Navigating 'k-land': a qualitative exploration of participants' experiences of ketamine-assisted psychotherapy for methamphetamine use disorder.

BACKGROUND: Methamphetamine use disorder (MAUD) is associated with substantial psychiatric and physical morbidity, and current treatment options remain limited. Ketamine-assisted psychotherapy (KAP) has shown promise in substance use disorders, but little is known about how individuals experience and interpret this intervention, particularly in MAUD. Qualitative investigation may provide insight into perceived mechanisms, acceptability, and factors influencing engagement. This study aimed to explore how participants experienced, interpreted, and evaluated KAP for MAUD.

METHODS: This qualitative study was embedded within an open-label pilot trial of KAP for MAUD. Fourteen participants who completed core components of the intervention undertook semi-structured interviews following treatment. Interviews explored motivations for participation, experiences of ketamine dosing and psychotherapy, and perceptions of change. Data were analysed using reflexive thematic analysis.

RESULTS: Four interrelated themes were generated: (1) treatment entry, characterised by prior treatment experience with limited sustained benefit and pragmatic openness to a novel approach; (2) a structured and supportive context for engagement, highlighting the importance of relational safety and clinical containment; (3) altered states and psychological shifts, in which participants described reduced emotional and cognitive reactivity following ketamine sessions; and (4) translation of psychological shifts into behavioural change, describing variable and contingent changes in methamphetamine use. Participants described ketamine as creating a temporary state characterised by reduced emotional and cognitive reactivity and enhanced receptivity, which we interpret as 'psychological space'. This state appeared to support engagement with psychotherapy, although behavioural change was variable and contingent on ongoing therapeutic engagement, personal motivation, and contextual factors. Acceptability was generally high within a supportive clinical environment. Participants expressed uncertainty regarding whether changes were attributable to ketamine, psychotherapy, or contextual factors.

CONCLUSIONS: KAP for MAUD was experienced as a multi-stage, context-dependent process rather than a stand-alone pharmacological treatment. Ketamine was characterised as facilitating a temporary state of 'psychological space' that appeared to support engagement with psychotherapy, while sustained change appeared to depend on the integration of these experiences into ongoing cognitive and behavioural processes. These findings support a model in which pharmacological, psychotherapeutic and contextual factors interact, and highlight the need for further research to clarify mechanisms and optimise intervention design.