Ketamine is having an iceberg moment

More and more people are turning to ibogaine for support with ketamine dependency. In this personal reflection, our team member Nienke explores this growing trend, drawing from her own experience in life and at IbogaQuest.

Originally published on her Substack, Aporia Lab: https://aporialab.substack.com

What exactly are we looking at when seeing this white powdery bump?

That tiny tip above the water’s surface, suggesting a vast, unseen mass below…

It’s an interesting substance, ketamine, and one I enjoyed for many years, with friends at raves, festivals, parties, and occasionally in more intimate settings, in a cosy room with a lover. Used recreationally, it offers a unique experience: a feeling of dissociation, sometimes accompanied by psychedelic visions, it can change your perception of music, time, your own body, and even a simple conversation. I think it’s one of the hardest drugs to describe, as each time the experience is a little different.

Entering a K-hole after a large dose can feel like you’re entering another dimension. I remember one time when I thought I’d died and was trapped in a liminal space where sounds and shapes twisted into incomprehensible forms. For a moment, I was terrified I’d never return to normality. I did, and was fascinated. My first encounter with it was in a nightclub in Berlin about 15 years ago, where it had been part of the party scene for years. I don’t remember it being the most popular drug back then. But fast forward to today, ketamine is everywhere, back in Europe, here in Mexico, and especially in the U.S. it has become ubiquitous. What interests me most is how its use has evolved. In recent years, I’ve seen it spread far beyond the party scene. Friends who once used it occasionally now use it at home more frequently, first during the week, then almost daily.

This shift seems to be partly influenced by ketamine’s changing reputation. Initially developed as a dissociative anesthetic for use in medical procedures, and later used as a recreational party drug, it’s now being marketed and prescribed as a “therapeutic tool” for a wide range of mental health issues. The mere speed at which it has been legalized and made widely available for mental healthcare, coupled by a flood of clinical research papers proclaiming its benefits, should ring some alarm bells.

How to start a crisis

Didn’t we see something similar happen with opioids? Once celebrated as the next big solution for all pain management and mental health issues, they were quickly embraced and overprescribed without scrutiny, based on research that was still emerging. The risks of misuse and dependence were extremely underestimated. We all know how that ended: with an opioid crisis still sprialling further into societal doom. With people reaching for “replacements” such as Kratom and Fentanyl, in order to be able to deal with life.

While ketamine is distinct from opioids, there are notable similarities worth considering. Pharmaceutical marketing has played a significant role in normalizing its use and driving its acceptance within the medical and therapeutic community, despite ongoing and still-emerging research. Additionally, the potential for misuse and dependence appears to be similarly underestimated.

While opioids are physically highly addictive, it’s said that ketamine is “just” psychologically so, but as we’re slowly finding out, it can be much harder to quit than initially thought. I am writing this not based on large databases, but on firsthand observations in the field of addiction treatment, and discussions with colleagues worldwide. Cases of severe ketamine addiction are increasingly entering treatment spaces – and are surprisingly hard to treat.

Again, I acknowledge that the analogy with opioids isn’t perfect, but my point is to issue a warning: embracing a substance without fully understanding its long-term effects is risky. What we currently know about ketamine’s impact may be just the tip of the iceberg. While the risks of bladder and kidney damage are well documented, other concerns, such as tolerance buildup, addiction potential, and cognitive impairment, remain underexplored and could be more significant than we realize.

K on the brain

I am not a neuroscientist, but after speaking with some, I understand that ketamine works by rapidly interrupting communication between different brain regions. Its primary mechanism is blocking NMDA receptors, which play a crucial role in glutamate signaling, a neurotransmitter essential for learning, memory, and mood regulation. This disruption temporarily disconnects different areas of the brain, particularly within the default mode network (DMN): a system linked to self-referential thinking, rumination, and negative thought loops, which are often overactive in depression.

This disconnection can bring relief, offering a break from rigid thought patterns and overwhelming emotions. Many describe it as a feeling of lightness, detachment, or a shift in perspective. However, at its core, this process is not just a break from negative patterns, it is a disintegration of the usual connections between emotions, thoughts, bodily sensations, and the meaning we assign to them.

Disconnection vs. integration

While a short period of disconnection can be useful, long-term mental and physical well-being rely on integration, and the ability to connect our emotions, thoughts, and bodily sensations into a coherent narrative. As Dan Siegel, a psychologist and pioneer of interpersonal neurobiology, emphasizes, mental health depends on a well-integrated mind, where different aspects of experience come together in a meaningful and embodied way.

While ketamine creates a window of neuroplasticity, which offers an opportunity to reorganize one’s mental landscape, this process is not inherently positive. As a state of heightened plasticity is only as beneficial as what fills it. Without conscious intention, it can lead to prolonged fragmentation rather than healing, especially when you keep using ketamine during this vulnerable period.

The risk is that instead of using this neuroplastic window to rebuild a more integrated sense of self, one that aligns with who we are and how we want to exist in the world, one remains in a state of ongoing disconnection. I’ve wondered about this while observing frequent users, when their values, words and actions seemed to become increasingly misaligned. Of course, that’s a common human flaw, but in these cases, it started to feel like a pattern. I noticed people becoming less self-aware, less congruent, and I couldn’t help but wonder what was happening in their brains.

A fragmented self

It seems that if ketamine is repeatedly used without an effort to reintegrate one's experiences, it can result in a disjointed sense of self, where emotions, thoughts, and bodily sensations remain disconnected rather than forming a cohesive whole. Over time, this can lead to dissociation rather than positive transformation, creating the illusion of change while reinforcing a fragmented state of mind.

While ketamine’s power lies in its ability to break patterns, its true therapeutic potential is realized only when that break is followed by intentional reintegration. Without this, disconnection becomes the default state rather than a temporary reset. And instead of fostering healing, it can actually deepen personal disintegration – but with less awareness of it.

Comfort culture cures

The thing is that we live in a comfort culture, where we’re taught that the goal is to feel good, to be happy and to avoid discomfort at all costs. We chase this through drugs, medications, technology, substances, experiences, relationships. Anything to distract ourselves from the discomfort of simply being with what is.

We escape from our anxiety of living in an uncertain social and political landscape. From our existential unease of a culture of death denial, obsessed with material success and youth. We escape from the intensity of our emotions, of the sadness, grief and fear that we have never been taught how to sit with. And we try to escape from the discomfort of facing ourselves, our flaws, our pain, our past, our limitations. From the overwhelm of heartbreak, loss, powerlessness, and the rapid changes of the world. We really try.

In this context, ketamine’s rise in popularity makes sense. It offers a quick break, a fast reset, an easy escape from the weight of existence. It dissociates us from ourselves, and in a world that feels unbearable at times, this can be incredibly appealing. And I get it. I can use this, too.

But let’s not romanticize it. Let’s not pretend this is what healing looks like. Healing is not about disconnection, nor is it about avoiding discomfort. Real transformation comes from the opposite, from learning to expand our window of tolerance for the full spectrum of human experience.

Staying with what is

What will serve us more than escape is learning how to be present with discomfort rather than running from it. It means sitting with pain, sadness, grief, and uncertainty, instead of numbing them. It requires cultivating compassion, for ourselves and for others. And calls for asking for help and building supportive communities rather than relying on chemical detachment. It invites us to engage fully with life, rather than seeking to dull our sensations. And asks us to face reality, not to be consumed by it, but to hold it with awareness, perspective, and humor.

To heal, we must develop our capacity to be with what is, rather than constantly searching for ways to alter it. We must learn how to laugh and cry at the same time, embrace paradox and hold the absurdity of life without needing to escape from it.

Tricks and tools

While ketamine can be fun and temporarily helpful. Let’s not mistake it for something else, for something more profound. Let’s not call it deep healing when it is, at best, a tool that requires conscious integration to be meaningful at all. Because in the end, it’s just another little trick, one that might offer a fleeting sense of relief, but won’t save us from the work of being fully human.

As a part of me keeps wanting to play with it, to enter moments of fun or disruption at a party, to explore what the mind does when you mess with its mechanics, to see what happens when you disrupt its usual patterns, to observe and to experiment. It makes me sad to see the growing number of people struggling with ketamine addiction.

Many started with innocent intentions, recreationally, or even “spiritually,” as they say. Others were prescribed it by doctors, receiving the unassuming nasal spray right to their door. For some, reality has simply become too painful to endure, and now they find themselves unable to stop.

I’m left with a sense that this isn’t the path we should be taking, and I find myself grappling with conflicting emotions about this substance. There's fascination, curiosity, and understanding for it, but also a growing sense of unease. It makes me ask myself: How can we, as humans, return to simply being with what is, without the need to escape, intensify, or disrupt?

When looking at ketamine, we can see its white, powdery top rising above the surface – hiding what I think might be a far more complex existential issue, one that is lurking out of sight but has been quietly and persistently making its way toward us.