Ketamine is a prescription-only medicine that may be prescribed off-label by our medical team following a comprehensive assessment to assist in the psychotherapy.
Ketamine is a prescription-only medicine that may be prescribed off-label by our medical team following a comprehensive assessment to assist in the psychotherapy.
UNDERSTANDING ADDICTION
Addiction is rarely as simple as making a bad choice or lacking willpower. A substance or behaviour may initially provide relief, stimulation, confidence, escape, focus, connection or a temporary sense of control.
For some people, addiction develops around trauma, anxiety, depression, loneliness or emotional pain. For others, neurobiology, ADHD, reward sensitivity, physical dependence, repeated exposure or environmental influences may play a greater role. Often, several of these factors become intertwined.
Whatever brought you here, the aim is not to judge the behaviour in isolation. It is to understand why it became important, what now keeps the cycle going and what may need to change for recovery to become possible.
The addiction may be causing harm now. That does not mean it never served a purpose.
Psychotherapy-led understanding
Medical and psychological assessment
Preparation and integration
WHEN STOPPING HAS BECOME A CYCLE
You may have set rules, made promises, deleted accounts, poured things away, avoided certain people or told yourself that this time would be different.
Sometimes it worked, at least for a while — days, weeks or even months. Then stress rises, an opportunity appears, a craving arrives or something inside you becomes difficult to tolerate — and the familiar behaviour returns.
The return is often followed by regret, secrecy or shame. You may wonder why the consequences have not been enough to make you stop. Yet addiction is rarely governed by logic alone. By the time a pattern has become established, it may involve reward learning, habit, emotional regulation, physical dependence and powerful associations between certain situations and relief.
YOU MAY RECOGNISE SOME OF THE FOLLOWING
“Only at weekends.”
“Just one more time.”
“I’ll stop when things calm down.”
“Nobody is being hurt.”
Some people develop physical dependence, tolerance or withdrawal. Others experience powerful psychological compulsion without significant physical withdrawal. Many experience both.
Shame asks, ‘What is wrong with me?’ Understanding asks, ‘What keeps this cycle alive?’
LOOKING BENEATH THE BEHAVIOUR
Addiction rarely begins with the intention of losing control. It often starts as a way to cope, to manage something that feels too heavy, too fast, or too much.
A substance or behaviour may quieten the mind, lift mood, create energy, soften pain or provide distance from something difficult to bear.
Over time, the brain learns from relief. It begins to equate the behaviour with safety, making it easier to return to it during stress, loneliness, boredom, conflict or overwhelm.
IT MAY HAVE HELPED YOU TO…
Numb
Create distance from grief, trauma, shame, fear or emotional pain.
Soothe
Ease anxiety, agitation, inner tension or a nervous system that rarely feels settled.
Stimulate
Create energy, focus, excitement, motivation or relief from emptiness and boredom.
Escape
Step away temporarily from responsibilities, memories, conflict or an inner world that feels difficult to tolerate.
Connect
Reduce inhibition, ease loneliness or create a sense of belonging, confidence or intimacy.
Dissociate
Feel less present in the body, less aware of painful emotions or less bound to what is happening.
Control
Create routines, rituals or predictable relief when other areas of life feel uncertain or unmanageable.
Function
Get through work, social situations, relationships or everyday demands that otherwise feel overwhelming.
Many people learn emotional regulation through safe, consistent relationships that provide comfort, reassurance, protection and attunement.
When those experiences were unavailable, inconsistent or overwhelming, the nervous system may have had to find other ways to manage distress. A substance or behaviour can feel reliable because it changes the internal state quickly, even if the cost becomes increasingly high.
For some people, repeated exposure, physical dependence, reward sensitivity, ADHD, impulsivity, genetics or environmental influences may be more significant. Often, psychological and neurological factors become intertwined over time.
QUESTIONS WORTH SITTING WITH
What changes inside you when you use or engage in the behavior?
What becomes easier for a while?
What becomes harder when it is unavailable?
What feeling, thought or situation tends to appear just before the urge?
Recovery is not only about taking something away. It is about helping you build what the addiction has been providing.
THE MANY PATHS INTO ADDICTION
For some people, addiction begins with emotional pain. For others, it begins with curiosity, medication, social drinking, or a brain that has always found stimulation unusually rewarding. Most people eventually discover that several of these pathways are present at the same time.
People with ADHD appear to be at increased risk of substance misuse, particularly stimulants and nicotine. Differences in reward processing, impulsivity and dopamine signalling may contribute to this increased vulnerability. It is not uncommon for people to describe alcohol helping them feel calmer, or stimulants helping them feel more focused or motivated. While these experiences can feel helpful initially, repeated use may gradually develop into dependence or compulsive patterns of use.
Alcohol, benzodiazepine and opioid dependence can produce significant and potentially dangerous withdrawal syndromes. These require specialist medical support and should never be stopped abruptly without appropriate clinical advice.
Addiction is rarely simple. Sometimes it begins with pain. Sometimes with dopamine. Sometimes with loneliness. Sometimes with a prescription. The question is not simply ‘Why the addiction?’ but also ‘Why this substance, why this behaviour, why now, and what has it been doing for you?’
DIFFERENT FORMS. OVERLAPPING PROCESSES.
Addiction can develop around a substance, an activity or an experience. Some patterns involve physical dependence and withdrawal, others are more driven by anticipation, reward, escape, habit and psychological compulsion. Many involve both. Understanding the form of the addiction helps clarify risk and treatment needs, and understanding the function helps explain why it persists.
When the substance changes the body as well as the mind. Repeated use of alcohol, opioids, stimulants, benzodiazepines, prescription medication or nicotine can alter brain chemistry, and the body may come to expect its presence. Some people continue seeking relief or pleasure, while others continue partly to avoid withdrawal or emotional collapse.
Alcohol, benzodiazepine and opioid dependence can involve medically dangerous withdrawal and should not be stopped abruptly without appropriate clinical advice.
KEY FEATURES
When the behaviour becomes the route to relief, stimulation or escape. Behaviours such as gambling, pornography, shopping, gaming, social media use, work, exercise or food-related compulsive behaviour can activate powerful systems of anticipation, reward, arousal and relief. These patterns may begin as entertainment, connection, productivity or self-soothing, but become problematic when control narrows and the behaviour continues despite consequences.
KEY FEATURES
Cue
Urge
Behavior or substance
Change in internal state
Temporary relief or reward
Learning
Stronger future urge
The route may differ. The brain still learns: ‘That changed how I felt. Remember it.’
Dependence
The body adapts to repeated exposure, and stopping may produce withdrawal.
Compulsion
The person feels driven to continue despite consequences or a genuine wish to stop.
Addiction
A broader pattern involving impaired control, craving, prioritisation and continued engagement despite harm.
These experiences can overlap, but they are not interchangeable. Someone can be physically dependent on prescribed medication without being addicted, while another person can experience severe behavioural addiction without physical withdrawal.
SAME NEED, DIFFERENT ROUTE
To quiet the mind
Alcohol, cannabis, benzodiazepines
To create stimulation
Cocaine, gambling, gaming, shopping
To escape or disconnect
Opioids, alcohol, binge eating, compulsive sexual behaviour
To feel focused or capable
Stimulants, work, exercise, gaming
Not every repeated or pleasurable behaviour is an addiction. The distinction lies in loss of control, increasing priority, persistence despite harm and the degree to which life becomes organised around it.
The substance or behaviour matters. So does the reason your brain learned to return to it.
WHEN CHOICE BECOMES NARROWER
Most people struggling with addiction have already used willpower repeatedly. They have made rules, avoided triggers, deleted accounts, changed routines and endured periods of craving. The problem is rarely that they have not tried hard enough.
Repeated relief or reward teaches the brain that a substance or behaviour is important. It begins linking that experience to people, places, emotions, times of day and familiar situations. Eventually, the cue itself can produce anticipation or craving before a conscious decision has been made.
At the same time, repeated use can change the systems involved in reward, stress, habit and self-control. What once felt like a chosen source of pleasure may gradually become something used to escape discomfort, feel normal or prevent withdrawal.
THE ADDICTION CYCLE
Cue
Urge
Behavior or substance
Change in internal state
Temporary relief or reward
Learning
Stronger future urge
Each repetition teaches the brain that this route should be remembered and prioritised.
WHY WILLPOWER IS USUALLY NOT ENOUGH
Dopamine is involved in motivation, learning and the drive to repeat experiences — not simply pleasure. When something produces a rapid or reliable internal change, the brain marks it as important and worth pursuing again.
Places, people, emotions, devices, money, smells, times of day and even bodily sensations can become associated with the substance or behaviour. Later exposure to those cues may trigger craving automatically.
With repetition, control can shift from conscious decision-making towards habit systems. The brain becomes more efficient at performing the familiar sequence, especially in predictable settings.
Repeated intense reward can reduce sensitivity to everyday sources of satisfaction. Relationships, hobbies, achievement and rest may feel less compelling while the addictive route remains unusually salient.
Over time, addiction may increase stress sensitivity and worsen anxiety, irritability, low mood or emptiness when the substance or behaviour is unavailable. Returning then becomes less about pleasure and more about relief.
Brain systems involved in planning, inhibition and decision-making can become less effective when craving, withdrawal, stress or strong cues are present.
AT FIRST
“I do this because it feels good.”
pleasure · stimulation · confidence
LATER
“I do this because not doing it feels worse.”
craving · restlessness · anxiety · withdrawal
The motivation can shift from seeking a high to escaping a low.
THE BROADER ADDICTION CYCLE
Binge or intoxication
Reward, anticipation and repeated engagement.
Withdrawal or negative affect
Reduced reward, increased stress and emotional discomfort.
Preoccupation or anticipation
Craving, cues, planning and impaired control.
These stages can repeat and intensify over time, involving reward, stress and executive-control networks.
Where physical dependence has developed, withdrawal is not a test of character. Alcohol, benzodiazepine and opioid withdrawal may require specialist medical assessment and treatment. The Emerge Clinic is not a detoxification service, and nobody should abruptly stop a potentially dependence-forming substance based on information from this page.
Behavioural addictions do not usually involve the same forms of physical withdrawal seen with alcohol, benzodiazepines or opioids. However, cue-driven craving, anticipation, habit, emotional regulation and loss of control can still become powerful enough to dominate everyday life.
Recovery also requires new learning, safer regulation, support, and — where necessary — medical care.
Addiction can narrow the space in which choice is made. Recovery helps widen it again.
HOW KETAMINE-ASSISTED PSYCHOTHERAPY MAY HELP
Ketamine-assisted psychotherapy is not a detoxification treatment, and it is not appropriate for everyone experiencing addiction.
However, for some individuals, it may provide an opportunity to step outside familiar patterns, view longstanding behaviours differently and explore the psychological, emotional and neurological processes that have kept them in place.
The aim is not simply abstinence. It is to help create the conditions in which a different relationship with yourself — and with the addiction — becomes possible.
Addiction often feels immediate and urgent. Some people describe ketamine-assisted psychotherapy as creating a temporary sense of distance from compulsive thoughts, urges or long-established narratives about themselves.
“I am not the addiction.”
For some people, treatment creates space to explore grief, trauma, anxiety, shame, loneliness or attachment wounds. For others, it helps them understand patterns of reward, stimulation, impulsivity and emotional regulation.
“What has this been helping me survive — or helping me feel?”
Integration sessions help translate experiences into practical changes — emotional regulation, improved relationships and new ways of responding when life becomes difficult.
“Recovery is practiced between sessions.”
Insight alone is rarely enough. Emerging evidence and clinical experience suggest some individuals — particularly those with substance dependence or severe, longstanding patterns — may benefit from more frequent treatment and support in the early stages.
Ketamine may help create a window of psychological flexibility. Therapy helps you decide what to do with it.
Ketamine-assisted psychotherapy should be viewed as an adjunctive, exploratory treatment. It is not a replacement for specialist addiction services, detoxification or established evidence-based interventions where these are required.
Ketamine-assisted psychotherapy should be viewed as an adjunctive, exploratory treatment. It is not a replacement for specialist addiction services, detoxification or established evidence-based interventions where these are required.
A FURTHER CLINICAL CONSIDERATION
This may include collaboration with your GP, addiction services, family support or other professionals.
You are more than the strategies your nervous system learned to survive. Recovery simply gives you the opportunity to discover what else is possible.
TRUST, EVIDENCE & CLINICAL REALITY
Research into ketamine for addiction has developed across alcohol, cocaine, cannabis, opioid and nicotine use disorders. Several controlled studies have reported encouraging effects on abstinence, craving, motivation and relapse when ketamine has been delivered alongside psychological support.
The evidence is not equally strong for every addiction. Alcohol and cocaine have some of the clearest modern clinical findings. Research into cannabis, opioids and nicotine is earlier, while direct evidence for behavioural addictions such as gambling, pornography, shopping and gaming remains extremely limited. At The Emerge Clinic, these findings inform clinical thinking, but evidence from one addiction is not presented as proof that the same approach will work for another.
The most developed modern evidence
A 2022 UK randomised controlled trial (the KARE study) led by Professor Celia Morgan examined three ketamine infusions alongside either relapse-prevention psychotherapy or alcohol education. Ketamine treatment was associated with more abstinent days during six months of follow-up.
(Morgan et al., 2022)
A separate controlled pilot trial found that one ketamine infusion, combined with motivational enhancement therapy, improved several drinking outcomes in people with alcohol dependence.
(Dakwar et al., 2020)
controlled studies suggest that ketamine, particularly when paired with structured psychological treatment, may help some people with alcohol use disorder increase abstinence or reduce harmful drinking.
the research does not establish one universally effective dose, schedule, psychotherapy model or maintenance plan.
Encouraging findings for craving, motivation and relapse
A randomised trial combining a single ketamine infusion with mindfulness-based behavioural treatment reported improved abstinence, reduced craving and a lower risk of relapse among adults with cocaine dependence.
(Dakwar et al., 2017)
Earlier research also found that ketamine increased motivation to stop cocaine use and reduced cue-induced craving shortly after treatment.
(Dakwar et al., 2013)
cocaine use disorder has no straightforward pharmacological equivalent to the established medication options available for some other addictions. Research investigating whether ketamine can temporarily reduce rigidity or strengthen engagement with psychological treatment is therefore clinically important.
The results are encouraging, but they arise from relatively small specialist trials and still require replication.
OTHER SUBSTANCE USE DISORDERS — EARLIER BUT EMERGING EVIDENCE
Cannabis Use Disorder
An early study combining ketamine with motivational enhancement and mindfulness-based relapse-prevention treatment found the approach feasible and tolerable, with potentially helpful outcomes, though it was preliminary rather than definitive. (Johnson et al., 2020)
Opioid Use Disorder
Research has explored ketamine in opioid use disorder, withdrawal management and treatment retention. Reviews describe the evidence as preliminary. Ketamine is not a replacement for established medications such as methadone or buprenorphine, nor should it be positioned as a stand-alone opioid detoxification treatment. (Loo et al., 2023)
Nicotine Dependence
Recent reviews identify at least one controlled ketamine study targeting nicotine addiction, but this remains a small evidence base compared with established smoking-cessation interventions. (Singh et al., 2023)
EVIDENCE AT A GLANCE
Alcohol Use Disorder
★★★
Promising controlled evidence
Cocaine Use Disorder
★★★
Promising controlled evidence
Cannabis Use Disorder
★★
Preliminary evidence
Opioid Use Disorder
★★
Preliminary evidence
Nicotine Dependence
★
Early evidence
Behavioural Addictions
—
Direct evidence not established
KAP & Long-term Maintenance
★
Developing
Ketamine research has largely focused on substance-use disorders. There is not currently a comparable clinical-trial literature showing that ketamine-assisted psychotherapy is an established treatment for behavioural addictions.
A rationale may be drawn from research into compulsivity, reward learning, mood, psychological flexibility and psychotherapy, but that is indirect evidence. Anyone considering treatment should understand that distinction clearly.
Several of the more encouraging studies combined ketamine with motivational enhancement, mindfulness, relapse-prevention therapy or another structured behavioural intervention. This supports the Emerge position that the medicine may create an opportunity, while preparation, psychotherapy, integration and ongoing recovery work determine how that opportunity is used.
Addiction does not necessarily fit the standard four-session Emerge schedule. Some research protocols have used repeated administrations over a shorter period, while others have studied one or three sessions alongside psychotherapy. The most appropriate frequency remains uncertain and may differ according to the substance, severity, dependence, medical risks and response to treatment. Where a more intensive initial schedule appears appropriate, this is discussed individually rather than decided automatically from the diagnosis.
EXAMPLES OF POSSIBLE ADDITIONAL SUPPORT
RESEARCH LEADERS IN THIS FIELD
Professor Celia Morgan
University of Exeter — lead researcher on the KARE study, investigating ketamine alongside relapse-prevention and mindfulness-based psychotherapy for alcohol and cocaine use disorders.
Professor Elias Dakwar
Consultant psychiatrist and addiction researcher whose controlled studies have investigated ketamine alongside motivational and mindfulness-based psychotherapy for cocaine use disorder.
That does not make supervised therapeutic use equivalent to uncontrolled recreational use, but it does mean addiction treatment involving ketamine requires particularly careful screening, dose control, medical oversight and boundaries around access. Recent reviews continue to examine reports of tolerance and dependence arising during repeated therapeutic ketamine exposure. (Dore et al., 2024)
HOW THIS SHAPES OUR APPROACH
The research offers a reason for cautious hope, not a reason to promise certainty.
YOU DON’T HAVE TO DO THIS ALONE
A member of our team will respond personally and help you understand whether Emerge may be the right support for you.
We reply to every message personally and confidentially.
Honest information to help you make the right decision for you.
A warm, non-judgemental space to explore what may be possible.
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hello@theemergeclinic.co.uk
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Change is possible. You are more than what you’ve been through. We look forward to hearing from you.