Reflection
Ketamine Addiction: What the UK Data Shows, and What I Hear in the Room
Three official figures about ketamine in the UK do not fit together, and the way they fail to fit is the whole story.
Prevalence has barely moved. The Crime Survey for England and Wales found that around 2% of people aged 16 to 24 had used ketamine in the last year — with no statistically significant change compared with the previous year, or with a decade earlier. Across all adults aged 16 to 59, an estimated 264,000 people used it in 2024/25, against 160,000 ten years before.
Consumption has risen enormously. The Home Office measures drugs in wastewater, which does not depend on anyone admitting anything. That programme estimates 30,800 kg of ketamine consumed in England between August 2024 and July 2025, and consumption up 229% from 2021 to 2025 — the largest increase of any drug it tests.
Treatment demand has multiplied. In 2024/25, 5,365 adults entered treatment in England with a ketamine problem. In 2014/15 the figure was 426. That is more than twelve times higher in a decade.
Roughly the same proportion of people are using it. They are using far more of it, and far more of them are asking for help.
That is not a story about a drug spreading. It is a story about a drug changing function — from something taken occasionally at the end of a night to something taken regularly, alone, for a reason.
The rest of the picture
Among children aged 17 and under in treatment services in England, 1,465 reported problems with ketamine in 2024/25, up from 512 in 2021/22. For the first time, more children reported problems with ketamine than with ecstasy.
Registered deaths involving ketamine rose from 18 in 2014 to 60 in 2024. A University of Hertfordshire study estimated that deaths following illicit ketamine use in England, Wales and Northern Ireland increased roughly ten-fold over the same period, from 15 to a projected 197. Most involved other substances taken at the same time.
In January 2026 the Advisory Council on the Misuse of Drugs published its updated harms assessment and recommended that ketamine remain a Class B drug rather than move to Class A. The decision was not unanimous. Among its fourteen further recommendations was that drug services be linked with mental health services and with specialist urology and pain management.
That last recommendation is the one I would draw attention to, because it describes the clinical reality better than the classification debate does. The people I see are not primarily a policing problem. They are people whose drug use and whose mental health are the same subject.
Two different people, one drug
In practice, ketamine arrives in the consulting room in two quite different forms.
The first is recreational, and behaves like most recreational drug use. What people describe wanting is a floaty, dreamy, slightly drunk, sometimes giggly state, along with a distortion of time, space and sound. It is sought socially, at particular occasions, and for most people it stays there.
The second is not that at all, and it is the group that ends up in treatment. These are heavy users, and almost without exception they are medicating something. Anxiety, depression, intrusive thought, an unprocessed trauma history, or simply an inner state they have never had any other means of altering.
The distinction matters because the two look identical from outside and are entirely different underneath. One is a pleasure. The other is a solution.
Chaos and cosmos
There is a way this state gets described that says more than any clinical definition.
Inside, there is chaos. The ketamine takes the chaos away, and puts me in touch with my cosmos.
Ask what cosmos means, and the answer comes back as something close to: it is the only time I feel at peace with myself in the world.
It is worth staying with those two words, because they are the oldest pair we have for this. Cosmos does not mean space. It means ordered world — the opposite of chaos, and the thing that comes out of it. Every creation myth is that same movement, from formlessness into order.
What is being described is a psyche that cannot produce its own order, borrowing order from a chemical. And the description is usually clear-eyed about the trade: for the length of the drug, the world has a shape.
That is a far more serious problem than wanting to feel good, and it explains why telling such a person that ketamine is harmful achieves so little. They already know. What they have not been offered is order that does not have to be bought.
Melting into the surroundings
There is a second description that recurs, and it belongs beside the first: the impression of melting into the surroundings.
The boundary between the person and the room stops being firm. They are not observing the world from inside a body so much as diffusing into it. This is usually reported as relief rather than alarm.
It is worth taking seriously as something other than a pharmacological curiosity. If the burden is being a separate self — holding an internal chaos that nobody else can see and nobody else can help with — then dissolving the boundary is not a strange thing to want. It is the most direct relief imaginable. You cannot be overwhelmed by an inner world if there is no longer a clear line around it.
In a 1961 letter to Bill Wilson, Jung described the craving for alcohol as a low-level equivalent of the spiritual thirst for union: spiritus contra spiritum, one spirit set against the other. I have written about that thirst for oneness elsewhere, because I think it sits under a great deal of addiction.
Ketamine makes the equivalence unusually literal. Most substances gesture at the loss of separateness. This one produces it, chemically, in about twenty minutes.
Which is precisely why it disappoints. The union does not survive the drug wearing off. What comes back is the separate self, unchanged, and now accompanied by the bladder, the memory problems and the hours that went missing.
Cutting the noise
Most heavy users describe something close to this in plainer language. They talk about cutting the noise in their head.
Anyone who has read what I have written about food noise will recognise the structure. It is the same complaint: an internal commentary that will not stop, and a substance or behaviour that briefly turns the volume down. Ketamine is unusually good at this, which is precisely the danger. It is not a blunt sedative. It removes the sense of being the one having the thoughts.
Ketamine taken before a job interview is not an unusual account: used because the anxiety was otherwise unmanageable, by someone who knew perfectly well it was a bad idea and did it anyway. That gap, between knowing and doing, is where the clinical work actually lives.
Note what that use is not. It is not escape from life. It is an attempt to participate in life — to get through the interview, to be in the room, to function. That is the same pattern I see in high-functioning professionals with alcohol and cocaine, and it is why the word recreational misleads so badly.
Why dissociation is the particular difficulty
Every substance stands in for something. Alcohol stands in for relaxation, cocaine for confidence, opiates for comfort. Ketamine is different in a way that matters clinically.
Ketamine is a dissociative. It produces detachment from the body, distance from experience, the sense of watching from slightly outside. That is not a novel state for a person with a trauma history. It is the state their psyche has been producing on its own, without permission, since childhood — the defence that made something unbearable survivable at the time.
So the drug does not offer them a new experience. It offers them reliable, on-demand access to their oldest defence.
This is why it takes hold so fast in this group, why “just stop” is even less useful here than usual, and why the work cannot only be about the substance. If dissociation is the problem and dissociation is the solution, then removing the drug without addressing the underlying capacity to be present simply returns the person to the unmedicated version of the same state — which is the state they were trying to get away from. That is also why trauma-focused work, including EMDR, is often central rather than optional here.
The paradise closes
What follows is the same in every addiction, and it is worth setting out plainly, because almost nobody using ketamine believes it will apply to them.
The state that arrived easily at the beginning stops arriving. Tolerance to ketamine builds quickly, so the dose that produced calm produces less, and then produces almost nothing. The dissociation becomes harder to reach, and reaching it costs more.
Craving moves into the space that opens between doses. That is a new problem, and it did not exist before the solution did.
Then the body begins to object. Alongside the bladder damage, chronic users describe severe abdominal pain, what they call K-cramps, which becomes its own reason to use again, since ketamine is an anaesthetic.
And the mood, which was very often the original complaint, becomes markedly worse. Not slightly worse. Unstable in a way it was not before, with memory and concentration degrading alongside it.
So the reason for taking it is the first thing lost. The person is left using a drug for a purpose it has stopped serving, while carrying every consequence of having used it. That is not a moral failure and not an absence of willpower. It is the ordinary shape of dependence, and it is why why don’t you just stop, you can see it isn’t even working any more misunderstands the situation so completely.
Baudelaire called it the artificial paradise. The clinical version is blunter: the artificial paradise becomes a real hell.
What the body records
Ketamine keeps an account in the bladder, and this is the harm most specific to it.
Regular use can damage the urinary tract and bladder, causing pain, bleeding and incontinence, and in severe cases requiring surgery to repair or remove the bladder. Alder Hey opened the first NHS clinic for under-16s with ketamine-induced uropathy in July 2025. European urologists have begun describing ketamine cystitis as a new epidemic in their field.
I state that plainly and then leave it, because frightening people is not a treatment and shame is a large part of why they arrive late. The clinically useful point is the opposite of a warning: symptoms can improve when use stops early. Pain on urinating, urgency, or blood in the urine after regular ketamine use is a reason to be seen medically now rather than when it becomes undeniable.
The awkward fact
Ketamine is also a medicine, and anyone writing honestly about it has to say so.
Ketamine and esketamine are used in controlled clinical settings for treatment-resistant depression — measured doses, monitoring, and psychological work built around them. People who use ketamine heavily are often perfectly aware of this, and will raise it, reasonably enough.
The distinction is not the molecule. It is the dose, the setting, and whether anything is being worked with afterwards. A supervised intervention designed to open a window for psychological work is a different activity from taking an unmeasured street drug alone at three in the morning to make a feeling go away. But the argument is more honest, and lands better, if it is made in those terms rather than by pretending the medical use does not exist.
What treatment involves
The physical side needs medical attention, particularly where there are urinary symptoms, and I will say so at assessment.
The psychological side begins with a question that is rarely asked of people who use ketamine: what does it do for you? Not what does it do to you, which everybody has already told them. What state does it remove. What does it make bearable. What was happening in the hours before, on the days it seemed necessary.
Stopping is the start of the work rather than the conclusion of it. The chaos does not leave with the drug. Someone has to sit with the person while they find out whether order can be arrived at rather than purchased — and that takes weekly sessions, with the same clinician, over a period that is honest about how long these things take.
I have said elsewhere that helping someone stop is the easy part, and that the hard part is helping them build something worth staying sober for. With ketamine I would put it slightly differently. The hard part is helping someone discover that their own cosmos was never actually in the drug.
The descriptions in this article are composites, drawn from how this state is commonly spoken about in clinical work. They are not accounts of any individual.
Dr Philippe Jacquet is a UKCP registered psychotherapist, Jungian analyst and Hazelden-trained addiction specialist. He worked inside private residential addiction treatment for nine years and has supervised clinical teams in residential addiction treatment and a private psychiatric hospital for over five. He offers addiction counselling in central London and online.
If ketamine use has become something you manage rather than choose, a first conversation is a discussion about what is actually happening, not an assessment against criteria.
