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GHB and Alcoholism
     One of GHB's best-known therapeutic applications is the easing of alcohol withdrawal. Human studies have addressed both the physiological and psychological aspects of this challenge.

Acute alcohol withdrawal
Vomitus Anonymous
     For the former, addicts were given a single dose of GHB and compared to a control group in terms of the following symptoms: tremors, sweating, nausea, depression, anxiety, and restlessness. The test was double-blind - each subject drank a strong-tasting cherry syrup, but neither they when they reported their symptoms nor the scientist evaluating them knew whether each one's syrup contained GHB. Blood pressure and subjective effects such as drowsiness and nausea were monitored. Afterwards, the control patients were released into standard therapy while the GHB group remained on the medication three times a day for the remainder of the week [50].

     The results were excellent. Severity of withdrawal dropped drastically within the first hour, and continued to decrease within the next eight. Control subjects became progressively worse in this same period. A majority of GHB subjects reported dizziness, but no other symptoms. To ensure that GHB was not just doping them into submission, subjects were tested on a word-fluency task - no differences were found between groups. After the third day of the experiment, GHB doses were reduced by 30% per day and discontinued on the eighth. Symptoms remained at this level throughout treatment, although followup data are not provided once GHB was removed.

Long-term craving
Comfort in a teaspoon*
     The latter experiment involved a 36-week study of recovering alcoholics, who took small doses of GHB thrice daily and were compared in terms of drinking behavior and goals. By the end, over 2/3 of the GHB group wanted to give up or moderate alcohol use, compared to less than 1/4 of the control. Urine analysis indicated that their behavior was consistent with these statements [151].
     A later experiment gauging craving* for alcohol showed a similar improvement, and also discovered that many unresponsive subjects began to benefit when the same daily dose was divided into six administrations [75].

     The dose given in both experiments was 50mg/kg, which for most is 3-4g. Subjects in the acute* withdrawal trial reported no noticeable effects except dizziness, which is somewhat odd given that 3g is a respectable recreational dose. Although GHB has never been reported to show cross-tolerance with alcohol, it is possible that chronic users are simply more accustomed to functioning while inebriated and thus less sensitive to GHB's effects. Needless to say, none of them suffered respiratory arrest, seizures, heart attacks, dissociative anaesthesia, or brain death, nor were any known rapists found among the treatment staff.
     In the long-term craving-reduction experiments, the dose was divided into 3 or 6 daily administrations. Although no data are supplied regarding the direct effects on the subjects, 1g is a borderline and 0.5g a completely inactive dose, as far as acute inebriation* goes.

Effects on non-addicts
Vote with your liver
     A number of readers have reported that GHB caused them to drastically reduce alcohol consumption, even though they did not consider themselves dependent and never entered into a formal treatment program. I am inclined to attribute this to a simple substitution - between the more pleasant emotional effects of GHB, its lesser mental impairment, and its lack of an unpleasant hangover*, alcohol simply lost its appeal. It is ironic that the qualities which might reduce alcohol consumption most in our society are the ones keeping GHB illegal.

     Users past the age of majority are free to imaging the more colorful terms I discarded in favor of "ironic."

     Despite the broad equivalence which I posit above, it is important to note that GHB and alcohol do not share a common mechanism of action. This therapy is quite unlike methadone* maintenance for opiate* users, which actually substitutes a close, but less addictive, relative of the drug being discontinued. EtOH* and GHB are structurally dissimilar and, generally speaking, act at different sites in the brain.

Self-medication with GHB

     For readers hoping to treat their own alcohol dependence, I definitely advise working with a doctor or other counselor. If you have reached a point of compulsive intake where you are considering drug therapy, then alcohol has probably assumed an importance in your life which can't be erased simply by easing the physiological impulse to drink. Additionally, a drinking binge (or even a normal dose of alcohol) concurrent with the use of GHB could have potentially deadly results. This probably doesn't apply to the small doses used to reduce craving, but it definitely does to the larger one to ameliorate withdrawal.

     That said, I think self-medication with GHB is a safe option once the stage of physical illness from abstention has passed (physiological withdrawal sickness lasts about a week). The study above found the thrice-a-day regimen effective in a large number of cases, and the six-times-a-day useful in ones where it failed. Realistically, I would recommend choosing one that fits your daily schedule and allows you to avoid risking any degree of impairment when you'll have to drive or otherwise be optimally alert. If such activities are inevitable within an hour of dosing, I recommend the schedule with the smaller doses. If you can arrange to avoid them, three doses might be more convenient. In any case, if you find yourself becoming noticeably inebriated, you should either increase the number of doses or decrease the overall quantity used.

Dosages for Craving Reduction
(Based on 50mg/kg/day)
Weight
(kg)
Weight
(lbs)
3 Doses
(g)
6 Doses
(g)
45 100 0.75 0.38
55 121 0.92 0.46
65 143 1.10 0.55
75 165 1.25 0.63
85 187 1.40 0.71
95 209 1.58 0.79
105 231 1.75 0.88
115 253 1.90 0.96


    Why this works I do not know. One possibility is that GHB normalizes dopamine* levels. Mesolimbic dopamine is a major factor in many addictions. The brain responds to the behavior or chemical with a DA rush, and in the most pernicious cases stops releasing DA in response to previously rewarding activities. Frequent, low doses of GHB may help sustain a constant level of dopamine that is sufficient for normal, nondepressed functioning, thus reducing the need to administer alcohol in order to feel decent.

     Users wishing to employ GHB for immediate detox can follow the model of the experiment above. Begin with 50mg/kg GHB 3 times each day, and reduce by 30% each day after the third. This should be done during a dedicated recovery period, as driving is absolutely inappropriate at such doses. It is vital to have another person assisting in this process, who can absolutely ensure that the subject does not drink.

     At this level, GHB doses become more serious. I recommend trying smaller doses first (as detailed in the dosage section, in order to learn one's individual tolerance and figure out how to deal with potential problems like nausea. You may expect some noticeable GHB effects, but if the suggested 50mg/kg leads to irresistible drowsiness or undesired impairment, I strongly suggest experimenting with reduced dosages. Remember that GHB does not ameliorate withdrawal by acting like alcohol, so getting "drunk" is entirely unnecessary.

Dosages for Alcohol Withdrawal
(Based on 50mg/kg for the first 3 days, -30%/day thereafter)
Weight
(kg)
Weight
(lbs)
Dose
(g)
Day 4
(g)
Day 5
(g)
Day 6
(g)
Day 7
(g)
Day 8
(g)
45 100 2.25 1.60 1.10 0.66 0.50 Freedom!
55 121 2.75 1.90 1.33 1.00 0.66
65 143 3.25 2.33 1.60 1.10 0.80
75 165 3.75 2.66 1.90 1.33 0.90
85 187 4.25 3.00 2.10 1.50 1.00
95 209 4.75 3.33 2.33 1.66 1.10
105 231 5.25 3.66 2.66 1.80 1.25
115 253 5.75 4.00 2.80 2.00 1.40
Some fudging committed to render quantities easy to measure

     GHB is free of physiologically addicting properties, and habitual use rarely becomes a problem in recreational uses. In this case, however, the frequent administration and palpable relief it brings the recovering addict may create a dependency problem. Moreover, alcoholics are likely to have some learned or genetic predisposition to addictive behavior, putting them at greater risk to begin with. This hardly vitiates its value for these purposes, but it does underscore the importance of a few commonsense warnings:
•As suggested elsewhere, an assistant can be employed to ensure that the subject sticks to the intended dosage regimen.

•Don't count on GHB to do the job by itself. The same skills and behaviors that can prevent a relapse after quitting or moderating alcohol consumption will be protection against excessive GHB use.

•Prepare for some rebound anxiety or insomnia when the GHB is discontinued. Small doses to help with sleep may be indicated for the next week.

•Try to remember that any negative effects of quitting GHB will disappear after a week or two. Bolster your fortitude by comparing these mild discomforts to alcohol withdrawal's cramps, vomiting, and delirium tremens*.

Good luck!

Anyone with stories of GHB and alcohol withdrawal is invited to share.

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