The number has been on the back of an envelope for two weeks.
Every time you pick up the phone you get as far as imagining one question, the one about past substance use, and you set it back down. You have already decided how the call ends.
So you search instead for ketamine with a history of addiction, bracing for a page that tells you no. This is not that page, and it does not tell you yes either.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).
SAMHSA National Helpline: 1-800-662-HELP (4357) – free, confidential, 24/7, in English and Spanish, for treatment referral and information.
If someone may be overdosing, call 911. Naloxone reverses opioid overdose and is available without a prescription in Texas.
Stopping alcohol or benzodiazepines suddenly can be dangerous. Talk with a clinician before you stop, and go to an emergency room if you develop shaking, confusion, or seizures.
We are an outpatient practice and cannot provide emergency care. Our Fort Worth office: 817-659-7344.
Is ketamine addictive, and what does Schedule III mean?
Ketamine is a Schedule III controlled substance, listed by name at 21 CFR 1308.13. The KETALAR label says the same, and its section on abuse speaks to your question: “Individuals with a history of drug abuse or dependence may be at greater risk for abuse and misuse of KETALAR.”
That label also reports tolerance and physical dependence with prolonged ketamine use, and withdrawal symptoms after stopping frequent, large doses taken over long periods. Those findings describe heavy use rather than a supervised course, but they are part of why a history like yours changes how carefully this is approached.
The National Institute on Drug Abuse answer is careful: regular use in humans “is associated with symptoms of addiction,” while “more research is needed to determine how addictive ketamine might be.”
Can you have ketamine with a history of addiction? What the guidelines say
Use of intravenous ketamine for depression is off-label and considered investigational by the FDA, as our ketamine infusion therapy page states.
The 2021 Canadian Network for Mood and Anxiety Treatments task force lists “substance use/dependence” among the relative contraindications to ketamine. Relative means weighed, not automatic.
A 2021 international expert opinion in the American Journal of Psychiatry does not include substance use history among exclusions, and writes that “current psychiatric comorbidities need not be exclusionary as long as major depressive symptoms are the principal focus of clinical concern.”
The same group adds that adults with depression and co-occurring substance use disorders “have not been sufficiently studied,” and that the evidence “has not excluded the potential for misuse and/or gateway activity with ketamine or esketamine among patients receiving these treatments” for treatment-resistant depression.
The label for esketamine, an FDA-approved product this practice does not offer, tells clinicians to “use careful consideration prior to treatment of individuals with a history of substance use disorder and monitor for signs of abuse or dependence.”
So it gets assessed, and watched more closely afterward. It is not an automatic no.
What gets assessed before an infusion series
One question sits underneath the rest: is the depression a separate condition, or is it produced or amplified by the substance use? Heavy alcohol use, stimulant withdrawal, and sedatives can all generate depressive symptoms that look like major depression and often lift with sustained abstinence. Sorting that out is a common reason an assessment lands on “not yet” rather than “no.”
| What gets asked about | Why it matters |
| Which substances, how much, how recently | Guidance treats substance use and dependence as a relative contraindication: weighed, not decisive |
| Whether any use is current | It changes what is reasonable now, and what may need to happen first |
| Heart and blood pressure history | Ketamine can temporarily raise blood pressure; the same guidance lists poorly controlled hypertension and unstable cardiovascular conditions as relative contraindications, and suggests an ECG if indicated by history or exam |
| What happens after a first series | Maintenance patients should be reassessed regularly for urinary symptoms, cognitive effects, and substance misuse or dependence |
That guidance may also recommend a urine drug screen if indicated by history or exam. That is published clinical guidance, not a description of services offered here: this practice does not provide drug testing, court-ordered or DOT/SAP evaluations, or letters for legal proceedings.
The assessment only works on true information. Saying it out loud is not the same as being turned away.
If you are reading this while still drinking or still using, that belongs in the conversation rather than counting as a mark against you. One thing is urgent, though: stopping alcohol or benzodiazepines suddenly can be life-threatening, and some people need medically supervised withdrawal. We do not provide detox or withdrawal management, which belongs at a higher level of care. If you develop shaking, confusion, or seizures after cutting down, go to an emergency room.
The safeguards that matter most if this is your history
Our service page states it plainly: “There is a small but real risk of habituation or problematic use with ketamine. At our clinic, ketamine is given only as supervised, time-limited, in-office treatment with no at-home dosing.”
Nothing is dispensed for you to take home. No bottle, no spray, no supply in the house between visits. That closes one route to misuse, though it does not remove the risk, which is why the page calls it small but real.
From that page:
- Infusions are performed in the office, with a monitored recovery period afterward.
- A responsible adult age 18 or older must bring you, stay in the waiting area throughout your visit, and drive you home. Discharge alone, or to a rideshare or taxi, is not permitted.
- For the rest of the day: no driving or operating machinery, do not leave the house alone, avoid alcohol, recreational drugs, and over-the-counter sedating medications, and avoid major personal, business, or financial decisions.
- You sign a consent form beforehand and can withdraw it at any time, including during an infusion.
Why is at-home ketamine riskier?
In an analysis of 25 studies, NIDA reports, “medically unsupervised ketamine use was associated with related substance use disorder symptoms, memory loss, depression, and anxiety.” NIDA adds that laboratory research and a few human studies suggest use outside a clinical setting “can lead to cravings as well as symptoms of withdrawal,” though more research is needed.
The FDA warned in October 2023 about potential risks of compounded ketamine products, including oral formulations, for psychiatric disorders.
By comparison, the FDA requires that esketamine, which we do not offer, be “only dispensed and administered in healthcare settings.”
Ketamine is not a treatment for addiction
NIDA states that “ketamine is not currently approved by FDA for the treatment of any substance use disorder,” while noting it is being investigated for alcohol, opioid, and cocaine use disorder. Ketamine here is considered for depression, off-label and investigational, never as therapy for a substance use disorder.
Dr. Ghelber’s provider page states what this practice does have: she treats addiction as part of general adult psychiatric care and is a certified provider of buprenorphine treatment for opioid use disorder. There is no addiction program here, no detox, no residential or intensive outpatient treatment, no methadone, and no 24/7 substance use service.
How long does the benefit usually last?
Our service page, which labels this use off-label and investigational, is clear that a substantial proportion of treatment-resistant patients benefit, that not everyone responds, and that improvements are often short-term, commonly around two weeks. The 2021 expert opinion agrees: most patients see symptoms return within a month, with a median of 18 days.
For anyone with a substance use history, the risk is not only the infusion itself. There is also the pull to keep chasing a two-week effect, worth raising early with a clinician who works with treatment-refractory depression.
Frequently asked questions
Will a history of addiction automatically disqualify me from ketamine treatment?
A substance use history is one of the things assessed before an infusion series, and the published guidance stops short of a rule. The 2021 Canadian task force calls it a relative contraindication; the expert opinion does not list it among absolute exclusions. That leaves no automatic yes and no automatic no. Use of IV ketamine for depression is off-label and considered investigational by the FDA.
I am in recovery. Would an infusion count against my sobriety?
Recovery communities answer that differently, and nobody at a clinic gets to settle it for you. What can be said is that this is a prescribed medication, given under supervision in an office, with nothing dispensed to take home. Put the question to your clinician, and to whoever supports your recovery, before a first infusion.
Can ketamine treat alcohol use disorder or another addiction?
Not as an established treatment, and not here. NIDA states that ketamine is not FDA-approved for the treatment of any substance use disorder. A proof-of-concept phase 2 trial in the American Journal of Psychiatry randomized 96 people with severe alcohol use disorder and reported mixed results: more days abstinent at six months with ketamine than placebo, but no significant difference in the rate of return to drinking. A 2025 systematic review in the American Journal of Drug and Alcohol Abuse found that variability across studies “limits the certainty of evidence.”
Does the practice have an addiction program, or offer Spravato?
No to both. We are an outpatient adult psychiatry practice with no addiction program, detox, residential or intensive outpatient treatment, and no 24/7 substance use service. We provide intravenous ketamine rather than Spravato, and its use for depression is off-label and considered investigational by the FDA. Dr. Ghelber treats addiction within general adult psychiatric care and is certified to provide buprenorphine treatment for opioid use disorder.
The bottom line
Ketamine is a Schedule III controlled substance, and its use for depression is off-label and considered investigational by the FDA. A substance use history is part of what gets assessed beforehand, and published guidance treats it as a relative contraindication rather than an automatic bar. Nobody can hand you a yes or a no from a distance, but the structure can be described: given and monitored in the office, nothing dispensed to take home, someone you trust driving you home. If you have not called because you assumed the answer was decided, it is not.
Talk with us
If you are in Fort Worth or the surrounding North Texas area and what you have read here sounds familiar, we would be glad to talk it through with you. The Institute for Advanced Psychiatry is an outpatient practice at 6800 Harris Parkway, Suite 100, treating adults 18 and older. You can request an appointment or call 817-659-7344.
If you are in crisis or thinking about harming yourself, please do not wait for an appointment. Call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7, or go to your nearest emergency room.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).
SAMHSA National Helpline: 1-800-662-HELP (4357) – free, confidential, 24/7, in English and Spanish, for treatment referral and information.
If someone may be overdosing, call 911. Naloxone reverses opioid overdose and is available without a prescription in Texas.
Stopping alcohol or benzodiazepines suddenly can be dangerous. Talk with a clinician before you stop, and go to an emergency room if you develop shaking, confusion, or seizures.
Sources
- Institute for Advanced Psychiatry. “Ketamine Infusion Therapy.” Accessed 2026. https://www.psychiatryfortworth.com/services/ketamine-infusion-therapy/
- Electronic Code of Federal Regulations. “21 CFR 1308.13 – Schedule III.” 2024 edition. https://www.ecfr.gov/current/title-21/section-1308.13
- DailyMed / U.S. National Library of Medicine. “KETALAR – ketamine hydrochloride injection (FDA-approved prescribing information).” Revised March 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14e8f864-8b8a-4e7e-8439-e510d3107063
- National Institute on Drug Abuse. “Ketamine (Research Topics).” Last updated April 9, 2024. https://nida.nih.gov/research-topics/ketamine
- National Institute on Drug Abuse. “Psychedelic and Dissociative Drugs (Research Topics).” Accessed 2026. https://nida.nih.gov/research-topics/psychedelic-dissociative-drugs
- Swainson J, et al. “The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder.” Canadian Journal of Psychiatry. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC7918868/
- McIntyre RS, et al. “Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation.” American Journal of Psychiatry. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC9635017/
- DailyMed / U.S. National Library of Medicine. “SPRAVATO – esketamine nasal spray (FDA-approved prescribing information).” Accessed 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d81a6a79-a74a-44b7-822c-0dfa3036eaed
- U.S. Food and Drug Administration. “Compounding Risk Alerts.” Alert dated October 10, 2023; index accessed 2026. https://www.fda.gov/drugs/human-drug-compounding/compounding-risk-alerts
- Grabski M, et al. “Adjunctive Ketamine With Relapse Prevention-Based Psychological Therapy in the Treatment of Alcohol Use Disorder.” American Journal of Psychiatry. 2022;179(2):152-162. https://europepmc.org/article/MED/35012326
- Rathore BS, Singh S, Gupta M, Verma P. “Safety and efficacy of ketamine for the treatment of patients with alcohol use disorder: a systematic review.” The American Journal of Drug and Alcohol Abuse. 2025. https://europepmc.org/article/MED/40773768
- National Institute on Drug Abuse. “Words Matter – Terms to Use and Avoid When Talking About Addiction.” Accessed 2026. https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction
- Substance Abuse and Mental Health Services Administration. “National Helpline.” Accessed 2026. https://www.samhsa.gov/find-help/helplines/national-helpline
- Institute for Advanced Psychiatry. “Diana Ghelber, MD.” Accessed 2026. https://www.psychiatryfortworth.com/providers/diana-ghelber-md/
Medical disclaimer
This article is for general education and is not medical advice, a diagnosis, or a treatment recommendation for any individual. Reading it does not create a physician-patient relationship. Treatment decisions, including whether any medication or procedure is appropriate for you, should be made with a qualified clinician who knows your history. Do not start, stop, or change a psychiatric medication without talking to your prescriber. If you are experiencing a medical or mental health emergency, call 911 or 988.