{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:46:12Z","timestamp":1782301572779,"version":"3.54.5"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u2018psychological space\u2019. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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 \u2018psychological space\u2019 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1873497","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T10:46:42Z","timestamp":1782298002000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating \u2018k-land\u2019: a qualitative exploration of participants\u2019 experiences of ketamine-assisted psychotherapy for methamphetamine use disorder"],"prefix":"10.3389","volume":"17","author":[{"given":"Kathryn","family":"Fletcher","sequence":"first","affiliation":[{"name":"The National Centre for Clinical Research on Emerging Drugs, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Alcohol and Drug Service, St Vincent\u2019s Hospital","place":["Sydney, NSW, Australia"]},{"name":"The National Drug and Alcohol Research Centre, University of New South Wales","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Ezard","sequence":"additional","affiliation":[{"name":"The National Centre for Clinical Research on Emerging Drugs, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Alcohol and Drug Service, St Vincent\u2019s Hospital","place":["Sydney, NSW, Australia"]},{"name":"The National Drug and Alcohol Research Centre, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Drug and Alcohol Clinical Research and Improvement Network, NSW Health","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista J.","family":"Siefried","sequence":"additional","affiliation":[{"name":"The National Centre for Clinical Research on Emerging Drugs, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Alcohol and Drug Service, St Vincent\u2019s Hospital","place":["Sydney, NSW, Australia"]},{"name":"The National Drug and Alcohol Research Centre, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Drug and Alcohol Clinical Research and Improvement Network, NSW Health","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"van der Helder","sequence":"additional","affiliation":[{"name":"The National Centre for Clinical Research on Emerging Drugs, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Alcohol and Drug Service, St Vincent\u2019s Hospital","place":["Sydney, NSW, Australia"]},{"name":"The National Drug and Alcohol Research Centre, University of New South Wales","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Freestone","sequence":"additional","affiliation":[{"name":"The National Centre for Clinical Research on Emerging Drugs, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"The National Drug and Alcohol Research Centre, University of New South Wales","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Brett","sequence":"additional","affiliation":[{"name":"St Vincent\u2019s Clinical School, School of Population Health, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Clinical Pharmacology and Toxicology, St Vincent\u2019s Hospital Sydney","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"May","sequence":"additional","affiliation":[{"name":"Drug and Alcohol Clinical Research and Improvement Network, NSW Health","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Acheson","sequence":"additional","affiliation":[{"name":"The National Centre for Clinical Research on Emerging Drugs, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Alcohol and Drug Service, St Vincent\u2019s Hospital","place":["Sydney, NSW, Australia"]},{"name":"The National Drug and Alcohol Research Centre, University of New South Wales","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Clifford","sequence":"additional","affiliation":[{"name":"The National Centre for Clinical Research on Emerging Drugs, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Alcohol and Drug Service, St Vincent\u2019s Hospital","place":["Sydney, NSW, Australia"]},{"name":"The National Drug and Alcohol Research Centre, University of New South Wales","place":["Sydney, NSW, Australia"]},{"name":"Drug and Alcohol Clinical Research and Improvement Network, NSW Health","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2020.0246","article-title":"Neurobiology, clinical presentation, and treatment of methamphetamine use disorder: A review","volume":"77","author":"Paulus","year":"2020","journal-title":"JAMA Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1111\/add.14434","article-title":"Which individual, social and environmental influences shape key phases in the amphetamine type stimulant use trajectory? A systematic narrative review and thematic synthesis of the qualitative literature","volume":"114","author":"O'Donnell","year":"2019","journal-title":"Addiction"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(16)00104-8","article-title":"Neurobiology of addiction: A neurocircuitry analysis","volume":"3","author":"Koob","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1511480","article-title":"Neurobiologic advances from the brain disease model of addiction","volume":"374","author":"Volkow","year":"2016","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurot.2025.e00770","article-title":"Novel neurotherapeutic targets for substance use disorders: Neuroplasticity, neuroinflammation, gasotransmitters and non-canonical organ systems","volume":"22","author":"Sharma","year":"2025","journal-title":"Neurotherapeutics"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.63.8.856","article-title":"A\u00a0randomized trial of an n-methyl-d-aspartate antagonist in treatment-resistant major\u00a0depression","volume":"63","author":"Zarate","year":"2006","journal-title":"Arch Gen Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1038\/s41386-023-01629-w","article-title":"Ketamine and rapid antidepressant action: New treatments and novel synaptic signaling mechanisms","volume":"49","author":"Krystal","year":"2024","journal-title":"Neuropsychopharmacology"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3390\/ijms19102888","article-title":"Eradicating suicide at its roots: Preclinical bases and clinical evidence of the efficacy of ketamine in the treatment of suicidal behaviors","volume":"19","author":"De Berardis","year":"2018","journal-title":"Int J Mol Sci"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2174\/1568026620666200131100316","article-title":"An update on glutamatergic system in suicidal depression and on the role of esketamine","volume":"20","author":"De Berardis","year":"2020","journal-title":"Curr Top Med Chem"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.18101123","article-title":"A\u00a0single ketamine infusion combined with mindfulness-based behavioral modification to treat cocaine dependence: A randomized clinical trial","volume":"176","author":"Dakwar","year":"2019","journal-title":"Am J Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S360733","article-title":"Ketamine assisted psychotherapy: A systematic narrative review of the literature","volume":"15","author":"Drozdz","year":"2022","journal-title":"J Pain Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.07.030","article-title":"Active mechanisms of ketamine-assisted psychotherapy: A systematic review","volume":"315","author":"Joneborg","year":"2022","journal-title":"J Affect Disord"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2025.209705","article-title":"Role of ketamine in the treatment of substance use disorders: A systematic review","volume":"175","author":"Janssen-Aguilar","year":"2025","journal-title":"J Subst Use Addict Treat"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2026.102706","article-title":"Ketamine-assisted psychotherapies for mental disorders: A historical overview and systematic review","volume":"124","author":"Veraart","year":"2026","journal-title":"Clin Psychol Rev"},{"key":"B15","article-title":"Ketamine toxicity","volume-title":"Statpearls","author":"Orhurhu","year":"2026"},{"key":"B16","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/S2215-0366(17)30272-9","article-title":"Side-effects associated with ketamine use in depression: A systematic review","volume":"5","author":"Short","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.695335","article-title":"This is something that changed my life: A qualitative study of patients' experiences in a clinical trial of ketamine treatment for alcohol use disorders","volume":"12","author":"Mollaahmetoglu","year":"2021","journal-title":"Front Psychiatry"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/inm.13425","article-title":"How do people who undergo ketamine treatment for a psychiatric problem subjectively experience this intervention? A meta\u2010synthesis of qualitative studies","volume":"34","author":"Trimmel","year":"2025","journal-title":"Int J Ment Health Nurs"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1177\/0269881114565144","article-title":"Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study","volume":"29","author":"Bogenschutz","year":"2015","journal-title":"J Psychopharmacol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.2174\/1874473708666150107121331","article-title":"Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction","volume":"7","author":"Garcia-Romeu","year":"2014","journal-title":"Curr Drug Abuse Rev"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2020.1808982","article-title":"Ketamine-facilitated behavioral treatment for cannabis use disorder: A proof of concept study","volume":"47","author":"Azhari","year":"2021","journal-title":"Am J Drug Alcohol Abuse"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/s0740-5472(02)00275-1","article-title":"Ketamine psychotherapy for heroin addiction: Immediate effects and two-year follow-up","volume":"23","author":"Krupitsky","year":"2002","journal-title":"J Subst Abuse Treat"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2007.10399860","article-title":"Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence","volume":"39","author":"Krupitsky","year":"2007","journal-title":"J Psychoactive Drugs"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.psycr.2025.100259","article-title":"Qualitative analysis of a patient's experience of ketamine-assisted psychotherapy for substance use disorder: Empirical synergies with twelve-step programs","volume":"4","author":"Petrovitch","year":"2025","journal-title":"Psychiatry Res Case Rep"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2019.1587556","article-title":"Ketamine assisted psychotherapy (kap): Patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy","volume":"51","author":"Dore","year":"2019","journal-title":"J Psychoactive Drugs"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02791072.2025.2527299","article-title":"Understanding the experience of ketamine-assisted therapy and the importance of context","author":"Stockwell","year":"2025","journal-title":"J Psychoactive Drugs"},{"key":"B27","volume-title":"World Drug Report 2025: Global Instability Compounding Social, Economic and Security Costs of the World Drug Problem","year":"2025"},{"key":"B28","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.eclinm.2019.09.014","article-title":"Mental health outcomes associated with of the use of amphetamines: A systematic review and meta-analysis","volume":"16","author":"McKetin","year":"2019","journal-title":"EClinicalMedicine"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDra2300160","article-title":"Methamphetamine toxicities and clinical management","volume":"2","author":"Coffin","year":"2023","journal-title":"NEJM Evid"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-020-00711-x","article-title":"Pharmacological treatment of methamphetamine\/amphetamine dependence: A systematic review","volume":"34","author":"Siefried","year":"2020","journal-title":"CNS Drugs"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011866.pub3","article-title":"Psychosocial interventions for stimulant use disorder","volume":"2","author":"Minozzi","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-092504","article-title":"Protocol of an open-label safety and feasibility pilot study of ketamine-assisted psychotherapy for methamphetamine use disorder (the kappa trial)","volume":"15","author":"Fletcher","year":"2025","journal-title":"BMJ Open"},{"key":"B33","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s40814-015-0026-y","article-title":"Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: Guidance for researchers","volume":"1","author":"O\u2019Cathain","year":"2015","journal-title":"Pilot Feasibility Stud"},{"key":"B34","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-5583-7_311","article-title":"Conceptual and design thinking for thematic analysis","volume":"9","author":"Braun","year":"2022","journal-title":"Qual Psychol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1038\/nm.4050","article-title":"Synaptic plasticity and depression: New insights from stress and rapid-acting antidepressants","volume":"22","author":"Duman","year":"2016","journal-title":"Nat Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/s2215-0366(17)30015-9","article-title":"How do antidepressants work? New perspectives for refining future treatment approaches","volume":"4","author":"Harmer","year":"2017","journal-title":"Lancet Psychiatry"},{"key":"B38","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jcbs.2019.12.004","article-title":"The use of the psychological flexibility model to support psychedelic assisted therapy","volume":"15","author":"Watts","year":"2020","journal-title":"J Contextual Behav Sci"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2021.21030277","article-title":"Adjunctive ketamine with relapse prevention-based psychological therapy in the treatment of alcohol use disorder","volume":"179","author":"Grabski","year":"2022","journal-title":"Am J Psychiatry"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1727487","article-title":"Ketamine-assisted group psychotherapy integrating cognitive processing therapy to address identity-based trauma: A pilot study","volume":"16","author":"Sevelius","year":"2025","journal-title":"Front Psychiatry"},{"key":"B41","volume-title":"Drug, Set, and Setting: The Basis for Controlled Intoxicant Use","author":"Zinberg","year":"1984"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1177\/0269881108093587","article-title":"Human hallucinogen research: Guidelines for safety","volume":"22","author":"Johnson","year":"2008","journal-title":"J Psychopharmacol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1177\/0269881116677852","article-title":"Set and setting, psychedelics and the placebo response: An extra-pharmacological perspective on psychopharmacology","volume":"30","author":"Hartogsohn","year":"2016","journal-title":"J Psychopharmacol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1177\/0269881118754710","article-title":"Psychedelics and the essential importance of context","volume":"32","author":"Carhart-Harris","year":"2018","journal-title":"J Psychopharmacol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-anthro-102116-041539","article-title":"Fluid drugs: Revisiting the anthropology of pharmaceuticals","volume":"46","author":"Hardon","year":"2017","journal-title":"Annu Rev Anthropol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jsat.2004.06.001","article-title":"A conceptual framework for drug treatment process and outcomes","volume":"27","author":"Simpson","year":"2004","journal-title":"J Subst Abuse Treat"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002715","article-title":"Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis","volume":"15","author":"De Crescenzo","year":"2018","journal-title":"PloS Med"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2006.01312.x","article-title":"A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals","volume":"101","author":"Rawson","year":"2006","journal-title":"Addiction"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1021\/acsptsci.1c00034","article-title":"Combining psychedelic and mindfulness interventions: Synergies to inform clinical practice","volume":"4","author":"Payne","year":"2021","journal-title":"ACS Pharmacol Transl Sci"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2025.1505894","article-title":"Psychedelics assisting therapy, or therapy assisting psychedelics? The importance of psychotherapy in psychedelic-assisted therapy","volume":"16","author":"Zamaria","year":"2025","journal-title":"Front Psychol"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1873497\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T10:46:44Z","timestamp":1782298004000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1873497\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":50,"alternative-id":["10.3389\/fpsyt.2026.1873497"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1873497","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"1873497"}}