		Thomas S. May, M.A. Medical Writer
Home Portfolio Contact		The Other Side of GHB: Date Rape Drug may be Used to Treat Alcoholism Thomas S. May, Medical Writer Gamma-hydroxy butyric acid (GHB) has gained considerable notoriety over the past few years as an illegal "club drug" that can be used as a date rape drug, due to its unique effects on the nervous system. Also known as Liquid Ecstasy, Liquid X, Georgia Home Boy, and Grievous Bodily Harm, GHB was first noted to have significant abuse potential by the US Food and Drug Administration (FDA) in 1990. Abuse of the drug as a diet aid, bodybuilding stimulant, and insomnia treatment had led to severe reactions, including coma, seizures, and even death. As a result, the FDA banned GHB in the United States on November 8, 1990. But according to some studies, this "sinister drug" can also be used in a much more benign fashion. For example, GHB has been used successfully as a pediatric anesthetic, an aid to childbirth, and as a treatment for narcolepsy and alcohol withdrawal. No more Craving? Excessive, long-term use of alcohol associated with alcoholism causes the brain to adapt to the effects of this drug, and when people with alcoholism stop drinking, they experience a very intense need to drink alcohol again. This strong craving makes it very difficult for alcoholics to quit; consequently, most of them are unable to do so. According to various statistics, 80-90% of people treated for alcoholism relapse, even after years of abstinence. Since craving for alcohol is largely responsible for the high failure rates of alcoholism treatments, a drug that would reduce the craving could be very useful in helping alcoholics abstain from drinking. GHB is one such drug, according to researchers in Italy, and this drug has been used to treat alcoholics in Europe for many years. In an article published in the April 2000 issue of the journal Alcohol, Luigi Gallimberti, MD, and his colleagues at the University of Padua reviewed two double-blind, placebo-controlled studies that tested the effectiveness of GHB for alcohol withdrawal. The studies showed that "daily administration of 50 mg/kg gamma-hydroxybutyric acid for three consecutive months reduced the number of drinks per day by approximately 50%, increased the days of abstinence approximately threefold, and reduced the alcohol craving score by up to 60%." These results show that gamma-hydroxybutyric acid (GHB) is an effective agent for the treatment of alcohol dependence, the scientists concluded. Similar results were also obtained in a study done by Giovanni Addolorato, MD, of the Catholic University of Rome, and his colleagues. "As far as GHB treatment for maintaining abstinence is concerned, the drug proved to be effective in reducing craving and in improving the abstinence rate in about 60-70% of alcoholics treated," Dr. Addolorato says. The investigators found that the rate of abstinence was even greater when the same amount of GHB (50 mg/kg/day) was administered in smaller but more frequent doses (six times a day, instead of three times a day). Like Methadone for Heroin Addicts Treating alcoholics with GHB is very similar to treating heroin addicts with methadone, the Italian researchers claim. Methadone maintenance treatment has been used for heroin addiction throughout the world for decades, and many studies have shown that it is a useful and effective treatment. "Methadone treatment may make it easier for some [heroin] addicts to stop eventually," says Barry Beyerstein, PhD, a physiological psychologist and addiction expert at Simon Fraser University, British Columbia, Canada. "But the real value of methadone is that it reduces the craving and the withdrawal symptoms," he explains. "Methadone enables people to stop using needles and to stay on a relatively low dose that doesn't keep them 'bombed' all the time. As a result, they may be able to turn their lives around, they can work, and they can be acceptable members of their families and of society in general." The situation is quite similar in the case of alcoholics treated with GHB, according to Dr. Gallimberti. Although some of them can stop taking the drug after two or three months, others may need maintenance treatment for many years, he says. But even those who need long-term treatment are much better off than those who are not treated at all and continue to abuse alcohol, Gallimberti argues. The reason for this, he says, is that--at therapeutic doses--GHB is much less harmful than the large amounts of alcohol usually consumed by alcoholics. Continental Divide Given the positive results obtained in Europe, one may wonder why GHB is not used to treat alcoholics in other parts of the world, particularly in North America. "GHB is not used legitimately in the United States, because it is not a benign drug," says David E. Smith, MD, medical director of the Haight Ashbury Free Clinics in San Francisco. "In Italy, they focused on its benefits and tended to minimize its abuse, whereas here in the United States therapeutic benefit has not been established, and we are seeing a lot greater abuse and dependence," he adds. Still, some addiction experts in the US believe that GHB treatment for alcoholism merits further study. For example, according to K. Michael Gibson, PhD, an Associate Professor at the Oregon Health Sciences University, "GHB is better than alcohol, because alcohol has long-range hepatotoxic and neurotoxic effects (it is poisonous to the liver and the nervous system), and these effects are not associated with GHB. Therefore, I think that GHB is going to demand more attention in the treatment of alcohol withdrawal syndrome in the future." *Sidebar:* GHB and Alcohol* A growing body of evidence suggests that GHB reduces the effects of alcohol withdrawal by being a substitute for alcohol, like methadone in heroin addiction. Alcohol and GHB share several pharmacological characteristics, suggesting that GHB may mimic the actions of alcohol in the central nervous system. Like alcohol, GHB has a strong anti-anxiety effect. The toxic effects of large amounts of alcohol normally consumed by alcoholics are well known. GHB appears to be safer, as indicated by the reduction in liver damage in the treated patients. The adverse effects of GHB that have been reported in the past (coma, seizure, confusion, hallucination) were mainly described in healthy, non-alcoholic subjects who took the "street version" of the drug, and were often related to acute toxicity and overdose. Like alcohol, GHB possesses abuse potential, being self-administered orally and intravenously. Cases of craving for GHB with consequent abuse of the drug and possible dependence may occur during treatment. Therefore, GHB must be used under strict medical surveillance and with the cooperation of a trusted family member, in order to obtain prompt reports of abuse. Excerpts from an interview with Dr. Giovanni Addolorato--one of the world's foremost experts on the use of GHB for alcoholism. Home* Portfolio Contact

Thomas S. May, M.A.

Medical Writer

The Other Side of GHB: Date Rape Drug may be Used to Treat Alcoholism

Thomas S. May, Medical Writer

Gamma-hydroxy butyric acid (GHB) has gained considerable notoriety over the past few years as an illegal "club drug" that can be used as a date rape drug, due to its unique effects on the nervous system.

Also known as Liquid Ecstasy, Liquid X, Georgia Home Boy, and Grievous Bodily Harm, GHB was first noted to have significant abuse potential by the US Food and Drug Administration (FDA) in 1990. Abuse of the drug as a diet aid, bodybuilding stimulant, and insomnia treatment had led to severe reactions, including coma, seizures, and even death. As a result, the FDA banned GHB in the United States on November 8, 1990.

But according to some studies, this "sinister drug" can also be used in a much more benign fashion. For example, GHB has been used successfully as a pediatric anesthetic, an aid to childbirth, and as a treatment for narcolepsy and alcohol withdrawal.

No more Craving?

Excessive, long-term use of alcohol associated with alcoholism causes the brain to adapt to the effects of this drug, and when people with alcoholism stop drinking, they experience a very intense need to drink alcohol again. This strong craving makes it very difficult for alcoholics to quit; consequently, most of them are unable to do so. According to various statistics, 80-90% of people treated for alcoholism relapse, even after years of abstinence.

Since craving for alcohol is largely responsible for the high failure rates of alcoholism treatments, a drug that would reduce the craving could be very useful in helping alcoholics abstain from drinking. GHB is one such drug, according to researchers in Italy, and this drug has been used to treat alcoholics in Europe for many years.

In an article published in the April 2000 issue of the journal Alcohol, Luigi Gallimberti, MD, and his colleagues at the University of Padua reviewed two double-blind, placebo-controlled studies that tested the effectiveness of GHB for alcohol withdrawal. The studies showed that "daily administration of 50 mg/kg gamma-hydroxybutyric acid for three consecutive months reduced the number of drinks per day by approximately 50%, increased the days of abstinence approximately threefold, and reduced the alcohol craving score by up to 60%." These results show that gamma-hydroxybutyric acid (GHB) is an effective agent for the treatment of alcohol dependence, the scientists concluded.

Similar results were also obtained in a study done by Giovanni Addolorato, MD, of the Catholic University of Rome, and his colleagues. "As far as GHB treatment for maintaining abstinence is concerned, the drug proved to be effective in reducing craving and in improving the abstinence rate in about 60-70% of alcoholics treated," Dr. Addolorato says. The investigators found that the rate of abstinence was even greater when the same amount of GHB (50 mg/kg/day) was administered in smaller but more frequent doses (six times a day, instead of three times a day).

Like Methadone for Heroin Addicts

Treating alcoholics with GHB is very similar to treating heroin addicts with methadone, the Italian researchers claim. Methadone maintenance treatment has been used for heroin addiction throughout the world for decades, and many studies have shown that it is a useful and effective treatment.

"Methadone treatment may make it easier for some [heroin] addicts to stop eventually," says Barry Beyerstein, PhD, a physiological psychologist and addiction expert at Simon Fraser University, British Columbia, Canada. "But the real value of methadone is that it reduces the craving and the withdrawal symptoms," he explains. "Methadone enables people to stop using needles and to stay on a relatively low dose that doesn't keep them 'bombed' all the time. As a result, they may be able to turn their lives around, they can work, and they can be acceptable members of their families and of society in general."

The situation is quite similar in the case of alcoholics treated with GHB, according to Dr. Gallimberti. Although some of them can stop taking the drug after two or three months, others may need maintenance treatment for many years, he says. But even those who need long-term treatment are much better off than those who are not treated at all and continue to abuse alcohol, Gallimberti argues. The reason for this, he says, is that--at therapeutic doses--GHB is much less harmful than the large amounts of alcohol usually consumed by alcoholics.

Continental Divide

Given the positive results obtained in Europe, one may wonder why GHB is not used to treat alcoholics in other parts of the world, particularly in North America.

"GHB is not used legitimately in the United States, because it is not a benign drug," says David E. Smith, MD, medical director of the Haight Ashbury Free Clinics in San Francisco. "In Italy, they focused on its benefits and tended to minimize its abuse, whereas here in the United States therapeutic benefit has not been established, and we are seeing a lot greater abuse and dependence," he adds.

Still, some addiction experts in the US believe that GHB treatment for alcoholism merits further study. For example, according to K. Michael Gibson, PhD, an Associate Professor at the Oregon Health Sciences University, "GHB is better than alcohol, because alcohol has long-range hepatotoxic and neurotoxic effects (it is poisonous to the liver and the nervous system), and these effects are not associated with GHB. Therefore, I think that GHB is going to demand more attention in the treatment of alcohol withdrawal syndrome in the future."

Sidebar:

GHB and Alcohol*

A growing body of evidence suggests that GHB reduces the effects of alcohol withdrawal by being a substitute for alcohol, like methadone in heroin addiction.

Alcohol and GHB share several pharmacological characteristics, suggesting that GHB may mimic the actions of alcohol in the central nervous system.

Like alcohol, GHB has a strong anti-anxiety effect.

The toxic effects of large amounts of alcohol normally consumed by alcoholics are well known. GHB appears to be safer, as indicated by the reduction in liver damage in the treated patients.

The adverse effects of GHB that have been reported in the past (coma, seizure, confusion, hallucination) were mainly described in healthy, non-alcoholic subjects who took the "street version" of the drug, and were often related to acute toxicity and overdose.

Like alcohol, GHB possesses abuse potential, being self-administered orally and intravenously.

Cases of craving for GHB with consequent abuse of the drug and possible dependence may occur during treatment. Therefore, GHB must be used under strict medical surveillance and with the cooperation of a trusted family member, in order to obtain prompt reports of abuse.

*Excerpts from an interview with Dr. Giovanni Addolorato--one of the world's foremost experts on the use of GHB for alcoholism.

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