Ketamine Psychedelic Therapy (KPT): Review of the Results of a 10-Year Study
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
1. Introduction

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. KPT Method

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 lifestyle.

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 session.

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 experiences.

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 ketamine session.

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.

3. Clinical Study of the efficacy of KPT of Alcoholism

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 procedure.

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. Study of KPT Underlying Mechanisms

4.1. Psychological Underlying Mechanisms
4.1.1. KPT influence on the personality MMPI

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 profiles. 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. 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 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 images.

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. 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 past.

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 the world.

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 ) 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.

5. Conclusion
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 powerful.
6. Separate clinical studies of KPT of drug dependence, personality disorders and neuroses

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 grid.

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 perception.

7. Appendix I. Patient's Self-Reports

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..." (patient D.F.).

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..." (patient S.L.).

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 life.

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 and balance.

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 (in Russian).

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, New York.

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", p.45. St.Petersburg.

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 Russian).

Kolb, V.G. and Kamyshnikov, V.S. (1976) Clinical Biochemistry. Belarus, Minsk (in Russian).

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 Russian).

Leontiev, D.A. (1992) Test of the meaning of life orientations. Smisl, Moscow (in Russian).

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 Russian).

Osgood, Ch., Susi, C.J. and Tannenbaum, P.M. (1957). The Measurement of Meaning. Urbana.

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 York.

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.