title: The effects of subanesthetic ketamine infusions on motivation to quit and cue-induced craving in cocaine-dependent research volunteers.
abstract: BACKGROUND
  Cocaine dependence involves problematic neuroadaptations that might be responsive to modulation of glutamatergic circuits. This investigation examined the effects of subanesthetic ketamine infusions on motivation for quitting cocaine and on cue-induced craving in cocaine-dependent participants, 24 hours postinfusion.
  
  
  METHODS
  Eight volunteers with active DSM-IV cocaine dependence not seeking treatment or abstinence were entered into this crossover, double-blind trial. Three 52-min intravenous infusions were administered: ketamine (.41 mg/kg or .71 mg/kg) or lorazepam 2 mg, counterbalanced into three orderings in which ketamine .41 mg/kg always preceded the .71 mg/kg dose. Infusions were separated by 48 hours, and assessments occurred at baseline and at 24 hours postinfusion. Outcomes were change between postinfusion and preinfusion values for: 1) motivation to quit cocaine scores with the University of Rhode Island Change Assessment; and 2) sums of visual analogue scale craving ratings administered during cue exposure.
  
  
  RESULTS
  Compared with the active control lorazepam, a single ketamine infusion (.41 mg/kg) led to a mean 3.9-point gain in University of Rhode Island Change Assessment (p = .012), which corresponds to an approximately 60% increase over preceding values. There was a reduction of comparable magnitude in cue-induced craving (p = .012). A subsequent ketamine infusion (.71 mg/kg) led to further reductions in cue-induced craving compared with the control. Infusions were well-tolerated.
  
  
  CONCLUSIONS
  Subanesthetic ketamine demonstrated promising effects on motivation to quit cocaine and on cue-induced craving, 24 hours postinfusion. Research is needed to expand on these preliminary results and to evaluate the efficacy of this intervention in clinical settings.
authors.affiliation: New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: dakware@nyspi.columbia.edu.
authors.forename: Elias
authors.initials: E
authors.lastname: Dakwar
authors.affiliation: New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Frances
authors.initials: F
authors.lastname: Levin
authors.affiliation: New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Foltin
authors.affiliation: New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
authors.affiliation: New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons, New York, New York; Department of Psychology, Columbia University, New York, New York.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Hart
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000188:drug therapy*; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D066249:Craving / Q000187:drug effects*; D018592:Cross-Over Studies; D003463:Cues; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D008140:Lorazepam / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009042:Motivation / Q000187:drug effects*; D055815:Young Adult
chemical_list: D018691:Excitatory Amino Acid Antagonists; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008140:Lorazepam
keywords: Addiction; cocaine; craving; glutamate; ketamine; motivation
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