other dimensions or worlds no less
real than ours. So ketamine produced diverse experiences ranging from spiritual
enjoyment to fear and even horror (in the same person). All of these experiences were
extremely intense, clear and compelling. Many people reported a difficulty in expressing
their experiences in words.
It should be noted that despite the common topics in patient's experiences themes were
almost always individually specific and reflected in symbolic form the individual's case
history and personality problems (Appendix I). Supported by group psychotherapy
patients were able to interpret more clearly what they had experienced during their
session initially in symbolic form and address the personal psychological problems that
were uncovered during the ketamine session. These particularly had to do with problems
associated with alcohol dependence and the positive prospects for a sober life; that is
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, think over 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 their psychological problems, first of all
associated with alcohol dependence ("...What has accumulated in me, i.e. everyrhing
associated with drinking, burst out of my consciousness, my soul. I feel relieved", patient
V.S.). The reflection upon and processing of their psychedelic experiences 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 from the written self-reports of 108 male
alcoholic patients whose personality characteristics were defined MMPI demonstrated a
number of statistically reliable correlations between some MMPI scales and the content
of the psychedelic experience described in self-reports. For example, the scores of the
hypohondria scale (Hs) were correlated with such characteristics of patients' self-reports
as "feeling of separation of consciousness from the body", "fear", "rapid movement (in
the labyrinths)", "memories about friends", "positive attitude to a psychotherapist",
"feeling of flight",etc. The scores of psychopathic deviation scale (Pd) were 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 correlated with 14 characteristics of
patients self-reports, psychopathic deviation scale (Pd) with 10 characteristics,
hypochondria (Hs) - with 8, depression scale (D) - with 6, hysteria scale (Hy) - with 5,
social introvertion scale (Si) - with 5, musculinity scale (Mf-m) - with 3, schizofrenia
scale (Sc) - with 3, psychastenia scale (Pt) - with 3, and paranoia scale (Pa) - with Thus
one may conclude that the ketamine psychedelic experiences are to a certain extent
determined by the personality characteristics of the patients.
In addition we also have demonstrated the relationship (statistically reliable correlations)
between the content of the ketamine session experiences and the MMPI profile changes
caused by KPT. It means that the content of the ketamine session experiences to a certain
extent determines the personality changes caused by KPT.
We also found that the more negative experiences during the ketamine session the longer
remission was observed. This underscores the importance of the negative aspects of
alcoholism being addressed directly to the deep levels of mind during the ketamine
session. The enhanced recollection of negative effects may prevent the psychological
defences of information suppression in consciousness deemed important in alcoholism
(Gaboyev, 1989). In this case a patient either denies his illness or the internal
representation of his disease has no emotional component to it. Thus the role of the
therapist is to de-suppress ideas regarding the disease, which we believe KPT is
successful in doing.
4.1.4. Effect on Life Values
30 patients assessed with LCS ( see 22.214.171.124 ) were examined also with the
Questionnaire of Terminal Life Values ( QTLV ) developed by Senin (1991) and based
on the Rokeach's approach to the human values and beliefs (Rokeach, 1972, 1973).
Patients were examined with QTLV twice: before and after KPT.
This study has demonstrated a number of significant positive changes in patients' values
as a result of KPT ( Table 3 ). KPT enhansed the importance of such life values as
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 patient's life values system brings about an
enhanced motivation for a sober life and favors sobriety.
4.1.5. Effect on the grasping the meaning of life (purposes in life)
Ten alcoholic patients (age 41,12,4) were studied before and after KPT with the Purpose-
in-Life Test (PLT) elaborated by Crumbaugh (1968) and based on the Frankl's concept of
the man's aspiration for the meaning of life. The PLT was adapted in Russia by Leontiev
(1992) in the Department of Psychology of the Moscow State University. This study has
shown that KPT causes a significant increasing of the index of grasping the meaning of
life in alcoholic patients (from 89,75,7 to 115,33,2; p < 0,01). Before KPT the index of
the grasping the meaning of life was below the average normal level, but after KPT it was
higher than that level.
These changes mean that after KPT patients were able to grasp better the meaning of
their lives, their life purposes and perspectives. The life became more interesting,
emotionally saturated and filled with the meaning for them after KPT. They felt
themselves more able to live in accordance with their concept of the meaning of life and
life purposes as a result of KPT. Such changes favors sober life particularly from the
standpoint of Frankl's approach which considers alcoholism as an "existential neurosis",
as a consequence of losing of the meaning of life and appearing a specific "existential
void" (Frankl, 1978), which KPT we believe is able to fill in at least in some extent.
4.1.6. Effect on Spirituality
We have studied the influence of a profound mystical (transformative) experience during
the KPT on the level of the spiritual development of the alcoholic patients. For the
assessment of the changes of spirituality we used our own special 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 Alcoholic
Anonymous (Whitfield, 1984), and the Life Changes Inventory developed by Ken Ring
to estimate the changes into values and purposes of life produced by near-death
experiences (Ring, 1984). We have investigated three groups of people with our
Spirituality Scale: 1) 25 alcoholic patients before and after KPT (average age 37,81,3);
2) 21 alcoholic patients before and after 15-days course of autogenic training program
(technique of deep relaxation and self-hypnosis) (average age 40,91,7); 3) 35 healthy
volunteers before and after four-month course of studying meditation (average age
37,91,6). It was demonstrated by our Spirituality Scale that the increase in the level of
spiritual development of our alcoholic patients due to KPT was comparable with the
increase induced in healthy volunteers by special course of meditation and was much
greater then the changes in spiritual development induced in alcoholics by a training
program of relaxation technique and selfhypnosis (Table 4). It is evident that the
increased spiritual development induced by KPT in alcoholic patients is very auspicious
for sobriety. Moreover, the results of the study of KPT's influence on spirituality testify
that KPT is much more than simply a creation of an attitude in alcoholic patients toward a
sober life. These results testify that KPT brings about profound positive changes in life
values and purposes, in the attitudes to the different aspects of life and death, and, in its
turn, in the alcoholics' world view. Many reports suggest religious or spiritual conversion
as an important factor in "spontaneous" recovery from drug abuse common and
Alcoholic Anonymous programs have a distinct spiritual/religious orientation (Whitfield,
1984; Corrington, 1989; Grof, 1990). A therapy that enhanced the likelihood for a
conversion type experience therefore might have utility in the treatment of substance
abuse. Psychedelic drug-assisted psychotherapy may represent one method to elicit
religious spiritual experience in patients with chemical dependence.
Thus the enhanced spirituality in patients after KPT might be an important element to the
therapeutic action. Regarding spiritual experiences induced by ketamine, it is interesting
that many people who never thought about spirituality or the meaning of life reported
having profound religious transformative experiences. At the ketamine session, people
often experienced the separation of consciousness from the body and the dissolving of the
body ego. For many patients, it is a profound insight that they can 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 the soul and the
body. Some people reported contact with God, and after coming back to ordinary
consciousness, they feel sure that they have 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 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 our patients, through their own experience, were
converted to a more spiritual approach to life, despite living in a country where people
have been brought up for generations with atheism. We suppose that our positive clinical
results in maintaining sobriety were not achieved simply because we were more
successful in establishing a set of sobriety and a deeper negative attitude toward alcohol,
but rather because of changes in the values, relationships, and world view of these
patients. They began to see other purposes, other values, other meaning and pleasures in
their lives, and this was the main reason for their sobriety. * * * Thus, the changes in the
psychological tests battery show that the patients grew more self-confident, sure in their
abilities and their future, less anxious and neurotic, more balanced, emotionally open and
self-sufficient, more responsible for their life and future.
We observed a transformation of patients' emotional attitudes, a decrease in the level of
self-disharmony, anxiety and internal tension, discomfort, and emotional isolation, along
with an improvement of self-assessment and the appearance of a tendency to overcome
the passive position of their personalities. We observed a certain positive transformation
of the patients' system of life values and meaning and even some world view changes.
All these changes favor sober life.
In conclusion then we believe that the efficacy of KPT can be interpreted from the
psychodynamic, hypnotherapeutic/suggestive and spiritual approaches.
4.2. Biochemical Underlying Mechanisms
We also carried out biochemical investigations of the underlying mechanisms of KPT.
Taking of blood with following determination of 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 -endorphine
content we fulfilled in 21 male alcoholic patients a day before the KPT and during the
ketamine session. The dopamine concentration was determined by Kogan's method
(Kogan and Netchayev, 1979); GABA by the method of Sutton and Simmonds (1974);
seritonin by the method of Loboda and Makarov (Kolb and Kamyshnikov, 1976); MAO-
A activity was determined by method of Stroyev and Gusak (1983); ceruloplasmin
activity by Moshkov's method (Moshkov et al., 1986). Blood platelets were excreted by
the usual method (Baluda et al., 1980) and then MAO-B activity with benzylamine as
substrate was determined (Voloshina and Moskvitina, 1985). -endorphine level in blood
serum was determined with radioimmunoassay (Ayrapetov et al., 1985).
The results of the biochemical investigations (Table 5) have shown that during the
ketamine session there occurred a real decrease in the activity of MAO-A in blood serum
and MAO-B in blood platelets, and also there was increased dopamine level in blood.
Serotonin and GABA concentrations were not altered significantly. Increase of
ceruloplasmin activity was statistically significant and the -endorphine level increased
during the KPT session (Krupitsky et al., 1990).
The changes of the neurotransmitters metabolism have some notable aspects. First, they
allow some opinions about the neurochemical underlying mechanisms of ketamine
psychedelic action to be formed (Krupitsky et al., 1990). For example, an increasing of
ceruloplasmin activity causes a correspondent increasing of conversion of monoamines
into adrenochromes which have hallucinogenic activity. This particularly has to do under
the conditions of the inhibited MAO activity and increased dopamine level. It is of
interest that such conditions are typical for the action of many hallucinogens (Hamox,
1984; McKenney et al., 1984).
Second, the fact that the pharmacological action of KPT effected 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 fact exactly causes to a certain extent the
efficiency of this method.
4.3. Neurophysiological Underlying Mechanisms
Another direction of our research was EEG computer-assisted analysis of the underlying
mechanisms of KPT of alcoholism. We carried out the EEG recording in seven male
alcoholic patients (average age 35,04,4) before, during and after ketamine session placing
16 electrodes according international 10/20% scheme. Ear electrodes were used as the
reference. After analogue-digital conversion standard programs of computer-assisted
spectral EEG analysis (fast Fourier transformation) and topographic mapping of EEG (
EEG topography ) were emploied. According to the data of EEG computer-assisted
analysis we discovered that ketamine increases delta-activity (in 1,5-2 times) and
particularly theta-activity (in 3-4 times) in all regions of the brain cortex (Table 6 and
Fig.3). This is evidence of limbic system activation during ketamine session, as well as
evidence of the reinforcement of the limbic-cortex interaction. This fact can be also
considered to a certain extent as indirect evidence of the strengthening of the interactions
between the conscious and subconscious levels of the mind during the KPT.
|We have been working with KPT since 1985 and have already treated with KPT more
than 1000 alcoholic patients without any complications like protracted psychoses,
flashbacks, agitation, or ketamine abuse. So, KPT seems to be safe and effective method
of treatment of alcohol dependence. It seems to be especially powerful tool in Russia,
where there was no psychedelic revolution in 60s, where almost nobody knows what does
it mean "psychedelics", where almost nobody can even imagine that this drugs can be
used for recreation, for fun, and therefore in Russia KPT looks particularly unusual and
6.1. Clinical observations
Separate our clinical observations suggest that KPT might also be helpful for the
treatment of other drug dependence (heroin, ephedron). In this case we have injected
small doses of ketamine repeatedly which allows for the maintenance of a constant verbal
relationship with the patient. It is important to be careful when applying KPT to drug
addicts. However we believe that KPT might induce in some drug abusing patients these
same psychotherapeutic effects that we have seen in alcoholics.
Ketamine psychedelic therapy turned out to be effective for the treatment of personality
disorders in alcoholic patients (Ivanov et al., 1995). 64 alcoholic patients with different
personality disorders (avoidant - 20 patients, histrionic - 21 patients, and borderline - 23
patients) were treated with KPT. Data of clinical (Bekhterev Psychoneurological
Research Institute rating scales) and psychological (MMPI, Spielberger State-Trait
Anxiety Scale, T. Leary test of interpersonal relationships) studies showed the differential
efficacy of ketamine psychedelic psychotherapy in the different groups of patients. KPT
turned out to be very effective in patients with avoidant personality disorders, less
effective in patients with histronic personality disorders and low effective in patients with
borderline personality disorders. It should be noted that KPT positively influenced on the
personality characteristics assessed by MMPI in all groups of alcoholic patients with
personality disorders (Fig.4).
The potential of ketamine-assisted psychedelic therapy is not restricted to the treatment of
addiction. According to data from our pilot study(20 patients, 7 male and 13 female),
ketamine-assisted psychedelic therapy is also quite effective in treating neurotic
disorders. This research have demonstrated that the efficacy of ketamine psychotherapy
differed with various form of neuroses: psychedelic therapy turned out to be most
effective in treating neurotic (reactive) depression and post-traumatic stress disorders,
and least effective in treating obsessive-compulsive and phobic neuroses. Hysterical
neurosis appeared to be most resistant to psychedelic therapy.
6.2. Psychosemantic Fields of Patients With Neurotic Disorders. A study with repertory
grids (Kelly matrixes).
We carried out special research into the influence of ketamine psychotherapy on the
psychosemantic fields of 14 patients with neurotic disorders. We employed for this
purpose the technique of so-called "assessment repertory grids" (Kelly matrixes)
(Fransella and Bannister, 1977). The grids were arranged in such a manner that their 12
elements were replaced by various aspects of the patients' "ego" and other significant
persons (such as "Me now", "Me in the future", "Me in the past", "Ideal image of self",
"Neurotic patient", "Healthy man", and so on). As for the constructs, 14 couples of
categories (construct poles) were preset to describe characteristics of the patient's
psychological state and traits of character which were significant from the standpoint of
humanistic psychology (such as "A man who is feeling inner tension, anxiety - A man
who is feeling him/herself in a peace and quiet", "A man who is seeing a meaning of
his/her life - A man who suppose his/her life has no meaning at all", "A man who is
feeling him/herself responsible for his/her life - Fatalist", and so on). We employed two
techniques of filling the repertory grids. According to the first (conventional) one, a
patient placed each of the elements at a certain point of the calibrated scales preset by the
construct poles (assessed each element with all construct scales). The second one was
specially developed to measure changes in nonverbal (and in this sense, less reflexive)
psychosemantics. This involved the following procedures: at first, a patient arranged 8
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 colors positions in the two allotments (by the
correspondence to a certain element and by the correspondence to the poles of a certain
construct), we quantitatively estimated the closeness of this element to the poles of the
given construct. The second ("color") technique allowed us to obtain nonverbal (and to a
considerable extent, unrealized, based on the unawared emotional assessments) estimates
of the elements in terms of the categories of given constructs. All 14 neurotic patients
were tested with verbal and color repertory grids before KPT and after it. Then we
calculated mean verbal repertory grid (MVRG) and mean color (nonverbal) repertory
grid (MCRG) for all 14 patients together. Final four MVRG and MCRG (2 before KPT
and 2 after KPT) were processed by the standard programs of repertory grid computer -
assisted analysis (Fransella and Bannister, 1977), and then semantic spaces of the
personality were built (Fig. 5 and 6). Semantic space of the personality (built on the basis
of multidimentional assessments of elements with constructs) shows semantic
interrelationships and interconnections between elements and/or constructs of repertory
The results of this research demonstrated that after ketamine-assisted psychedelic therapy
the neurotic patients showed, as a rule, positive changes in the estimates of their
individual self. These changes concern both verbal and nonverbal estimates and evidence
a certain reduction of neurotic symptoms (Fig.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" (Fig.5A). At the same time such images as "Ideal image of self", "Me in the
past", and "Healthy man" were close to each other. It means that patients before KPT felt
they were healthy in the past, not now. After KPT in 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" (last four images were close to each other) (Fig.5B). It means patients
after KPT felt they were neurotic in the past, and they are healthy now and will be
healthy in a future. Similar positive tendencies took place in MVRG after KPT (Fig.6A
and B). These data are evidences of significant positive changes after KPT both in verbal
(realized) and nonverbal (unawared, mostly emotional) perception by neurotic patients
their individual self. Thus, it is possible to conclude that KPT positively transformed self-
concept of neurotic patients both at the level of verbal reflection and emotional
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 at the day after the ketamine session and then discussed during the final group
session, several days after the patients' ketamine experiences.
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 spiralled 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 asnwered 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 up drinking".
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. 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: "...I lost myself. I felt bewilderment because I lost myself, my body. Then it was
death. Death, a calm flight downward through dense gray-and-white clouds. And
suddenly rebirth. At somebody's command I saw a series of terrifying pictures, 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 everything should be done some other way. People
must know about my oath and hear it..." (patient V.Z.).
A piece of cotton moistened in alcohol always induced in patients pronounced negative
experiences and strong aversions: "...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 G.G.). "...I got to feel the
smell of vodka. The aversion was so strong that it would be impossible to describe it..."
(patient A.K.). "...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. "...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, I lost her..." (patient S.L.). "...I saw
my parents, wife and children. They didn't approach me, they passed by, paying no
attention to me..." (patient S.Ya., who was afraid of losing his family).
The psychedelic experiences often involved the psychotherapist who tried to help the
patient to reach something desirable, get out of the nightmare, etc. "...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..." (patient A.K.). Due to this, the
patients attached great importance to the specific contact with the psychotherapist
established during the procedure: "...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..."
(patient V.G.). Many patients mentioned that the words of the psychotherapist
pronounced during KPT were somewhat particular, and were very ponderable and
significant. Some words differed from their usual sounding, they induced a pronounced
emotional reaction: "...Most of all, I was annoyed by the word "vodka", more exactly,
two letters "dk". A very inconvenient combination, this "dk". And just this combination
almost physically tortured my consciousness" (patient V.K.).
It is of interest that the psychotherapist somehow helped the patients to go from the
horrible visions of their hallucinatory experiences to more clear and calm ones: "...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 black-out, 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.:
"...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" (patient
V.Z.). By the presentation of alcohol and appropriate verbal influence the therapist could,
as a rule, turn such positive emotional experiences into negative ones.
Patients of higher intellectual level and sensitivity had, as a rule, more vivid, colorful,
diverse, and personality-relevant experiences which profoundly impressed them. Here are
some more 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 the 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 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 collapsed 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". Everything the
patient experienced was then interpreted by him (with the help of the therapist) in order
to solidify positive attitudes towards a sober life, family, responsibility for his son and his
bringing up, etc.
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 deply
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
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
point which is important for you, which you should not miss, since it is a matter of life or
death. I slid for quite a long time, but I never met this point. Abruptly, I found myself in
cave on the top of a high granite rock... The rock rose high about the ocean that exactly
resembled the thinking ocean of Lem's "Solyaris". The ocean was brownishcrimson,
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 non-existence 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), a desire to maintain this state of clear consciousness, sobriety, serenity
Some reports revealed the fact that, though the patients' experiences during their
ketamine sessions were not been immediately associated with their alcoholism problems,
their experiences still catalyzed some changes in their attitudes towards their ego and the
world around, 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 (like 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
subconscious. 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 youself 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 youself, 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-mindness and at the cosmos that
is also in 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 youself and the universe, to test youself once again...
Only after the voyage, you begin to discover with surprise that there are people that
"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 you are, though a little, a bit different and that at any moment you can stop,
look inside youself and recall...".
|First of all, we wish to thank the staff of the Research Laboratory of Leningrad Regional
Dispensary of Narcology who took part in our studies during 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 lot to our work. Second,
our deep appreciation goes to the research fellows and physicians of the various scientific
research institutes involved in our studies. We need to thank particularly Drs.
I.Dunaevsky, I.Kungurtsev, O.Luchakova and L.Priputina. Third, we are very thankful to
the Multidisciplinary Association for Psychedelic Studies (MAPS) and to Rick Doblin,
MAPS President, for the assistance and support of the research we were doing.
Ayrapetov, L.N., Zaychik, A.M., Trukchmanov, M.S., Lebedev, V.P., Sorokoumov,
V.A., Katsnelson, Ja.S., Abisogomyan, V.G. and Kodsaev, Ju.K. (1985) Change of the
brain and cerebrospinal fluid-endorphine levels after transcranial electroanalgesia.
Physiol. J. USSR 51, 56-44 (in Russian).
Baluda, B.P., Barkagan, S.S., Goldberg, E.D., Kusnik, B.I. and Lakin, K.M. (1980)
Laboratory Methods for Research in the System of Hemostasis. Tomsk (in Russian).
Bazhin, E.F. and Etkind, A.M. (1983) A Manual for Personality Differential. Leningrad
Bazhin, E.F., Golynkina, E.A. and Etkind, A.M. (1993) Locus of Control Questionnaire.
Smysl, Moscow (in Russian).
Corrington, J.E. (1989) Spirituality and recovery: relationships between levels of
spirituality, contentment and stress during recovery from alcoholism in AA. Alcoholism
Treatment Quarterly 6, 151-165.
Crumbaugh, J.S. (1968) Cross-validation of Purpose-in-Life Test based on Frankl's
concept. J. Individual Psychology 24, 74-81.
Etkind, A.M. (1980) Color test of attitudes and its use in the study of neurotic patients.
In: Social-Psychological Studies in Psychoneurology (Bazhin, E.F., ed.), pp.110-114.
Leningrad Research Psychoneurological Inst., Leningrad (in Russian).
Frankl, V. (1978) The unheared cry for meaning. New York.
Fransella, F. and Bannister, D. (1977) A Manual for Repertory Grid Technique.
Academic Press, London - New York.
Gaboyev, V.N. (1989) Alcoholism anosognosia. S.S.Korsakov's J. Neuropathol.
Psychiatry 89, 98-101 (in Russian).
Grinspoon, L. and Bakalar, J.B. (1979) Psychedelic Drugs Reconsidered. Basic Books,
Grof, Ch. (1990) The impoverished soul: addiction as spiritual emergency. Spiritual
Emergency Network. J. 2, 20-29.
Hamox, M. (1984) Common neurochemical correlates to the action of hallucinogens. In:
Hallucinogens: Neurochemical, Behavioral and Clinical Perspectives, Vol.4, pp.143-169.
Raven Press, New York.
Ivanov, V.B., Krupitsky, E.M., Romanova, T.N., Dunaevsky, I.V. and Grinenko, A.Ya.
(1995) Ketamine psychedelic therapy of personality disorders in alcoholic patients. In:
Abstract Book, 3rd International Conference "AIDS, Cancer and Related Problems",
Kogan, B.M. and Netchayev, N.V. (1979) Sensitive method of analysis of dopamine,
norepinephrine and serotonin in the same sample of the blood. Lab. Delo 5, 301-303 (in
Kolb, V.G. and Kamyshnikov, V.S. (1976) Clinical Biochemistry. Belarus, Minsk (in
Krupitsky, E.M. (1992) Ketamine psychedelic therapy (KPT) of alcoholism and neurosis.
Multidisciplinary Association for Psychedelic Studies Newsletter 3, 24-28.
Krupitsky, E.M. (1995) Ketamine psychedelic therapy (KPT) of alcoholism and neurosis.
In: Yearbook of the European College for the Study of Consciousness (Leuner, H., ed.),
pp.113-121. Verlag Fur Wissenschaft und Bildung, Berlin.
Krupitsky, E.M. and Grinenko, A.Ya. (1992)Psychedelic drugs in psychiatry: past,
present and future. V.M.Bekhterev Review of Psychiatry and Medical Psychology 1, 31-
47 (in Russian).
Krupitsky, E.M., Grinenko, A.Ya., Karandashova, G.F., Berkaliev, T.N., Moshkov, K.A.
and Borodkin, Yu.S. (1990) Metabolism of biogenic amines induced by alcoholism
narcopsychotherapy with ketamine administration. Biogenic Amines 7, 577-582.
Krupitsky, E.M., Grinenko, A.Ya., Berkaliev, T.N., Paley, A.I., Petrov, V.N., Moshkov,
K.A. and Borodkin, Yu.S. (1992). The combination of psychedelic and aversive
approaches in alcoholism treatment: the affective contra-attribution method. Alcoholism
Treatment Quarterly 9, 99-105.
Krupitsky, E.M., Ivanov, V.B., Priputina, L.S., Dunaevsky, I.V., Rzhankova, E.V.,
Puzirev, A.A. and Grinenko, A.Ya. (1995) The influence of the central calcium channel
antagonist nimodipine on the memory about ketamine psychedelic session. In: Abstract
book, 2-nd Russian National Congress "A Man and a Drug", p.302. Moscow, (in
Leontiev, D.A. (1992) Test of the meaning of life orientations. Smisl, Moscow (in
McKenney, T.D., Towers, G.H.W. and Abbots, T.S. (1984) Monoamine oxidase
inhibitors in South American hallucinogenic plants. Part 2: Constituents of orally-active
Myristicaceous hallucinogens. J. Ethnopharmacol. 12, 179-211.
Moshkov, K.A., Burmistrov, S.O., Usatenko, M.S., Grinenko, A.Ya., Petrov, V.N.,
Maslov, V.G. and Borodkin, Yu.S. (1986) Activity and content of ceruloplasmin in
human blood by acute and chronic alcohol intoxication. Pharmacol.Toxicol. 49, 92-96 (in
Osgood, Ch., Susi, C.J. and Tannenbaum, P.M. (1957). The Measurement of Meaning.
Phares, E.J. (1976) Locus of Control in Personality. New York.
Plutchik, R. and Conte, H. (1989) Measurity emotions and their derivatives: personality
traits, Ego defences and coping stiles. In: Contemporary Approaches to Psychological
Assessment, pp.241-269. New York.
Ring, K. (1984) Heading Toward OMEGA. William Morrow and Company, Inc., New
Rokeach, M. (1972) Beliefs, Attitudes and Values. Josey-Bass Co., San Francisco.
Rokeach, M. (1973) The Nature of Human Values. Free Press, New York.
Saha, N., Chigh, Y., Sankaranarayanan, A. and Datta, H. (1990). Interaction of verapamil
and diltiazem with ketamine: effects on memory and sleeping time in mice. Meth. and
Find. Exp. and Clin. Pharmacol. 12, 507-511.
Senin, I.G. (1991) Questionnaire of Terminal Life Values. Yaroslavl (in Russian).
Smirnov, V.M. and Borodkin, Yu.S. (1979) Artificial Stable Functional Connections.
Meditsina, Leningrad (in Russian).
Sobchik, L.N. (1990) Standardized Multiphasic Method of the Research of Personality,
Moscow (in Russian).
Strassman, R. (1995). Hallucinogenic drugs in psychiatric research and treatment:
perspectives and prospects. J.Nervous and Mental Diseases 183, 127-137.
Stroyev, E.A. and Gusak, Yu.K. (1983) Analysis of blood serum monoamine oxidase
activity. Lab. Delo 5, 13-14 (in Russian).
Sutton, J. and Simmonds, H. (1974) Effects of acute and chronic pentobarbitone on the
aminobutiric acid system in rat brain. Biochem Pharmacol. 23, 1801-1808.
Voloshina, O.N. and Moskvitina, T.A. (1985) The method of platelet monoamine oxidase
activity analysis. Lab. Delo 5, 289-291 (in Russian).
Whitfield, C.L. (1984) Stress management and spirituality during recovery: a
transpersonal approach. Part 1: Becoming. Alcoholism Treatment Quarterly 1, 3-54.