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GHB Detox & Treatment Guide

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Symptoms, Timeline, and Effects

Gamma-hydroxybutyrate (GHB), a commonly used club drug, is a central nervous system (CNS) depressant commonly used for its euphoric, sedating, and disinhibiting effects.1,2,3 Much GHB is categorized as a Schedule I controlled substance, which means that it has no accepted medical uses and has high potential for abuse.2 However, a Schedule III formulation of the drug (sodium oxybate; trade name Xyrem) is used in the treatment of cataplexy or the excessive daytime sleepiness associated with narcolepsy.1,2,3,4 

GHB is often used in party settings for the euphoric and calming feelings it produces.2 Because it has strong sedative effects, this drug has been used to facilitate sexual assault by incapacitating unaware victims.1,2,3,4 It was historically used by bodybuilders who thought the substance would stimulate the release of growth hormone to help them increase muscle mass and reduce body fat.1,5

Common Alternative Names for GHB
  • Grievous Bodily Harm
  • Georgia Home Boy
  • Soap
  • X
  • Liquid ecstasy
  • Scoop
  • Goop

GHB is usually taken orally in a clear liquid form. It has a slightly salty taste and is often mixed with another liquid, such as juice or alcohol, to cover up the taste.1,2,3

GHB may be used alone or mixed with other drugs, especially alcohol. Some people use it in combination with stimulants, marijuana, and hallucinogens, which can compound the dangers of abusing the substance alone.1,2,4,5

Following regular use, attempting to quit or decrease use of GHB can result in a number of withdrawal symptoms.

When taken in excessive amounts, symptoms of GHB overdose can range from unconsciousness and slowed heart rate to seizures, coma, and death.2  Combined use with other drugs including alcohol can result in breathing difficulties.1 Because it comes in liquid form, it can be difficult to have an accurate measure of the amount of drug being ingested—leading to a higher likelihood of overdose. GHB overdose can be dangerous and frequently requires medical treatment.

Following regular use, attempting to quit or decrease use of GHB can result in a number of withdrawal symptoms.1 Because of the large risk of overdose and the existence of a GHB withdrawal syndrome, both people who are compulsively using GHB and those who are attempting to quit would benefit from some form of professional rehabilitation and medically supervised detox to keep them safe during withdrawal and decrease the ever-present risk of overdose that accompanies unchecked, continued abuse. Individuals abusing this drug are advised to seek treatment for addiction as continued abuse of GHB can be fatal.

What Are the Immediate Effects?

In small amounts, GHB is produced naturally in the body as a metabolite of the inhibitory neurotransmitter GABA. Though its mechanism of action isn’t entirely clear, the molecule itself may have some activity as a GABA-B receptor agonist.1,5 When consumed as a drug, the intoxicating effects of GHB may be difficult to distinguish from those of other CNS depressant substances. GHB has a rang of short-term effect. Often lasting between 2-4 hours, these may include:2,3,6

  • Euphoria.
  • Reduced anxiety.
  • Drowsiness
  • Disinhibition.
  • Increased sociability.

Although there are some people who see the intoxicating effects of GHB as desirable, it can be an extremely dangerous substance. The range between safe and toxic is very small and there is no antidote for GHB overdose.2 At high doses, GHB can result in a variety of hazardous side effects, including:1,2

  • Hazardous side effects of GHB use can include memory loss, confusion, and visual hallucinations.Dizziness
  • Memory loss
  • Confusion
  • Visual hallucinations
  • Nausea and vomiting
  • Seizures
  • Reduced body temperature
  • Slowed heart rate
  • Respiratory depression
  • Decreased muscle tone
  • Unconsciousness.
  • Coma.
  • Death

As with other sedatives, such as benzodiazepines, some GHB users may be at risk of a paradoxical reaction characterized by aggressive or excited behavior.2 Their actions may be unpredictable and, with impaired judgment and coordination, can increase their risk of injury due to accident or assault.6

Chronic Use and Physical Dependence

Chronic GHB users can develop physical dependence and could experience the onset of withdrawal symptoms with the abrupt cessation of or reduction in use.1,5 Further, if someone who is dependent on the drug continues to use it to avoid or minimize withdrawal symptoms, they place themselves at higher risk of cementing the compulsive patterns of substance use common to addiction.2

Sings and Symptoms of  Withdrawal

GHB has a short duration of effects and is cleared from the body quickly.4 Because of this, users may experience a relatively rapid onset of withdrawal—typically within a few hours after the last use of the drug.5 The acute GHB withdrawal syndrome may include signs and symptoms such as:1,2, 3,5,8

  • The acute GHB withdrawal syndrome may include insomnia.Insomnia.
  • Anxiety.
  • Agitation.
  • Sweating.
  • Increased heart rate (tachycardia).
  • Increased blood pressure (hypertension).
  • Tremors.
  • Confusion.
  • Psychosis.
  • Delirium.
  • Seizures.

Though somewhat rare, severe cases of withdrawal from GHB can be life-threatening if not appropriately managed.5 For this reason, detoxing under supervision is imperative, especially if you’ve used it regularly or in high doses.

What is the Detox Timeline and Protocol?

Man trying to fall asleep

As part of a supervised medical detox program, medical professionals monitor withdrawal progress to ensure that significantly troublesome symptoms and any complications be managed appropriately. In many cases, GHB withdrawal is associated with few serious physical symptoms; however, in some cases, certain withdrawal effects may escalate and may even be fatal.2

As part of a supervised medical detox program, medical professionals monitor withdrawal progress to ensure that significantly troublesome symptoms and any complications be managed appropriately.

Less severe withdrawal syndromes will typically involve supportive care; however, in addition to supportive care, more severe cases may require quick medical action to address potential complications like seizures and agitation.5,8 In supervised detox programs, close monitoring of withdrawal symptoms allows medical and mental health professionals to ensure your safety. They will also be able to prescribe supportive medications when needed, such as sleep aids for insomnia and sedatives for severe anxiety and seizure management.3,5

Do I Need a Detox Program?

GHB is a dangerous substance, and its chronic use can negatively impact your health and wellbeing. When it comes to compulsive use, simply quitting can be difficult and, due to the presence of potentially-dangerous acute withdrawal symptoms, may not be advisable. In order to figure out if you need a medical detox program to keep you safe and comfortable during the withdrawal portion of early recovery, you should ideally be evaluated by a medical doctor or other substance abuse treatment professional.

By evaluating the details of your substance abuse history, they can better gauge factors such as addiction severity, magnitude of physical dependence, and the likelihood of a severe and/or complicated withdrawal to guide their recommendations for the appropriate level of treatment. They will be able to ascertain if your path to recovery needs to involve a period of medical detox that will put you in a situation where your withdrawal progress is monitored—and your safety ensured.

How Does Supervised Detox Help?

A supervised detox program will provide the necessary medical and emotional support someone needs when detoxing from GHB.9 For one thing, the support given by staff is invaluable in meeting the emotional needs of someone in detox. The counselors, nurses, and doctors can encourage and help a person to keep going with a detox from GHB—whereas alone, someone could easily become discouraged and relapse to relieve the withdrawal symptoms.9,10

Formal detox removes the element of needless suffering from, and minimizes the potential risks of, GHB withdrawal.

A professionally supervised detoxification program will also facilitate the administration of medications to help manage sleep, control anxiety, and treat any other severe or troublesome symptoms that may arise.10

Formal detox removes the element of needless suffering from, and minimizes the potential risks of, GHB withdrawal.

Finding a Treatment Program

After the detox period, people often transition into a longer treatment program that could run for varying amounts of time, depending on the severity of the patient’s addiction to GHB and/or other drugs. Treatment programs emphasize counseling and therapy, which may occur on a group and/or individual basis. Continued therapy and counseling work to help a person in recovery best avoid relapse and continue to stay free of substances, such as GHB. Patients are taught skills and techniques to help:

  • Change maladaptive thinking and self-destructive behavioral patterns.
  • Identify triggers for their substance abuse.
  • Find ways to avoid relapse.
  • Find and participate in healthy activities that promote sobriety.
  • Build a supportive network to help maintain abstinence.

Inpatient Treatment

Inpatient settings vary, with some locations being hospital-based and others more residential—an example of programs at one extreme being spa-like, luxury rehabs. Program specifics will vary, but the more expensive programs do tend to be more luxurious. However, regardless of whether a program offers private rooms and a variety of amenities or a more standard environment, all programs will have trained staff who work closely with the patients to help them through the process of achieving and maintaining sobriety from drugs such as GHB.

Outpatient Treatment

Outpatient programs may include individual counseling.Some people seek recovery help from outpatient substance abuse programs. Outpatient programs range from a few hours a week to several hours per day, up to seven days per week.

Depending on the level of intensiveness, some outpatient treatment programs may utilize a similar range of therapeutic approaches to their inpatient treatment counterparts, including group and individual counseling as well as access to medical and mental health services, when needed. However, a person in outpatient treatment will continue to have the ability to return home at night and possibly also continue in their job or in school while going through treatment.

The course of either inpatient or outpatient substance recovery will vary greatly, depending on the needs of the individual, including how severe their addiction to GHB is, if they are using other drugs, and if they have other mental health issues in addition to substance abuse.


References:

  1. National Institute on Drug Abuse. (2014). DrugFacts: Club Drugs (GHB, Ketamine, and Rohypnol).
  2. U.S. Department of Justice Drug Enforcement Administration. (2017). Drugs of Abuse: A DEA Resource Guide.
  3. National Institute on Drug Abuse. (n.d.). NIDA Community Drug Alert Bulletin-Club Drugs: Gamma-hydroxybutyrate (GHB).
  4. National Institute on Drug Abuse. (2018). Commonly Abused Drugs Charts.
  5. Kapoor P, Deshmukh R, Kukreja I. (2013). GHB acid: A rage or reprieve. Journal of Advanced Pharmaceutical Technology & Research. 4(4):173-178.
  6. Substance Abuse and Mental Health Services Administration. (2017). Keeping Youth Drug Free.
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).Arlington, VA: American Psychiatric Publishing.
  8. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
  9. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction.
  10. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).

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