Ketamine Rehab

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KEY TAKEAWAYS

Ketamine Rehab provides: 

  • A 7-10-day ketamine detox to safely manage withdrawal symptoms (e.g. abdominal pain)
  • CBT and mindfulness to regulate mood and develop healthy coping skills (e.g. warm bath for relaxation vs ketamine to dissociate)
  • Coordinated care with GPs and urologists to manage depression and ketamine bladder syndrome  
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When Is Ketamine Rehab Necessary?

Using Ketamine For Its Dissociative Effects

Using ketamine for dissociative effects necessitates ketamine rehab because some users consume up to 20g daily (lethal dose = 4.2g for a 70kg human) due to a high tolerance after frequent use (≥4 times per week) and relying on the drug to “escape reality” [1][2][3]:

  • Clinicians administer the Evaluation of Lifetime Stressors (ELS) questionnaire and conduct 1 – 3-hour-long interviews during admission to develop individual treatment plans that address underlying trauma (e.g. sexual abuse) [4] 
  • 90-minute exposure therapy sessions use imagery and real-life scenarios to manage intrusive thoughts and flashbacks by processing trauma-related cues (e.g. darkness) as an alternative to using 150mg of ketamine to induce a ‘K-hole’ [3][4] 
  • 60-minute skills training sessions challenge distorted thinking and encourage practice of distraction techniques (e.g. reading) to manage intense cravings lasting up to 3 weeks after consuming 4g of ketamine hourly to “Take the edge off everything” [3][5][6] 

Garg, Amit, et al. (2014) researched a man that was abstinent 1 year after engaging in relaxation and distraction techniques whilst receiving 25mg of naltrexone daily during a 3-week stay in ketamine rehab, after previously injecting 1 – 4g daily and relying on ketamine's ‘numbing’ effect [6].

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Onset Of Ketamine Bladder Syndrome 

The onset of ketamine bladder syndrome (KBS) requires addiction treatment because symptoms (e.g. dysuria) develop within 24 months of heavy use (e.g. 8g daily) and may lead to permanent urological damage, as only 10% of symptomatic users seek medical help [1]:

  • Psychoeducation informs patients about the negative consequences of heavy ketamine use (e.g. developing KBS after using up to 20g daily), treatment options (e.g. 5mg Oxybutynin daily), and the benefits of recovery (e.g. avoiding permanent bladder damage)  
  • Rehab liaises with GPs and urologists for the management of KBS and arranges hospital care (if needed) during or after treatment for specialised procedures (e.g. bladder augmentation) to improve bladder capacity and prevent further complications 
  • Weekly 90-minute relapse prevention sessions focus on enhancing motivation whilst identifying and managing internal (e.g. grief) and external (e.g. parties) triggers to encourage long-term abstinence (>1 year) and bladder recovery [7]
  • Up to 300mg of Pentosan Polysulfate is administered daily alongside therapy to ease abdominal pain and inflammation, as one study found that a patient with KBS relapsed within 7 months after claiming "Ketamine is the only thing that manages the pain"[1]

Abbeycare cannot provide medical treatment for ketamine bladder syndrome, although we may coordinate with GPs to discuss appropriate care strategies during or after treatment.

Self-Medication For Depression

Using ketamine to self-medicate depression requires addiction treatment because up to 80% “Use K without stopping, until it’s all gone” to relieve depressive symptoms (e.g. worthlessness), although depression increases by 51% within 1 year of frequent use (>4 times per week) [3][9]: 

  • SSRIs (e.g 40mg citalopram daily) are administered as an alternative to ketamine due to low abuse potential and the ability to reduce depressive symptoms (e.g. suicidal ideation) by 38% in drug users with major depressive disorder (MDD) [10] 
  • 45-minute counsellor-led discussions using the ‘Coping With Feelings and Depression’ handout help patients to identify symptoms (e.g. low energy, crying spells) and develop strategies to alleviate low mood (e.g. 10  - 20 minutes of exercise daily) [7] 
  • Weekly CBT sessions incorporate cognitive restructuring and skills training to modify harmful thoughts and behaviours associated with hazardous ketamine use (e.g. consuming ketamine when depressed because it “takes sadness away in a bubble”) [3]. 

Schak, Kathryn M., et al. (2016) studied a 52-year-old man with a ketamine addiction and a 30-year history of depression who experienced a 78% reduction in depressive symptoms (e.g. low mood) after receiving 7 sessions of Electroconvulsive therapy (ECT) and 18 days of mirtazapine monotherapy during rehab (ECT is not currently available at Abbeycare) [8]. 

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Hallucinations And Delusional Thinking

Hallucinations and delusions require ketamine addiction treatment because 30% develop psychosis after 9 years of use, resulting in 6-day-long psychotic episodes and a 2-fold increase in violence, often leading to arrests due to inappropriate behaviour in public [11][12][13]:

  • A 15 – 30-minute interview takes place during admission to establish the severity of psychotic symptoms and the patient's level of functioning using the Mental Health Screening Form-III or the Modified Mini Screen to develop an appropriate treatment plan [14]
  • Antipsychotics (e.g. 5mg Haloperidol) are administered daily to control auditory hallucinations (e.g. commands from a ‘demon’) and paranoia caused by glutamate and dopamine imbalances in the brain after heavy ketamine use (e.g. 4g per day) [13]
  • Clinicians help to minimise shame and guilt by using the iceberg analogy (e.g. behaviour = tip of the iceberg vs delusions = hidden under water), implying that beliefs aren’t permanent and can be ‘chipped away’ by behaviour change (e.g. abstinence) [15]

Lim, D. K (2003) examined a man in his 30s who required a residential rehabilitation programme for his severe ketamine addiction (used 4g a day and spent >£2000 a month) because: 

  • Physical restraint was initially required by staff trained in de-escalation techniques (e.g. AGRO+ method) due to the safety risk he posed to himself and others, insisting that “People were trying to catch his soul” 
  • 4.5mg Haloperidol was provided daily in a quiet/calm environment to encourage feelings of safety, diminish agitation, and manage persistent tactile hallucinations (e.g. feeling like his ear was being moved) and delusions about his mother trying to harm him 
  • The patient claimed to 'sniff' ketamine as a distraction for low self-esteem, unresolved grief, guilt, and frustration about losing sense of smell after constantly snorting the drug, requiring counselling to enhance self-esteem and minimise shame [13] 

Abbeycare may use screening tools (e.g. BPAQ) during admission to assess individual aggression levels and tendencies, training staff in methods to de-escalate anger, and arranging onward referral for psychiatric care, for patient protection, if required.

How Is Detox Done In Ketamine Rehab?

A ketamine detox in rehab works by: 

  • Treating physical (e.g. abdominal cramps) and psychological (e.g. hallucinations) symptoms of withdrawal on a case-by-case basis using chlordiazepoxide for 7 - 10 days and/or symptomatic medication (e.g. 400mg Mebeverine daily) for up to 28 days 
  • Placing patients in the detox wing for the first 7 days to closely monitor progress with observations every 15 – 30 minutes and regular mental status assessments to develop a personalised treatment plan, including a medication and therapy schedule 

How Is Therapy Done In Ketamine Rehab? 

Therapy in ketamine addiction treatment addresses dissociative trauma patterns and anaesthetic-seeking behaviours (e.g. consuming 3.8g of ketamine per session to "take the edge off everything" or have a "whole new world inside your head") by [3]:

  • Using the 8-phases of EMDR (e.g. body scan, desensitisation) to process trauma that previously led to frequent use (>4 times per week), as some users rely on up to 20g of ketamine a day to induce a temporary loss of consciousness [1][3][4]
  • Incorporating 10-minute mindfulness exercises to teach patients how to tolerate painful emotions (e.g. grief) by placing thoughts onto leaves and allowing the thoughts to flow down a stream, rather than using 150mg of ketamine to ‘escape’ from reality [3][4]
  • Building comprehensive self-care plans that aim to improve mood and overall well-being by engaging in drug-free activities, including reading for relaxation rather than using ketamine to create a “Lovely wave of relaxation that washes all over you” [3]
  • Delivering group skills sessions for 6 – 10 patients to practice disrupting the trigger–thought–craving–use sequence using ‘thought-stopping’ techniques (e.g. visualisation: Imagining moving an on/off switch to stop thoughts about using ketamine when sad) [7]

Siu, Andrew, et al. (2018) found that 16 to 30-year-old ketamine abusers experienced a 25 – 30% reduction in depression, anxiety, and stress within 2 weeks of receiving therapy that incorporated skills training, mindfulness, and self-care practices [16].

Abbeycare does not provide dissociative trauma care as part of a standard 28-day treatment programme; please speak to the admissions team for more information about the specific therapeutic approaches used for patients with ketamine dependency.

How Is Aftercare Planning Done In Ketamine Rehab? 

Further Cognitive Recovery

Aftercare planning in rehab for ketamine addiction is required to address the 14 - 30% reduction in neurocognitive abilities (e.g. executive function and verbal memory) caused by 3 – 4 years of ketamine misuse by (e.g.) [17]:

  • Providing a structured routine for up to 18 months post-treatment, including weekly telephone check-ins and therapy to strengthen decision-making and planning abilities in up to 39% of users who feel demotivated and ‘slowed’ down after cessation [18] 
  • Liaising with mental health services to provide CBT for up to 6 months after treatment as counsellors repeat information, provide a journal, and encourage patients to recall past experiences (e.g. "Explain a time that a negative emotion caused you to consume ketamine”) to aid memory consolidation [7]
  • Encouraging mindfulness (e.g. leaf and stream metaphor) to promote neuroplasticity by integrating various brain regions/networks (e.g. the prefrontal cortex) required to focus attention on breathing, bodily sensations, and the present environment [4]
  • Providing 20-minute guided meditations, advice about healthy sleep habits (e.g. turning the TV off 30 minutes before bed), and relaxation training using diaphragmatic breathing or guided imagery to regulate glutamatergic signalling and encourage synaptic repair [5]

Abbeycare's aftercare planning will be custom to each individual, as agreed between keyworker and client, consulting with our medical and clinical teams as needed.

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Follow Up Care

Aftercare planning in ketamine addiction treatment addresses lower urinary tract symptoms (e.g. nocturia, urgency, hesitancy, urinating with interrupted flow) in 20 – 30% of patients by working with urologists to [1]: 

  • Develop a pain-management plan that includes continued abstinence from ketamine and oral medication (e.g. pentosan polysulphate, NSAIDs), as some users relapse within 7 months after claiming “It’s the only thing that’s getting rid of the pain” [1] 
  • Conduct regular abdominal and pelvic examinations, blood count, renal and liver function tests on a 3-monthly basis, followed by a 6-monthly renal tract ultrasonography to screen for hydronephrosis and refer patients to a hepatologist if necessary [20] 
  • Offer Intravesical instillations (e.g. Parson’s cocktail) to patients with ongoing symptoms after 1 month of ketamine cessation, requiring weekly instillations for 4 to 6 weeks and then monthly instillations in the following 6 months [20] 
  • Refer patients to a tertiary unit after 6 months of cessation if reconstructive surgery is required for end-stage ketamine bladder, requiring life-long follow-up appointments to prevent leaks or infections [20] 

Aftercare planning in ketamine rehab may liaise with GPs to: 

  • Prevent patient access to therapeutic ketamine because, without coordinated care, intranasal ketamine may be prescribed, leading to relapse and hazardous drug use (e.g. using a ketamine nasal spray 12 times daily rather than every 4 hours) [8]
  • Provide monitoring guidelines for signs of relapse (e.g. tremor, dissociation, hallucinations) and regular check-ins to assess mood, cravings, and overall stability 
  • Initiate referrals to psychiatrists or trauma-specialists for ketamine-induced psychosis, dissociative disorders, or persistent symptoms of anxiety or depression (e.g. low mood, restlessness) 
  • Implement a prescription monitoring programme to ensure medication compliance by allowing doctors and nurses to track the use of controlled substances and offer alternative treatments to avoid ketamine use (e.g. 25 - 50mg naltrexone daily) 

How Does Pre-Existing Depression Alter Ketamine Rehab? 

Pre-existing depression changes ketamine recovery because patients often believe that ketamine is “Needed to relieve depressive symptoms” due to the drug’s temporary therapeutic effect (e.g. 2 – 3 hours), requiring up to 10 sessions of 1-1 psychoeducation to [5][8]:

  • Learn that frequent ketamine use (>4 times per week) actually increases depression by 51% after 12 months, despite intranasal use (e.g. 150 mg/ml, 0.5–1 ml 4 times daily) initially providing an antidepressant benefit for 4 - 5 days at a time [8][9]
  • Educate patients about alternative medications with low abuse potential used to treat depression, including antidepressants (e.g. mirtazapine or citalopram), resulting in a 38 – 78% reduction in depressive symptoms (e.g. suicidal ideation) within 3 weeks [8][10]
  • Inform patients about how engaging in 2 – 3 hours of aerobic exercise (e.g. cycling, walking, swimming) or muscle strengthening activities (e.g. lifting weights, push-ups) per week can reduce depression and anxiety by up to 30% within 2 weeks [5][16]

Ketamine Rehab Outcomes 

Ketamine use decreases by 78% within 3 months of receiving psychoeducation, motivational interviewing, coping skills training, and mindfulness during inpatient treatment because: 

  • Scores increase by 29% on the contemplation ladder (0 = “I cannot live without Ketamine” vs 10 = “I will never consume Ketamine again”), as patients move from the pre-contemplation stage to the stages of preparation, action, and maintenance 
  • Depression and anxiety decrease by 26 – 30%, and patients engage in 25% more healthy lifestyle behaviours (e.g. eating a balanced diet, exercising 30 minutes per day) in comparison to pre-treatment [16]

Wang, Liang-Jen, et al. (2018) found that 65% of ketamine users were abstinent 7 years after attending a 10-week outpatient programme that included weekly 2-hour therapy sessions focused on relapse prevention and concepts of motivational enhancement (e.g. feedback, reflection) [21].

Executive functioning and memory abilities (e.g. delayed recall) increase by up to 21% within 3 months of completing 15 60-minute cognitive training sessions focused on problem solving during inpatient treatment for severe ketamine dependence (daily use for 6 years) [19].

Siu, Andrew M. H., et al. (2018) found that ketamine rehab patients no longer showed signs of cognitive impairment (MoCA score <26) at 13 weeks, as scores increased by 6% from baseline after practising mindfulness, self-care, and healthy sleep habits to restore executive function [16]. 

Ketamine Rehab At Abbeycare

Abbeycare's 4-week recovery programme helps to overcome ketamine addiction by:

  • Providing a 7-day detox to treat symptoms of withdrawal (e.g. abdominal pain) using Chlordiazepoxide and/or symptomatic medication (e.g. ibuprofen), subject to our medical team's decision making
  • Delivering 90-minute CBT sessions, 60-minute mindfulness sessions, and daily feelings check-ins to identify, process, and reflect on positive (e.g. gratitude) and negative (e.g. existential anxiety)
  • Liaising with GPs and urologists, where appropriate, to develop pain-management plans, conduct regular tests (e.g. LFT every 3 months), and administer medication (e.g. Citalopram) to prevent patients from self-medicating depression or bladder pain with ketamine
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About the author

Mischa Ezekpo

Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: January 9, 2026