GHB Addiction and Treatment

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Kerry Canning, MBChB
Page Clinically Reviewed on by Kerry Canning, MBChB | Medical Editor
  • Key Takeaways

    • GHB, or gamma hydroxybutyrate, is a central nervous system (CNS) depressant drug that can make someone feel relaxed, euphoric and disinhibited
    • GHB usually takes the form of an odourless and colourless liquid that has a salty or bitter taste. It is usually swallowed but can also be injected, insufflated or inserted rectally
    • GHB is known by various street names, including G, scoop and liquid ecstasy 1
    • Use of GHB produces an array of effects within 20 minutes of use that can last for up to 4 hours 3
    • In the UK, GHB is classified as an illicit, Class B drug 4
    • Risks associated with GHB include its addictive potential, use as a ‘date-rape’ drug and potential for overdose, particularly when used in high doses or alongside other substances (i.e., polydrug use) 1,3,8
    • Signs of a GHB overdose include difficulty breathing, seizures and loss of consciousness. Overdoses are medical emergencies that require immediate and effective intervention 1,3
    • Withdrawing from GHB can be dangerous. People who are dependent on GHB should seek professional support and slowly taper the dose of GHB to protect against these harmful effects 1
    • GHB withdrawal effects can be profound and include delirium (i.e., sudden confusion), cardiac arrest and kidney failure 3
    • Further research is needed to confirm the efficacy of GHB addiction and withdrawal treatments. Current approaches, like benzodiazepine therapy, can be helpful in supporting patients during detoxification 11

    Please note, the full name of this drug is gamma hydroxybutyrate. To promote accessibility for our readers, we will use its abbreviation, GHB, throughout this web page.  

What Is GHB?

GHB, or gamma hydroxybutyrate, is a central nervous system (CNS) depressant.1 This means that the drug slows brain activity2, reducing the rate at which chemical messages are transmitted between the brain and body.3 Using GHB can therefore lead to someone feeling very relaxed with lowered inhibitions.1

GHB typically comes in liquid form in small bottles or vials. The liquid is usually clear and odourless, with a bitter or salty taste, however, GHB can also be known as ‘blue nitro’ in its bright blue liquid form. Less commonly, GHB can be sold in powder form.1,3

Most people using GHB will swallow it. In some cases, people will inject, insufflate or insert the drug rectally.1

GHB is known by a variety of street names including G, liquid ecstasy, scoop and grievous bodily harm.1,3

In the UK, GHB is classified as a Class B drug. This means that it is illegal to possess, manufacture or supply GHB. Maximum penalties for these illicit activities can include prison sentences, unlimited fines or both.4

The Food and Drug Administration (FDA) have approved a prescription form of GHB, called sodium oxybate, for the treatment of narcolepsy. Symptoms of this condition, such as excessive daytime sleepiness and sudden muscle weakness (i.e., cataplexy), can improve with use of this medication. Sodium oxybate is available by prescription only and should be used under the supervision of a healthcare professional.5,6

Substances that are closely related to GHB include GBL (gamma butyrolactone) and 1,4-BD (1,4-butanediol). These industry chemicals are used in the production of pesticides, plastic coatings and other products. They are misused recreationally and are rapidly converted to GHB in the body upon use. These substances come in liquid form and have a less pleasant and more bitter taste than GHB. Due to their similarities, they can sometimes be used as a GHB substitute.1,3,5

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The Effects of GHB

GHB acts on different receptors in the brain to exert its effects. It crosses the blood-brain barrier, influencing central nervous system activity.7

By acting on gamma-aminobutyric acid (GHB) receptors and altering dopamine and serotonin transmission, GHB can produce a variety of effects, such as:1 

  • Feelings of euphoria 
  • Feelings of relaxation 
  • Increased sociability 
  • Increased libido (i.e., sex drive) 
  • Lowered inhibitions 

Use of GHB can also bring about an array of undesirable physical and psychological side effects:

  • Physical Side Effects
    • Drowsiness
    • Dizziness
    • Nausea and/or vomiting
    • Shaking
    • Diarrhoea
    • Urinary incontinence
  • Psychological Side Effects
    • Anxiety
    • Confusion
    • Memory loss (i.e., amnesia)
    • Paranoia
    • Loss of contact with reality (i.e, psychosis)

These effects typically begin around 15–20 minutes after use of GHB and can last for approximately 3–4 hours. 

Some people using GHB may also consume other substances, such as alcohol or ketamine, at or around the same time. This is known as polydrug use, a practice which increases a person’s risk of harmful and potentially fatal effects. For example, use of GHB with other CNS depressants, like alcohol, heightens the risk of overdose.1,3

Another risk associated with GHB is its potential for misuse as a ‘date rape’ drug, particularly in social spaces, like clubs and parties. As it is odourless and colourless, it can be maliciously inserted into a person’s food or drink without them knowing. GHB is used in these circumstances by those seeking to take advantage of its ability to make someone feel drowsy, weak or forgetful.8

Factors Influencing the Effects of GHB

GHB can affect everyone differently. The effects a person experiences after using GHB can depend on several factors, including: 

  • The amount and strength of GHB used 
  • A person’s general health, size and weight 
  • A person’s experience of using GHB
  • Use of multiple substances at or around the same time (i.e., polydrug use)

The composition of GHB can vary significantly, so a person can take too much without knowing it, which can lead to an overdose.3 

GHB Overdose 

Overdoses occur frequently among people using GHB. These events can occur as there tends to be a fine line between the amount needed to achieve desired effects and the amount that precipitates overdose.

The risk of a GHB overdose is further increased if high amounts are used over a short period of time, or if other drugs, particularly other CNS depressants, are taken alongside GHB.1

Overdoses are medical emergencies. If you are suspicious of overdose, it is important to seek medical help immediately by calling 999.

  • The Signs and Symptoms of a GHB Overdose Can Include:
    • Agitation
    • Breathing difficulties
    • Vomiting
    • Confusion
    • Blackouts
    • Memory loss
    • Hallucinations (i.e., false sensory perceptions)
    • Seizures
    • Loss of consciousness, or coma
    • Death

    These overdose events can be life-threatening. It is crucial to seek emergency medical assistance if you, or someone around you is experiencing these effects.

A significant risk associated with GHB misuse is development of physical dependence and addiction. Addiction to GHB can occur quickly and can have wide-ranging negative health and social consequences.1,9

Other negative health effects linked with long-term GHB use include:3

  • Significant memory issues
  • Severe anxiety
  • Hallucinations 
  • Heart disease 
  • Breathing issues 

GHB Addiction 

GHB is an addictive drug. People who use it can quickly develop dependence.1 

Risk Factors for Developing Addiction 

A person’s risk of developing addiction is influenced by various biological, genetic and environmental factors. Having a single risk factor does not mean that a person will develop addiction. However, in general, the more risk factors a person has, the greater the risk that taking drugs, like GHB, will lead to addiction.10 

  • Risk Factors for Developing GHB Addiction Include
    • Genetic predisposition
    • Family history of drug misuse or addiction
    • Family history of criminal activity
    • Aggressive behaviour as a child
    • Early use or experimentation with drugs
    • Peer pressure, particularly in teenage years
    • Drugs available at school
    • Struggling academically in school
    • Being a teenager
    • Local poverty
    • Existing mental health condition(s)
    • Smoking or injecting the drug (these routes can increase a drug’s addictive potential)

Signs and Symptoms of GHB Addiction 

Addiction to substances like GHB leads to structural changes in the brain. This influences a person’s ability to make decisions and judgements and control their behaviour. It also impacts learning and memory functions. These underlying changes can produce significant signs and symptoms, such as impaired control, which are characteristic of addiction.10 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a widely used medical text used by healthcare professionals to diagnose mental health conditions, including addiction. The DSM-5 provides helpful criteria for recognising addictions, or substance use disorders (SUDs), arising from a variety of substance classes, including stimulants. 

A stimulant use disorder resulting from GHB misuse can feature the following signs and symptoms: 

  1. Inability to reduce or stop use of GHB 
  2. Taking larger amounts of GHB or taking it for longer than intended 
  3. Investing lots of time in sourcing, using or recovering from GHB use
  4. Experiencing cravings 
  5. Inability to cope with usual responsibilities at home, work or school due to GHB use
  6. Withdrawing from important work, social or hobby activities due to GHB use 
  7. Repeated use of GHB despite dangerous consequences
  8. Continued use of GHB despite relationship issues 
  9. Continued use despite health issues that could be caused or exacerbated by use of GHB 
  10. Development of tolerance (i.e., requiring higher amounts of GHB to achieve the desired effects) 
  11. Development of withdrawal effects that are alleviated by further use of GHB 

These 11 criteria describe the lack of control, physical dependence, risky use and social issues that can arise from a substance use disorder (SUD), like GHB addiction. The DSM-5 criteria can be helpful in diagnosing this disorder and in classifying the severity of the disease.

Two or three symptoms indicate a mild SUD, four or five indicate a moderate SUD and six or more suggest the presence of a severe SUD.

GHB Withdrawal 

People who are dependent on GHB can experience significant and potentially harmful withdrawal effects. Getting professional support and slowly tapering the dose of GHB is recommended to protect against these harmful effects.1

Symptoms of GHB withdrawal can appear around 6–72 hours following GHB use and may continue for around 5–15 days.3 

  • Psychological GHB Withdrawal Symptoms
    • Confusion
    • Anxiety
    • Agitation
    • Panic
    • Paranoia
    • Hallucinations (i.e., false sensory perceptions)
    • Delusions (i.e., strongly held false beliefs)
    • Delirium (i.e., sudden confusion)
  • Physical GHB Withdrawal Symptoms
    • Insomnia
    • Increased heart rate
    • Nausea and/or vomiting
    • Sweating
    • Shaking

Abruptly stopping use of GHB is not recommended as this can lead to severe withdrawal effects, such as reduced heart rate, cardiac arrest, seizures and renal failure.3 

The effects of GHB withdrawal can be dangerous. It is recommended that individuals experiencing acute withdrawal effects who have no GHB should seek emergency medical assistance.1

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Treatment for GHB Addiction 

At Castle Craig, we recognise that withdrawal from GHB can cause significant effects, such as delirium and seizures, which can be similar to, or more severe than, alcohol withdrawal effects. 

Our experienced clinical team provides regular assessments and monitoring and delivers medications, like benzodiazepines and/or Baclofen, to help reduce the severity of withdrawal effects and mitigate complication risks for patients. 

In some cases, patients may not respond to these interventions as expected, or they may have additional medical or psychiatric conditions. In such cases, we may refer patients to general medical wards for further support. 
If a patient has been regularly using high doses of GHB for over six months to a year, this puts them at increased risk of severe withdrawal effects. According to one of our psychiatrists, “Very severe cases (of GHB withdrawal) can result in a need to be in a general medical hospital with intensive care unit support.”

GHB Detoxification 

As GHB withdrawal presents similarly to alcohol or benzodiazepine withdrawal, similar approaches tend to be used to manage the detoxification process.11 

First-line treatment with a reducing regimen of a high-dose, long-acting benzodiazepine, such as diazepam, is recommended in the management of GHB withdrawal. If benzodiazepine therapy is insufficient, another class of medications, called barbiturates, can be considered. Medicines such as baclofen can be an effective treatment during GHB withdrawal. 

For people experiencing psychotic symptoms, such as delusions, treatment with antipsychotic medications, such as olanzapine or haloperidol, can be helpful.

GHB withdrawal is associated with higher risks of delirium compared to alcohol withdrawal. This can complicate treatment and necessitate higher doses of diazepam to effectively manage withdrawal effects.

Regular, high-dose use of GHB can increase the severity of withdrawal effects and warrant hospital-level treatment and supported withdrawal. In cases where outpatient (i.e., out-of-hospital) withdrawal is recommended, medical supervision and monitoring of vital signs, such as heart rate and blood pressure, should be provided. Regular monitoring and assessments can help ensure that the correct dose of medication is being given to reduce the risk of complications.11

In the most severe cases, people going through detoxification for GHB addiction may require intensive care treatment. In one study, over 20% of patients required this level of treatment.12

Following detox, it is crucial for patients to be aware of their increased overdose risk. Their tolerance to GHB will have reduced following withdrawal, so relapse could result in overdose.

How Can Castle Craig Help?

At Castle Craig, our residential rehab programme offers patients a safe and supportive environment to manage their substance addiction. During your stay, you will be supported by an experienced team of doctors, nurses and therapists who can provide specialist treatment to help you on your journey to recovery.

Medically-Supervised GHB Detox  

Detoxification, or detox, is a crucial first step in substance addiction treatment. Our specialist detox unit is supported by a team of detox specialists who can provide close monitoring and medical interventions based on your needs and requirements. Our team can help to ensure that you are stable and comfortable throughout this process. 

Some patients may experience severe GHB withdrawal effects that necessitate a higher level of care. In such cases, patients can be transferred from our care into hospital care.  

Safe Detox in Comfort

Castle Craig has a dedicated detoxification centre and 24/7 supervision by doctors and nurses to ensure the utmost patient safety.
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Personalised Treatment Plans for GHB Addiction

Our  abstinence-based addiction treatment programme is grounded in the 12-Step model of addiction and combines evidence-based therapies with complementary treatments. Together, these aim to help you challenge negative thoughts, attitudes and behaviours that block recovery, and treat the root cause of your addiction.

At Castle Craig, we focus on the person, rather than the addiction. Our comprehensive treatment plans are tailored to your unique needs and circumstances to help you find lasting recovery. We believe in providing holistic care for managing addiction, and so we offer a variety of complementary therapies to enrich your physical, mental and emotional wellbeing. 

For those struggling with other addictions or mental health conditions, we provide dual diagnosis treatment to aid recovery from a wide range of psychological conditions including trauma, anxiety and depression. 

Continuing Care Programme

To promote success beyond inpatient care, patients are taught relapse prevention and family members also have the opportunity to participate in therapy sessions. 

All of our patients are given a customised, two-year aftercare plan, as part of our Continuing Care Programme. This helps to ease the transition from inpatient to outpatient care and provides helpful support to maintain lasting recovery.

Get Help for GHB Addiction Today

If you or someone you know is struggling with GHB addiction, reaching out for help is an important first step to recovery. We understand that this can be difficult, but our friendly and professional team is here to support you with our collective experience and compassionate approach. 

To find out more about GHB addiction treatment at Castle Craig, contact us by calling 01721 546 263 today.

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