Understanding the Truth About Addiction, Tolerance, and Overdose Risks
At Harmony Harbor Counseling & Wellness, we understand that many people are curious about Ketamine-Assisted Psychotherapy (KAP)—while also carrying very real and understandable concerns.
Questions about safety, addiction, overdose, tolerance, and whether someone could “become dependent” on ketamine are legitimate. Much of the public conversation around ketamine has become clouded by headlines, misinformation, celebrity tragedies, recreational misuse, and fear-based narratives that often do not reflect how ketamine is actually used in a safe, medically monitored therapeutic setting.
One highly publicized example was the tragic death of Matthew Perry. While many people understandably associated his death with ketamine itself, reports indicated multiple contributing factors and circumstances involving misuse outside of a structured therapeutic environment. It is important to distinguish between unsupervised, recreational, or medically inappropriate use, versus carefully prescribed, medically monitored Ketamine-Assisted Psychotherapy delivered within ethical clinical care—they are simply not the same.
What is Ketamine Therapy?
Ketamine is a medication that has been used safely in medicine for decades. It has long been utilized in hospitals, emergency medicine, surgery, anesthesia, and pediatric care—even with infants and children—because of its strong safety profile when properly administered.
Today, ketamine is increasingly being used as therapeutic tool in the course of mental health treatment for conditions such as:
- Treatment-resistant depression
- PTSD and complex trauma
- Anxiety disorders
- Suicidal ideation
- OCD
- Chronic stress and burnout
- Emotional numbness or stagnation
- Difficulties not improving through “treatment as usual” (TAU)
At Harmony Harbor, we approach KAP through a trauma-informed, integrative, and neuroscience-informed lens. Our focus is not simply symptom suppression—but helping clients reconnect with themselves, process unresolved experiences, increase psychological flexibility, and support nervous system healing in a safe therapeutic container.
Often a course of KAP will include up to 6 to 8 microdoses of ketamine over the course of weeks to months. Some people improve with only one session and others may require more. Our approach includes wrap-around support from the client’s individual therapist with whom a trusting relationship is built.
The individual therapist follows the client through the entire process, from answering questions, the in-person medicine journey, and afterwards to help with the integration of the new perspectives and how they relate back to intentions and goals for therapy.
A Common Fear: “Can You Overdose?”
This is one of the most common questions people ask.
The reality is that ketamine has a very wide safety margin when prescribed appropriately and monitored medically. Unlike opioids or benzodiazepines, ketamine does not significantly suppress breathing or lung function at therapeutic doses. This is one reason it has historically been valued in anesthesia and emergency medicine.
In carefully prescribed therapeutic settings, the doses used are significantly different from dangerous recreational misuse scenarios. For example, many KAP protocols utilize a psychelytic dose—often around a 200 mg troche—which is designed to support therapeutic openness, nervous system flexibility, and emotional processing without necessarily inducing a full psychedelic experience. A more immersive psychedelic dose may be closer to a 400 mg troche—which is still considered a low dose—depending on the individual, metabolism, and prescribing physician’s assessment.
Importantly, ketamine is also rapidly metabolized by the body. The acute effects generally resolve within a relatively short period of time (usually under one hour), especially compared to many other psychiatric medications.
At Harmony Harbor, clients are first psychologically assessed for whether KAP would be a good fit for them. Then, clients are referred to a prescribing physician for medication clearance who the practice has vetted as not only specializing in prescribing ketamine, but also shares the value of the therapeutic process around KAP. With proper medical oversight and direction, we monitor blood pressure onsite and prioritize a calm, supportive, retreat-like therapeutic environment designed to promote safety and integration.
What About Addiction or Building a Tolerance?
This is another understandable concern, especially in a culture where many people have witnessed the devastating effects of addiction.
However, research and clinical experience suggest that when ketamine is used responsibly within a medically supervised therapeutic setting, the risk of addiction is relatively low for appropriately screened individuals and building a tolerance is not something that typically results from ketamine therapy. The reason for this is that the dosing provided in KAP is a microdose and is situated within a generously paced protocol. Clients may choose to explore with doses to see how it affects them, but this is not the same as building tolerance. In our outpatient setting, the “high” doses are still mild and safe.
Curiosity is not the same thing as tolerance or addiction.
A proper screening of addiction history is part of the KAP screening, and anyone in active addiction is not considered appropriate for KAP. Recreational misuse often involves repeated uncontrolled use, escalating doses, polysubstance use, or using ketamine to escape reality.
Therapeutic KAP is fundamentally different. Sessions are intentional, monitored, integrated into psychotherapy, and not prescribed for daily use. Clients who participate in KAP, are not typically taking ketamine continuously or ongoing for other purposes like pain or symptom management.
In light of this fundamental difference, current research is being conducted to explore ketamine’s potential to reduce cravings and addictive behaviors in some people struggling with alcohol dependence, substance use disorders, and compulsive patterns. Some individuals report that ketamine-assisted therapy eases the withdrawal process from other medications such as certain psychotropic medications by increasing emotional flexibility, decreasing despair, and helping the nervous system regulate during transitions. Please note, this should always be done under medical supervision and not independently.
How Ketamine Works in the Brain
Ketamine works differently than traditional antidepressants. In many therapeutic models, ketamine acts more like a catalyst—providing a window of increased neuroplasticity and psychological openness that allows therapy to work more effectively.
Rather than primarily targeting serotonin, ketamine influences glutamate, one of the brain’s major neurotransmitter systems involved in learning, memory, and neuroplasticity. A “glutamate wash” is a term often used to describe the ketamine effect on the brain, meaning it’s like pressing reboot on your computer or unclogging your pipes. After a ketamine medicine journey people often feel they are in a flow state. This increased neuroplasticity may help loosen rigid thought patterns, trauma loops, emotional stuckness, and chronic survival states.
Many clients describe feeling:
- Less emotionally trapped
- More connected to themselves
- More compassionate toward their experiences and others
- Better able to process trauma
- More hopeful after years of feeling numb or stagnant
For some people, this shift can occur more rapidly than with traditional treatments alone.
KAP Is Not for Everyone
While ketamine therapy is considered very safe for many individuals, it is not appropriate for everyone.
KAP may not be recommended for individuals with:
- Active psychosis
- Certain unmanaged dissociative conditions
- Pregnancy
- Uncontrolled high blood pressure
- Certain unstable medical conditions
- Specific substance use concerns requiring additional stabilization
This is why proper screening matters.
At Harmony Harbor, we collaborate closely with prescribing physicians and carefully assess whether KAP is clinically appropriate before treatment begins.
A Safe Container for Healing
It is healthy to ask questions about any mental health treatment.
People deserve informed, ethical, transparent care—not hype, fear, or false promises.
Ketamine-Assisted Psychotherapy is not a miracle cure—in fact, one out of three people may not benefit from KAP. So, it is not for everyone. And it should never be approached casually or recreationally.
But when provided responsibly within a medically supervised, trauma-informed therapeutic setting, KAP has shown remarkable promise for many individuals who have felt stuck, hopeless, emotionally disconnected, or exhausted from years of unsuccessful treatment approaches.
At Harmony Harbor, we have witnessed many transformative experiences, including some of our own, and we know that healing happens best in environments rooted in safety, compassion, science, and human connection.
For many, KAP is not an escape from themselves—but a pathway back to their best self with their Inner Healer as the guide. If you are curious and want to explore ketamine therapy, our team is ready to support your healing journey.
