02 May 2025
Ketamine States: A Journey Through the Mind
—An Excerpt about Dependency
By: Phil Wolfson, M.D., and Mark Braunstein, D.O.
Ketamine Research Foundation
MAPS Bulletin: Volume XXXIV
Ketamine can be a wonderful and enticing experience. It often promotes a better mood, vivid imagination, and relief from anxiety, trauma, rumination, and depression. It can be sensual, elevating, and lead to a sense of communion with the divine, fostering greater tolerance and closeness in relationships. These are the qualities that make ketamine compelling and potentially transformative.
But ketamine is also highly variable. Its impact depends on dosage, route of administration, individual sensitivity, the setting, and the emotional state brought into the experience. In some clinical contexts, ketamine is intentionally underdosed to avoid psychedelic effects, making the experience subtle or even imperceptible.
The most important therapeutic benefit is often the time out from ordinary mind—what we call ego dissolution. This provides a break from persistent mental patterns and a chance for reorganization of self-perception.
Low-Dose: Relaxation and Insight
At lower doses, ketamine tends to produce emotional and somatic relaxation. It fosters communication and emotional openness—similar in some ways to MDMA—and can allow difficult feelings or traumatic memories to surface in a manageable way. We call this the psycho-revelation process. With skilled facilitation, these low-dose experiences can lead to meaningful emotional breakthroughs and growth.
Medium to High Dose: The Transformational Space
As the dose increases, so do the anesthetic and dissociative effects. Eventually, the user enters a deeply internal state—lasting about 20–30 minutes—where all connection with the external world is suspended. Traditionally referred to as the “k-hole,” we prefer the term Transformational Space.
In this space, one is entirely immersed in inner consciousness. The five senses are muted, and memories of the experience may be limited. Having a sitter or skilled therapist present is essential, especially because external agitation or “enactments” may occur without awareness. These moments, while potentially alarming to an observer, are often remembered by the participant as profound or even ecstatic.
The Transformational Space is powerful but unpredictable. Journeys may include contact with archetypes, dreamlike scenarios, or sensations of cosmic unity. Common themes include: dying without fear, reunion with deceased loved ones, immersion in natural elements, and feelings of universal connection. The experience may also surface painful memories or provoke anxiety, especially in unsupervised settings.
The Risks of Full Ego-Dissolving Journeys
At high doses, the risk of physical disconnection from the environment becomes acute. Errors in judgment may occur—choosing an unsafe setting, attempting to drive afterward, or taking more than intended, particularly when using powder. Potency and absorption can vary widely, especially with insufflation.
Furthermore, repeated deep journeys can lead to diminishing returns. The more frequently ketamine is used, the more likely it is that the experience becomes self-absorbed, disconnected from relational life, and reinforcing of grandiosity. It’s critical to integrate these experiences to make use of their healing potential.
The Importance of Integration and Support
Every ketamine experience is unique. You may feel you’ve received a message, seen a new reality, or tapped into a part of yourself previously unknown. But if these revelations aren’t integrated—shared, reflected on, and supported—they can become disjointed or even destabilizing.
Having a therapist or sitter skilled in integration is invaluable. Talking through the experience, writing a “trip report,” or even recording your narrative can help preserve insight and prevent confusion. This is especially true after deep journeys, where memory may fade quickly.
Ketamine is, at its core, a meditative medicine. It facilitates access to otherwise unreachable states of consciousness. With care, intention, and support, it can become a tool for profound healing and self-discovery.
The overwhelming number of people who use ketamine don’t get hooked. For most of us, the ketamine experience is not just an easy ride. Like most psychedelic experiences, there are inevitable stresses and rough aspects. While our experience may say ‘there is more to be learned and experienced from ketamine,’ we do not wish to be seduced to a compulsive repetition.
Most studies report no cases of misuse in the clinical setting, indicating that an appropriate and safe container significantly reduces the risk for dependence.
The allure to escape into an altered state and experience enhanced sense of well-being that accompanies a ketamine experience is powerful.
Among ketamine users, there are those who follow a course of increasing use and get hooked. You may start slowly, at a party, with friends, at home alone. It is not an instant hook, but rather a crescendo of use that varies for each person. K has that capacity to be captivating and a lure to its use. We don’t want to respond to that. A considerable risk factor is easy access to ketamine. Too frequent use is a recipe for dependence. Ketamine experiences need to be integrated into daily life and relationships — serving us for healing, growth, and consciousness.
K dependency is not a pretty experience. It is a state of being elsewhere; residing in a universe of the ‘elsewhere’; absent the ability to ground in this reality; with loss of connection to our friends and loved ones; with loss of connection to the core of our lives lived, however difficult those lives may be.
It tends to be a state of grandiosity, complete or near complete self-absorption, with a feeling of separateness, importance, and Mission. It is intensely illusional, and hallucinatory, and has an appeal to it that is hard to dismiss. The theme song of being hooked goes like, ‘This is it and I don’t want to be anywhere else.’
There are dangers – ketamine may well impair memory while you are high and, in the aftermath, – forgetting when and how much your last dose was and leading to having taken more than you want to — and more frequently. There are the problems that come along with ketamine intoxication in the wrong setting; and making errors in judgement that risk your safety — like getting in a hot tub when you are about to go ketamine unconscious; or getting in an altercation when you are socially impaired; or driving much too soon. Stupid mistakes can be injurious or even fatal.
Ketamine dependence is difficult to overcome. It is hard to let go of; hard to let others in; hard to admit to oneself that one is hooked as the unhook is so unappealing. To accept your personal use as problematic is to challenge your own feelings and beliefs. In the return to a shared reality, we may re-gain awareness of the reality we were seeking to escape. It is typical to fight off interventions no matter how well meaning. The involvement and concern of the family is often necessary to affect change. And once an intervention is made and is successful, ketamine cravings may cause relapse(s).
The first Guideline is: Life requires each of us to have a functioning Mind – and a connection with that mind – and with people outside of us. Purpose, meaning, kindness, and functioning in the world are imperatives. If personal use is all about me, my drug inflated, introverted, private cosmos will ultimately be my ruin, and not my liberation.
The depth of a ketamine experience depends on several factors: The amount of ketamine you ingest. The more you take – by any route of administration, the deeper your experience will be. Leaving this reality entirely for the deep ketamine journey space is referred to as the k-hole and k-holing. We prefer The Transformative Space. As you will not be responsive to your environment or others, it is an imperative that you be accompanied, cared for, and watched over—if you choose to go to that depth; or if inadvertently you take an amount of ketamine that puts you there. Users naïve to ketamine can get agitated and uncomfortable without any knowledge of their actions or safety. The same is true for experienced users who may be surprised by the depth of their experience. Ketamine is fairly unpredictable, and each experience is different – both in depth and the qualities of that experience – where you go, who you are in it.
Warning Signs of Impending or Actual Dependence
In the Clinical Setting (A Consumer and Practitioner Guide—check out the ‘Guidelines”)
Carefully designed treatment protocols can significantly reduce dependence risk while maximizing therapeutic benefit:
Conclusion
The Ketamine Research Foundation Guidelines for Clinical Use represent an important step toward establishing standards of care in ketamine treatment. By implementing comprehensive screening, informed consent, structured protocols, integration support, and ongoing monitoring, clinicians can help ensure that ketamine’s therapeutic potential is realized while minimizing the risks of dependence.
As ketamine continues to expand in both therapeutic and recreational contexts, the clinical community has both an opportunity and a responsibility to establish standards of care that maximize benefit while minimizing harm. Through thoughtful implementation of these Guidelines, clinicians can navigate the complex balance between providing access to this promising treatment while protecting patients from the potential harms of dependence.
To sign up for upcoming webinars regarding ketamine use and misuse please email krfguidlines@gmail.com
[While MAPS does not officially endorse or verify every claim made in this guidebook, the authors are credible, the perspective is informed, and the information is valuable. We encourage readers to engage with it critically and thoughtfully.]
Phil Wolfson, M.D.
Dr. Phil Wolfson is a pioneering psychiatrist, psychotherapist, and leader in psychedelic-assisted therapy. He served as Principal Investigator for the MAPS-sponsored Phase 2, FDA-approved clinical trial of MDMA-assisted psychotherapy for individuals facing significant anxiety due to life-threatening illnesses. His clinical work with ketamine led to his foundational role in the development of Ketamine-Assisted Psychotherapy (KAP), and his landmark book The Ketamine Papers, published by MAPS, remains a cornerstone in the field.
A lifelong activist and seeker, Phil has been a fixture in the Bay Area for nearly four decades. He is the author of Noe – A Father/Son Song of Love, Life, Illness and Death and has published extensively on psychedelics, transformation, and consciousness. In addition to teaching at institutions like JFK University, CIIS, and UCSF’s Department of Psychiatry, Phil has participated in MDMA research since the 1980s and was a founding member of the Heffter Research Institute. He holds five patents for unique herbal medicines and has been widely featured in publications including The New Yorker, Vanity Fair, and Wired.
As founder and CEO of the Ketamine Research Foundation, Phil is committed to the ethical expansion of psychedelic psychotherapy. With over 50 years of clinical experience, he continues to champion a humanized, compassionate approach to care—especially for those navigating loss, grief, and the profound terrain of the psyche.
Mark Braunstein, D.O.
Dr. Mark Braunstein, graduated medical school in 1997, then completed a General Psychiatry Residency at the University of New Mexico and then a fellowship in Child and Adolescent psychiatry at Maine Medical Center in 2002. Upon graduation from his fellowship and becoming board certified in general psychiatry he established a private practice in Durango, Colorado, where plant medicine became part of his everyday integrative psychiatric practice.
In 2005, Dr. Braunstein integrated psychiatry into a residential wilderness setting, recognizing the advantages of plant medicine and nature in contrast to the limited efficacy and high side effect profile of traditional psychiatry. Although he is skilled in traditional psychopharmacology, his niche is in deprescribing psychiatric medications while optimizing patients’ lifestyles through elements such as exercise, diet, spirituality, and plant medicine.
Having studied under Dr. Phil Wolfson at the Ketamine Training Center, Dr. Braunstein now collaborates with his mentor, leading training globally. He maintains a bespoke psychedelic practice licensed in 13 states and fosters relationships for psychedelic care in Central and South America, Africa, Europe, Israel, and Asia.
