Researchers from University of California San Diego School of Medicine have found that adding ketamine to a mindfulness-based treatment for opioid use disorder may strengthen people's ability to recognize and respond to signals from their bodies — changes that may help reduce opioid cravings. The study, published on Nov. 5, 2026 in the Journal of Psychopharmacology, provides new insight into how ketamine-assisted psychotherapy may enhance addiction treatment.
"Addiction can make it extraordinarily difficult for people to recognize what is happening inside their bodies and respond in ways that support recovery," said Eric Garland, PhD, professor of psychiatry at UC San Diego School of Medicine and senior author. "Our findings suggest ketamine combined with mindfulness may create an opportunity for people to become more attuned to those internal signals and, importantly, learn how to respond to them more skillfully rather than automatically reacting to cravings."
The new findings build on a randomized clinical trial published in Nature Mental Health in March 2026 (titled: Ketamine-assisted Mindfulness-Oriented Recovery Enhancement for opioid use disorder: a randomized controlled trial ). The trial included 68 adults with opioid use disorder who were taking buprenorphine, one of the most effective medications for treating opioid use disorder. Participants were randomly assigned to receive either Mindfulness-Oriented Recovery Enhancement (MORE) alone or MORE combined with two sessions of ketamine-assisted psychotherapy.
MORE is an eight-week, evidence-based, mind-body therapy developed by Garland that combines mindfulness with techniques designed to help people reframe stressful experiences and savor positive experiences and emotions. Previous clinical trials have found that MORE reduces opioid misuse by 45% — nearly three times more effective than supportive psychotherapy — and among people receiving medication for opioid use disorder, reduces drug relapse by 42%.
In the Nature Mental Health study, the researchers found that participants who received MORE plus psychedelic doses of ketamine reported significantly fewer instances of drug use after treatment and lower opioid craving at the three-month follow-up than those who received MORE alone. Across the period from the end of treatment through the three-month follow-up, the ketamine group had 44% fewer instances of drug use. Ketamine-induced experiences such as a sense of oneness with the universe were associated with greater reductions in cravings. The new study examined why the combined treatment may have produced those benefits.
The researchers focused on interoception — the ability to sense, interpret and respond to signals coming from inside the body, such as changes in breathing, heart rate, tension or other physical sensations. These skills play an important role in emotional regulation, decision-making and self-control and may be disrupted in people with substance use disorders.
Throughout treatment and for one month afterward, participants received smartphone prompts three times a day asking how aware they were of sensations in their bodies at that moment. Researchers found that body awareness increased more rapidly among participants receiving MORE plus ketamine, with the gain in body awareness emerging around the time of the first ketamine session. Higher levels of body awareness were maintained through follow-up at the one month mark.
But simply noticing bodily sensations may not be enough. The researchers also found that participants receiving ketamine showed greater improvements in two specific abilities: listening to their bodies for useful information and using awareness of bodily sensations to regulate distress. Together, improvements in these abilities were associated with lower opioid cravings three months later, suggesting a potential pathway through which ketamine may enhance the therapeutic effects of mindfulness training.
"Craving isn't just a thought, it can be experienced throughout the body," Garland said. "Mindfulness teaches people to notice those sensations without immediately reacting to them. What these findings suggest is that ketamine-induced experiences may help accelerate or deepen that learning process, so bodily sensations can become useful information for self-regulation rather than triggers for drug use."
The researchers caution that the findings are preliminary. The new analysis relied on self-reported measures of body awareness and participants also knew they received the ketamine treatment. Larger studies using objective measures of how the brain and body process internal signals are needed to confirm the findings.
Future research could also investigate whether ketamine creates a temporary period in which the brain is especially receptive to learning new mindfulness and self-regulation skills, and whether those changes can produce longer-lasting reductions in cravings and drug use.
"The goal isn't simply to avoid cravings," Garland said. "It's to help people develop skills they can carry into everyday life — skills that allow them to recognize what their bodies are telling them, regulate difficult feelings and make choices that support recovery."
Read the full study: Ketamine, an interoceptive associative agent? Evidence from ketamine-assisted Mindfulness-Oriented Recovery Enhancement for opioid use disorder
Additional co-authors on the study include: Benjamin Lewis, MD, from the University of Utah.
The study was funded, in part, by a gift from Tanya and Richard Andrew. Garland was also supported by UG3DA062106, R01DA056537 and R01DA057631 from the National Institutes of Health.
Eric Garland is the director of UC San Diego ONEMIND (Optimized Neuroscience-Enhanced Mindfulness Intervention Design). UC San Diego ONEMIND provides MORE, mindfulness-based therapy and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Garland has received honoraria and payment for delivering seminars, lectures and teaching engagements (related to training clinicians in mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals and medical centers. Garland also receives royalties from the sale of books related to MORE. No other authors have any related conflicts of interest to disclose.
