“Pretty quickly he started to feel sick, threw up, became incoherent and passed out. Soon after passing out, he started to convulse, his arms and stomach and legs spasming. He continued to vomit and his breathing was disturbing. Luckily we had a doctor and some equipment available so we hooked him up to a blood gas monitor, turned him on his side and cleared his airway, which was difficult because his mouth would clench and unclench.... He had a terrible hangover the next day and claimed that he felt negative after-effects for more than two weeks after the event.” (Erowid, 2003)

A brief history of GHB
GHB was first synthesized in 1960 and was sold in health food stores as a dietary supplement. In the ‘80s, GHB was popular among bodybuilders because of its supposed anabolic effects. Over the years, many claims about GHB have included the ability to fight stress and depression, stimulate Human Growth Hormone, induce deep sleep, relieve anxiety, aid in muscle-building, enhance sexual feeling, enhance athletic performance, and combat aging (Project GHB, 2003). On November 8th, 1990, the FDA banned the over-the-counter sale of GHB in the United States. Today, GHB is viewed as a powerful drug of abuse, as well as a substance linked to criminal behavior.

Drug effects and FDA warnings
The effects of GHB, in small doses, are similar to those of alcohol, as it reduces social inhibitions and increases the libido. In higher doses, the drug becomes a sedative and ultimately a hypnotic. As the dose increases, GHB can produce a comatose state.
Since 1990, the Food and Drug Administration has issued multiple warnings to consumers about the drug’s sometimes deadly effects ranging from nausea, violent behavior, tremors, and slow heartbeat to problems breathing, seizures, problems thinking clearly, and coma. The U.S. Drug Enforcement Administration officially cites more than 45 deaths and 5,500 emergency room overdoses associated with GHB (Project GHB, 2003).

GHB is currently circulating within the techno-music scene at raves and nightclubs. It is taken as an alternative to ecstasy (MDMA) or methamphetamine. Easily manufactured in a basement chemistry lab, the drug is often used in combination with alcohol. In this instance, each drug enhances the sedative effect of the other.

GHB and date rape
GHB is notoriously known as a “date rape” drug. Drugs like GHB and a benzodiazepine sedative drug with the trade name Rohypnol (“roofies”) are used to facilitate sexual assault due to the sedation and amnesia produced in the potential victim. These effects leave the victim unable to resist — or even be aware of — the assault (Weir, 2001). About 25 percent of the women who contacted the Canadian Sexual Assault Center reported that drugs were a factor in a rape (Lewis & Fremouw, 2001).

When treating victims of sexual assault, clinicians need to be aware of the fact that sexual assault victims may not see their partner’s action as violent and may not want to admit that the attack took place. Studies have found that young adult female victims of severe sexual violence report more depression including suicidal ideation and attempts than do non-victims (Magdol, 1997). Sleep disturbance, decreased appetite, pelvic pain, and abdominal pain can be symptoms of sexual violence. Clinicians also should be aware that date rape victims might suffer from self-blame, decreased self-esteem, and difficulty maintaining relationships. Other mental health concerns include signs of anxiety including the hyperarousal, intrusive, and constrictive symptoms found in Posttraumatic Stress Disorder (PTSD) (Vaughn, 2003).

Treating GHB abuse
Treatment of GHB abuse should be performed using an addictions treatment model. Special attention should be paid to the other drugs of addiction, such as alcohol and methamphetamine, which are commonly part of the user’s profile. The intake assessment should ask the client for any history of the use of drugs with sexual activity. If drugs such as GHB have been used, the clinician should ask questions regarding forced sex or incidences where the client was drugged and sexually abused against his or her will. These questions should be asked of both men and women, as the incidence of use of GHB to accomplish date rape has risen in both the heterosexual and the gay and lesbian communities. Empirical data show that issues involving PTSD symptoms can best be treated using behavioral exposure techniques. A skilled clinician — only when the client is ready and safe from any harm — should treat trauma issues using this type of technique.

As a preventative measure, it is recommended that clinicians caution clients about the risks of having GHB or other depressant drugs surreptitiously placed in their drinks. These recommendations include:

• Drink from tamper-proof bottles or cans and insist on opening them yourself.
• Do not ask someone to watch your drink while you dance, go to the bathroom, etc.
• Insist on personally observing while any beverage you drink is prepared.

Today, GHB joins the ranks of popular drugs such as Valium and Librium that were marketed astoundingly for non-addicting and beneficial qualities only to be discovered later as substances of abuse. In the case of GHB, not only is there a concern about an individual’s personal use but also a concern about the criminal act of forced sexual contact after an innocent victim has been drugged. In plain terms, it’s clear liquid trouble.

Cardwell C. Nuckols, PhD, is President of Cardwell C. Nuckols & Assoc., LLC, a national and international training and consulting organization. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

References
Erowid. (2000). GHB overdoses and poisonings. Retrieved August 9, 2003, from http://www.erowid.org/
experiences/exp.php?ID=1926
Lewis, S.F. & Fremouw, W. (2001). Dating Violence: A critical Review of the Literature. Clinical Psychology Review, 21: 105-127.
Magdol, L., Moffitt, T.E., Caspi, A., Newman, D., Fagan, J., & Silva, P.A. (1997). Gender differences in partner violence in a birth cohort of 21-year-olds: Bridging the gap between clinical and epidemiological studies. Journal of Clinical and Consulting Psychology, 65: 68-78.
Project GHB. (2003). Retrieved August 9, 2003, from http://www.projectghb.org
Vaughn I., Vaughn, D., & Wiemann, M. (2003). Violence Against Young Women: Implications for Clinicians. Contemporary OB/GYN, 48(2): 30-45.
Weir, E. (2001). Drug-facilitated rape. CMAJ, 165(1): 80. Retrieved August 9, 2003, from http://www.cmaj.ca/cgi/content/full/165/1/80

This article is published in Counselor,The Magazine for Addiction Professionals, February 2004, v.5, n.1, pp.51-52.

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