Guide to GHB : Abuse & Treatment Options
Gamma-hydroxybutyric acid, or GHB, is a drug that people often abuse at clubs, parties, or bars. GHB has some anti-anxiety properties and some people may use it to lower inhibitions. GHB may also give rise to a sense of euphoria which, in addition to these other desired effects, may prompt repeated use. In some instances, people have used it as a date rape drug because it can cause amnesia and unconsciousness.
Despite claims to the contrary, someone who frequently uses GHB can become addicted to the drug. They may develop significant physical dependence and go through withdrawal if they suddenly stop using it. As a predominantly illicitly manufactured drug, the ever-variable potency of the street supply of GHB can increase one’s risk of overdose, particularly if mixed with alcohol.
What Is GHB?
Gamma-hydroxybutyric acid (GHB) is a central nervous system (CNS) depressant. It acts on at least two sites in the brain: a GABAb receptor and a GHB binding site. GHB occurs naturally in the brain, but at much lower concentrations than those found in street doses.1
GHB has had many uses over the years:2
- It was first synthesized and introduced for medical use in 1960. It was initially used as an anesthetic, then used to treat narcolepsy in the 1970s. Its therapeutic capacity was diminished by the fact that its use could potentially create euphoric sensations in those being treated with the drug.
- In the 1980s, it was marketed with the unsubstantiated claim that the drug could help users burn fat and build muscles. But in 1990, the Food and Drug Administration (FDA) declared it unsafe after more than 30 reports of illnesses from the drug.
- In the late 90s, GHB became a “club drug” at raves and parties. In 2000, the federal government classified it was a Schedule I drug, which means it has no approved medical use and may lead to abuse and dependence.
However, pharmaceutical GHB still has one legal medical use. In 2002, the FDA approved Xyrem, which is prescribed to reduce cataplexy (a rare medical condition characterized by a sudden weakening of muscles due to strong emotion) and improve symptoms of narcolepsy.3
The ever-variable potency of the street supply of GHB can increase one’s risk of overdose, particularly if mixed with alcohol.
Recreationally, teens and young adults abuse GHB at bars, nightclubs, concerts, and parties. Its reputation as a euphoric, disinhibiting aphrodisiac with a short duration of action, absence of a hangover, and difficult detection on many toxicology screens have no doubt fueled its recreational use.4
Even though it was banned as a bodybuilding aid, it is still sometimes used to help reduce fat and increase muscle mass.1,5 Other people may use it as a sleep aid or to help with alcohol cravings.5
Use as a Date Rape Drug
People who are given GHB without their knowledge may become unconscious and unable to defend themselves.Sexual predators may use GHB as a “date rape” drug because it is odorless and colorless and can be easily put into victims’ drinks without detection. People who are given GHB without their knowledge may become unconscious and unable to defend themselves from sexual assault. They also have a hard time being witnesses in court because they cannot remember the details of what happened during the incident.5
Street names for GHB include:2
- Georgia Home Boy.
- Liquid Ecstasy.
- Grievous Bodily Harm.
- Salty Water.
- Growth Hormone Booster.
- Liquid X.
- Vita G.
What Are the Effects?
The full range of GHB effects experienced by those using the drug will depend on the dose and whether it’s taken with other drugs.2
A user will generally begin to feel the effects within 10 to 20 minutes of taking the drug. The effects start to wear off after about 45 to 90 minutes, and the user may feel drowsy for 2 to 12 hours after taking it.2
- Lowered inhibitions.
- Decreased anxiety.
- Muscle relaxation.
- Impaired memory.
Side effects include:2,3,6
- Blurred vision.
- Poor coordination.
- Lowered heart rate and breathing.
- Decreased body temperature.
- Excited and aggressive behavior.
When combined with alcohol, GHB may cause nausea, trouble breathing, and greatly lowered heart rate and blood pressure.6
What Are Club Drugs?
GHB is sometimes classified as a “club drug.” Other club drugs include LSD, Rohypnol, ketamine, methamphetamine, and MDMA (ecstasy). Teens and young adults use these drugs at bars, raves, nightclubs, and parties.1,5
People use these drugs to enhance their senses (sight, sound, touch) and feel more connected to others. These drugs are generally inexpensive and are sold as pills, powders, or liquids that people can take orally or mix with other drugs. Users may combine club drugs or take them with alcohol. Because the manufacturing of these drugs is largely illicit and not regulated, they are often “cut” with other substances. As a result, users cannot know for sure what they are taking.5,7
How Many People Use Club Drugs?
A 2016 study found that in the past year, 0.90% of 12th graders had used GHB, 2.70% had used ecstasy (MDMA), and 1.2% had used ketamine. The study also found that 1.80% of 10th graders had used ecstasy in the past year and 0.50% had used Rohypnol in the past year. As for 8th graders, 1% had used ecstasy in the past year, 0.40% had used methamphetamine in the past year, and 0.50% had used Rohypnol.8
Another 2016 national study found that 1% of people age 12 and older had used ecstasy in the past year, 0.60% had used methamphetamine in the past year, and 0.60% had used LSD.8
What Are the Risks?
The main health risks of GHB are overdose and profoundly impaired consciousness. Both situations could potentially lead to significant bodily injury, victimization (e.g., date rape), and/or death.
When combined with alcohol, GHB can cause blackouts and memory loss. Victims lose consciousness and cannot remember what happened to them, which makes it difficult for them to seek justice against the perpetrator.2,5
GHB as a Date Rape Drug
In January 1999, Samantha Reid, a 15-year-old girl, lost consciousness and died after teenage boys slipped GHB into her drink. The boys were convicted of manslaughter.5
Around the same time, Hillary J. Farias, another girl, was raped after unknowingly consuming GHB.5
Shortly after, the Hillary J. Farias and Samantha Reid Date-Rape Drug Prohibition Act of 2000 made GHB a Schedule I drug.5
Combining GHB with alcohol can lead to nausea, blackouts, amnesia, coma, and trouble breathing, and it can even cause death.1–3 GHB was linked to more than 60 deaths from January 1992 to May 2001, and many of these deaths involved its combination with alcohol.5
Opioids, barbiturates, and benzodiazepines can enhance the effects of GHB, which may lead to dangerous effects such as severe respiratory depression.5
It is possible to overdose on GHB. Overdose is always a risk with GHB since it is difficult for users to know the concentration of the dose.2
Symptoms of an overdose include:2
- Trouble breathing.
- Memory loss.
- Loss of consciousness.
There is no antidote for a GHB overdose.3 Treatment is supportive and generally includes keeping the person’s airway open and using assisted ventilation, if necessary.5
Tolerance, Dependence, & Addiction
Many websites downplay the risks of GHB addiction.4 But several sources indicate that addiction is possible.2,3,9
Regular use of GHB can lead to tolerance, in which the user must take increasingly higher doses of the drug to achieve the same effect they felt before. This repeated and escalated use can drive the development of physiological dependence, where the person’s system adapts to the presence of the drug and relies on it to function.2 Severe GHB dependence was found to follow daily intake of different amounts of GHB over a period that ranged from 2 months to 3 years.5
Tolerance and dependence are two of the criteria used to diagnose addiction in clinical settings. But they are not the same thing as addiction. According to the National Institute on Drug Abuse, addiction is a chronic condition where a person continues to use a substance even though it harms their life.10 Addiction often includes tolerance and dependence, but there are social, physical, and psychological components as well. For example, the person may neglect their work or school responsibilities in favor of drug use, or crave the substance.11
Someone might start off experimenting with GHB in a club setting and progress to using it in other settings, such as at home. They may begin to rely on the drug to help them relax, sleep, or loosen up in social situations. Over several weeks of regular use, they can develop tolerance and dependence and find it difficult to stop using due to the withdrawal symptoms.
When someone becomes dependent on GHB, they will experience withdrawal symptoms when they stop using. Withdrawal occurs because the body must adjust to the sudden lack of the drug.
Withdrawal symptoms from GHB can include:6,9
- Increased heart rate.
- Increased blood pressure.
People who have used GHB heavily for a long period of time or are otherwise at risk for experiencing severe or complicated withdrawal may require a supervised detox in a medical setting or as part of an inpatient rehab program.
Signs of a Problem
Signs that may indicate that a person should seek treatment for GHB addiction include:11
- Using GHB in increasingly larger amounts over time.
- Being unable to stop or reduce GHB use.
- Spending a great deal of time obtaining, using, or recovering from GHB use.
- Craving GHB.
- Having a hard time taking care of responsibilities at work, school, or home because of drug use.
- Continuing to use even though GHB use is interfering with relationships.
- Giving up previously enjoyed activities in favor of GHB.
- Using GHB in situations where it is unsafe to do so, such as while driving.
- Continuing to use GHB even though you know it is causing physical or psychological problems.
- Developing a tolerance to GHB.
- Experiencing withdrawal symptoms when you stop using.
If you or someone you know has displayed at least 2 of these behaviors in the past year, you may have developed an addiction to GHB which could benefit from professional substance abuse treatment help.11
Recovering from a GHB addiction is a process that generally includes 3 steps: detox, rehab, and aftercare.
Before someone can begin recovery, they must go through withdrawal and clear the remaining traces of the drug from their system. Detox is the process of monitoring a person in withdrawal and making sure the person is safe. It can include medical monitoring and supervision, as well as medications when needed.
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends close medical supervision of GHB withdrawal in a hospital setting for 1 to 2 weeks.5 But the right type of care depends on how long you have been using the drug, how much you used, and whether you used GHB with other drugs.
After detox, a recovering user spends time in a rehab setting. The two major types of programs are inpatient and outpatient.
Inpatient is often the treatment of choice for those with significantly severe addictions. Throughout an inpatient or residential treatment program, you live at the facility and follow a structured schedule each day that includes educational groups and therapy. These programs often last 30 to 90 days.
Outpatient treatment varieties are part-time programs that can last anywhere from a few hours a week to several hours a day. Much of outpatient care entails group therapy, but some people see therapists on a one-on-one basis.
Once someone leaves a rehab program, the real work begins. A good program can help you get a start on your recovery, but you have to work to maintain sobriety. Many treatment centers will help you find support groups or therapists in your area that can help you stay motivated and manage any issues that come up as you build a new life free of drugs. Challenges inevitably arise for people who are trying to leave drugs behind, and it can be extremely helpful to have someone who can help you navigate them.
Twelve-step groups such as Narcotics Anonymous, non-12 step support programs such as SMART Recovery, as well as individual or group therapy with licensed addiction counselors, are some common forms of support that former addicts use.
Some people who have struggled with addiction find that they are not quite ready to return to their home environment and everyday lives after treatment. In these cases, sober living may be a good option. You live with other people who are recovering from drug and alcohol addiction in a supervised environment. Residents are encouraged to look for a job, volunteer, and attend 12-step meetings or other support groups.
Therapy is at the core of most rehab programs, and behavior therapies are the most common. These therapies help people change people’s attitudes about drugs, teach them skills to handle stress and cravings to use drugs, and give them rewards for staying clean.12
The most common behavioral therapies are:12
- Cognitive behavioral therapy (CBT): This therapy is based on the belief that addiction is a learned behavior. Participants are taught how to replace harmful behaviors with healthier ones, and they learn skills for how to cope with situations or thoughts that make them want to use. A key component is enhancing users’ self-control through techniques such as evaluating the pros and cons of continued drug use, self-monitoring for the onset of cravings and situations that might lead to drug use, and developing strategies for coping with cravings and avoiding high-risk situations.
- Contingency management (CM): Research has shown that giving people rewards for positive behaviors or outcomes such as providing clean urine samples can help people stay sober. CM involves using a number of different incentives, such as vouchers and prizes, for desirable behaviors, such as attending a certain number of counseling sessions.
- Motivational interviewing or motivational enhancement therapy: Motivational therapies are often used in the beginning of treatment to help people resolve their reluctance to quit using drugs or engage in therapy. The therapist helps the person tap into their own internal motivation for change.
Recovery Is Possible
It can be very difficult, and in some cases dangerous, to make attempts to stop using GHB or another drug on your own. Some people who try to quit find the withdrawal symptoms uncomfortable and may try to manage them on their own by “medicating” with other drugs or alcohol.4 Relapse is also more likely without an awareness of what drove you to use the drug and what triggers make you want to use.
Recovery is a commitment, but it is possible. It can be hard to admit that you or someone you know has a problem. However, it’s the first step to getting sober. Once you decide that you need help, explore the different options out there and find one that works for you. It’s never too late to turn your life around.
- National Institute on Drug Abuse. (2014). Club Drugs (GHB, Ketamine, and Rohypnol).
- University of Maryland Center for Substance Abuse Research. (2013). GHB.
- Drug Enforcement Administration. (2013). Gamma-Hydroxybutyric Acid.
- Herron, A. & Brennan, T. (2015). The ASAM Essentials of Addiction Medicine. Philadelphia: Wolters Kluwer.
- Substance Abuse and Mental Health Services Administration. (2002). GHB: A Club Drug to Watch. Substance Abuse Treatment Advisory, 2(1).
- National Institute on Drug Abuse. (2017). Commonly Abused Drugs Charts.
- Gahlinger, P. (2004). Club Drugs: MDMA, Gamma-Hydroxybutyrate (GHB), Rohypnol, and Ketamine. American Family Physician, 69(11): 2619-2627.
- National Institute on Drug Abuse. Club Drugs.
- National Highway Traffic Safety Administration. (n.d.) Gamma-Hydroxybutyrate (GHB, GBL, And 1,4-BD).
- National Institute on Drug Abuse. (2014). Drug Abuse and Addiction.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2012). Behavioral Therapies.