Ketamine for the Treatment for Alcohol Use Disorder in the ED

Inclusion Criteria:

* English speaking adults aged 18 and above
* Diagnosed with DSM5 alcohol use disorder, severe
* Admitted to BWF inpatient withdrawal management unit (Addiction Recovery Program)

Exclusion Criteria:

* Any psychotic disorder, bipolar disorder, active suicidality or homicidality
* Inability to perform consent due to impaired mental status
* Clinical Institute Withdrawal Assessment (CIWA) score \> 20 at any point in the ED
* Alcohol withdrawal seizure prior to or during the ED visit
* Systolic blood pressure persistently elevated above 180mmHg, or heart rate \>130bmp, in the ED
* History of hypersensitivity to ketamine, or experience of emergence reaction
* History of any illicit or recreational use of ketamine
* Receipt of ketamine treatment for depression in the past 3 months
* History of DSM5 hallucinogen use disorder, intracranial mass or bleed, porphyria, thyrotoxicosis, seizure disorder other than from alcohol withdrawal, liver cirrhosis, renal failure, obstructive lung disease, or sleep apnea
* History within 6 months of head trauma, stroke, or myocardial infarction
* Liver dysfunction with LFTs \>3x upper normal limit
* Current use of medications with known drug-drug interactions with ketamine (i.e., St. John's Wort, theophylline, opioid analgesics, CNS depressants other than benzodiazepines or phenobarbital)
* Pregnant