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Psychedelics · 1992

Ketamine Psychedelic Therapy (KPT)

The psychedelic experience with ketamine transforms recovery when emotional and symbolic material is integrated into new meanings, values and life purposes.

Ketamine Psychedelic Therapy (KPT) is a model of ketamine-assisted psychotherapy developed by Evgeny M. Krupitsky, Alexander Ya. Grinenko and colleagues at the Leningrad Regional Dispensary of Narcology in Novoye Devyatkino, where the team began working clinically with KPT in 1985 and in 1992 published the formulation of Affective Contra-Attribution together with an explicit presentation of Ketamine Psychedelic Therapy. Its structure organises treatment into psychotherapeutic preparation, a psychedelic session with ketamine and subsequent integration. The early formulation combined personality-oriented psychotherapy, suggestion, dialogue during the altered state and aversive conditioning towards alcohol; as the programme developed, the authors described psychodynamic, hypnosuggestive, existential and transpersonal mechanisms and gave increasing weight to catharsis, the reduction of defences, symbolic access to conflicts and personality problems, the transformation of non-verbal emotional attitudes, the reorganisation of the self-concept, the clarification of life meaning and values, and the integration of mystical or transpersonal experiences. In later applications to heroin dependence, the psychotherapy was defined explicitly as existentially oriented and centred on building a meaningful life and a stable motivation towards abstinence. Ketamine + existential, psychodynamic and behavioural work, especially in addictions. The historical method was developed within a medical frame with clinical selection, consent, the presence of an anaesthetist during administration, music, support from the psychotherapist and integration work; its early results were promising in alcoholism and heroin dependence, although contemporary systematic review underlines the methodological heterogeneity of the literature on ketamine-assisted psychotherapy and the absence of definitive evidence for a specific synergy between ketamine and psychotherapy.

Theory of change

The person changes when an intense psychedelic experience makes deep conflicts, attitudes and meanings accessible and these are integrated into a self, a set of values and a life direction compatible with sobriety.

Core ideas

  1. The psychedelic experience is used as an amplifier of psychotherapy

    KPT was conceived as a treatment in which ketamine creates an extraordinary state capable of intensifying emotion, imagery, disidentification and openness to clinically relevant material, while psychotherapy provides preparation, direction and integration. The model attributes change to the way that state is embedded within a therapeutic structure and not solely to the pharmacological administration. The later heroin studies reinforced this conception by comparing a psychedelic dose with a sub-psychedelic dose while maintaining the same psychotherapy, although the contemporary literature continues to note that the specific contribution of psychotherapy and its possible synergy with ketamine require more rigorous research. (Krupitsky & Grinenko, 1996, 1997; Krupitsky et al., 2002; Veraart et al., 2026).

  2. The therapeutic set organises the meaning of the session

    Preparation does not function merely as information about risks or expected effects. Krupitsky and Grinenko hold that the "psychotherapeutic myth" or individualised set becomes one of the most important factors in determining the psychological content of the session, because it links motives, goals of sobriety, the personal theory of the dependence, conflicts and expectations to a shared therapeutic narrative. The psychedelic state is thus understood as highly dependent on the framework built before administration and on trust in the therapist. (Krupitsky & Grinenko, 1996, 1997; Krupitsky et al., 2002).

  3. Emotional intensity can turn an abstract understanding into a personally convincing experience

    KPT starts from the idea that many patients already know intellectually the destructive consequences of their addiction and that, even so, this understanding does not sufficiently modify their emotional attitudes. The psychedelic experience concentrates fear, loss, symbolic death, relief, rebirth or other states into scenes of great intensity and allows problems previously dealt with rationally to acquire an immediate affective quality. Catharsis and emotional peaks are considered mechanisms that can make new orientations towards sobriety deeper and more memorable. (Krupitsky et al., 1992; Krupitsky & Grinenko, 1996, 1997).

  4. Change includes reducing the discordance between conscious and implicit emotional attitudes

    One of the programme's most original features is its interest in the discrepancy between what the patient states verbally and what their non-verbal emotional organisation shows towards alcohol, sobriety, self, therapist and family members. Studies using the Color Test of Attitudes and the Personality Differential showed a greater convergence between the two levels after KPT, and the authors interpreted this reduction of dissonance as a sign that sobriety had ceased to be merely a declared position and had acquired a deeper emotional acceptance. (Krupitsky & Grinenko, 1996, 1997, 1998).

  5. The symbolic material relates to conflicts and personality problems

    The authors observed that, despite certain recurrent themes, experiences under ketamine tended to be organised idiosyncratically around the patient's history and problems. KPT interprets that specificity from a psychodynamic perspective: the reduction of defences and the appearance of emotionally saturated images can make poorly conscious conflicts and attitudes accessible, and therapy must help relate that material to real life. Subsequent integration completes this process by turning symbols and insights into comprehensible and usable formulations. (Krupitsky et al., 1993; Krupitsky & Grinenko, 1996, 1997).

  6. The early formulation combined psychedelia and aversive conditioning

    The Affective Contra-Attribution of 1992 attempted to resolve a clinical tension: aversion therapy could create physical rejection of alcohol without sufficiently modifying personal attitudes, while psychedelic psychotherapy could transform attitudes without generating a specific aversive association with the substance. The procedure combined both logics by making alcohol cues coincide with an intensely negative psychedelic experience and then reinforcing their meaning in group psychotherapy. This behavioural layer belongs to the historical origin of KPT and makes it possible to understand why the initial model is more directive and aversive than its later developments. (Krupitsky et al., 1992; Krupitsky et al., 1993; Krupitsky & Grinenko, 1996).

  7. KPT evolved towards an explicitly existential psychotherapy

    As the programme accumulated clinical experience, the focus widened from aversion to alcohol towards questions of identity, values, purpose and meaning. Krupitsky and Grinenko used Frankl's framework to interpret the loss of meaning associated with dependence and studied changes by means of the Purpose-in-Life Test; in the heroin trials the psychotherapy was explicitly described as existentially oriented and intended to help the patient formulate a purposeful life and a personal motivation towards abstinence. (Krupitsky & Grinenko, 1996, 1997, 1998; Krupitsky et al., 2002, 2007).

  8. Transpersonal experience can reorganise values and worldview

    KPT integrates within its theory experiences of transcendence, unity, ego dissolution, death-rebirth and spiritual connection, and regards them as potentially capable of modifying the relationship with life, death, the self and values. The authors linked this dimension to Grof, transpersonal psychology, near-death experiences and the literature on spiritual recovery in addiction. The clinical formulation uses these experiences as material for integration and a change of perspective, while their metaphysical interpretation remains beyond what the studies can demonstrate empirically. (Krupitsky et al., 1993; Krupitsky & Grinenko, 1996, 1997, 1998).

  9. Integration transforms an exceptional experience into everyday change

    KPT reserves a specific stage to prevent the session from remaining an intense but isolated episode. The written account, the individual or group discussion and the clinical interpretation seek to connect images and insights with dependence, relationships, self-concept, values, purpose and real decisions. Integration functions as a bridge between experience and behaviour: it selects which meanings can be incorporated into the biography, which attitudes need consolidating and what concrete changes will sustain a substance-free life. (Krupitsky et al., 1992; Krupitsky & Grinenko, 1996, 1997; Krupitsky et al., 2002).

  10. Recovery identity is a central mechanism of consolidation

    KPT's psychosemantic studies show that change is not limited to rejecting a substance: the representation of "me now" can move away from the drinker identity and closer to images of recovery, the ideal self and the future. The authors interpreted these shifts, together with a more internal locus of control and greater ego strength or self-sufficiency, as signs that the person is beginning to experience themselves as the author of a sober life. Identity reorganisation connects meaning, motivation and behaviour and constitutes one of the programme's most specific mechanisms. (Krupitsky & Grinenko, 1996, 1997, 1998; Krupitsky et al., 2002).

Influences

  • Psychedelic psychotherapy
  • Psychodynamic psychotherapy
  • Hypnosuggestive psychotherapy
  • Behaviour therapy and aversive conditioning
  • Personality-oriented psychotherapy
  • Logotherapy
  • Transpersonal psychology

Key references

  • Krupitsky, E. M., Grinenko, A. Ya., Berkaliev, T. N., Paley, A. I., Petrov, V. N., Moshkov, K. A., & Borodkin, Yu. S. (1992). The combination of psychedelic and aversive approaches in alcoholism treatment: The affective contra-attribution method. Alcoholism Treatment Quarterly, 9(1), 99–105. https://doi.org/10.1300/J020V09N01_09.
  • Krupitsky, E. M. (1992). Ketamine psychedelic therapy (KPT) of alcoholism and neurosis. MAPS Newsletter, 3(4), 24–28.
  • Krupitsky, E. M., Paley, A. I., Berkaliev, T. N., Ivanov, V. B., Dubrovina, O. O., Kozhnazarova, D. A., Dunaevsky, I. V., Rzhankova, E. B., & Grinenko, A. Ya. (1993). Ketamine-assisted psychedelic therapy. International Journal of Transpersonal Studies, 12(2), 56–59.
  • Krupitsky, E. M., & Grinenko, A. Ya. (1996). Ketamine psychotherapy: Results and mechanisms. International Journal of Transpersonal Studies, 15(2), 32–66.
  • Krupitsky, E. M., & Grinenko, A. Ya. (1997). Ketamine psychedelic therapy (KPT): A review of the results of ten years of research. Journal of Psychoactive Drugs, 29(2), 165–183. https://doi.org/10.1080/02791072.1997.10400185.
  • Krupitsky, E. M., & Grinenko, A. Ya. (1998). Ten year study of ketamine psychedelic therapy (KPT) of alcohol dependence. The Heffter Review of Psychedelic Research, 1, 56–61.
  • Krupitsky, E. M., Burakov, A. M., Romanova, T. N., Dunaevsky, I. V., Strassman, R. J., & Grinenko, A. Ya. (2002). Ketamine psychotherapy for heroin addiction: Immediate effects and two-year follow-up. Journal of Substance Abuse Treatment, 23(4), 273–283. https://doi.org/10.1016/S0740-5472(02)00275-1.
  • Krupitsky, E. M., Burakov, A. M., Dunaevsky, I. V., Romanova, T. N., Slavina, T. Y., & Grinenko, A. Ya. (2007). Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence. Journal of Psychoactive Drugs, 39(1), 13–19. https://doi.org/10.1080/02791072.2007.10399860.
  • Frankl, V. E. (1978). The Unheard Cry for Meaning. New York: Simon & Schuster.
  • Grof, S. (1990). The impoverished soul: Addiction as spiritual emergency. Spiritual Emergency Network, 2(1), 20–29.
  • Veraart, J. K. E., Schimmers, N., Breeksema, J. J., Seybert, C., Kamphuis, J., Huber, L. F. T., Rota, A., Coerts, D. T., Oliveira-Maia, A. J., & Schoevers, R. A. (2026). Ketamine-assisted psychotherapies for mental disorders: A historical overview and systematic review. Clinical Psychology Review, 124, 102706. https://doi.org/10.1016/j.cpr.2026.102706.