Now that GHB has been around for a while, reports are surfacing from people who have problems regulating their own use (habituation) as well as from those who experience physical withdrawal symptoms (addiction) after periods of heavy use. These seem similar in level to the habituation and addiction that occur with heavy alcohol use, the main difference being that people generally feel better after coming down off of a single heavy use of GHB than they do with heavy alcohol hangovers, so this can lead to a perception that GHB has less negative side effects when used heavily.

Unfortunately for users, the effects of constant use of GHB may have some very negative physical and mental side effects. There are reports of very serious withdrawal symptoms including some reported deaths documented by Jo Ellen Dyer of the California Poison Control Center and a collection of negative GHB-related info and forums can be found at Trinka Porrata's Project GHB.

A good new document on addiction and treatment of GHB overuse was published in March 2001 by the Texas Commission on Alcohol and Drug Abuse detailing withdrawal symptoms and treatment guidelines. Definitely worth reading: GHB Withdrawal Syndrome. It has a good set of journal references at the bottom of the article.

Habituation
Many people enjoy the effects of GHB enough that they find themselves using it more frequently than they intended to or are comfortable with. Using GHB every weekend can turn into a few times a week or every night and can, for some people, turn into several times a day. People who find themselves using GHB daily or multiple times a day for periods of weeks or months often report that they have some difficulty ceasing use. Some people have also report that after using GHB daily for many months, strange psycho-physical effects, such as hearing bells constantly, were experienced.

Addiction
Physical withdawal symptoms appear in some people who stop using GHB after more than a few consecutive days of repeated use. Symptoms can include difficulty sleeping, anxiety, edginess, chest pain and tightness, muscle and bone aches, sensitivity to external stimuli (sound, light, touch), dysphoria, and mental dullness. The symptoms seem to last between a few days and 2 to 3 weeks as the body comes back into balance. We have received reports from a handful of individuals who have had difficulty ceasing use. For at least some percentage of regular users, the combination of mental habituation and physical withdrawal symptoms can lead to heavy use with great difficulty stopping.

GHB withdrawal occurs in most people who use it for more than one day in a row and the hangover from GHB use could possible be called a mild form of withdrawal, since the hangover can be treated with additional doses of GHB / 14b.

Treatment
Many GHB users are able to stop using by themselves by quitting 'cold turkey' or by tapering down over the course of 14 days. We've recieved several reports from heavy users who have described an inability to stop cold, but had luck with tapering down over a couple weeks.

GHB Withdrawal is being treated with Benzodiazepines (valium, librium, ativan, etc), as well as barbiturates, other gabaneric drugs such as gabapentin, beta blockers to treat some of the unpleasant muscle/heart effects, vitamins. Antipsychotics are used in some of the worst cases. From GHB Withdrawal Syndrome:

Most patients in GHB with-drawal have an extremely high tolerance to the sedating effects of benzodiazepines and require large frequent doses similar to those required for the treatment of severe alcohol withdrawal.

Relapse
For some users, they find themselves drawn to GHB after they've stopped using it, although this appears to be a minority of heavy users (the data we have is very limited). GHB can occupy a similar place to other addictive/habituating drugs in that it is used to reduce anxiety, manage stress, decrease social anxiety, etc. For some people, it is extremely difficult to let go of using it in this way.

ARTICLES
GHB Withdrawal Syndrome, by Miotto & Roth, TCAD

EXPERIENCE REPORTS
GHB Withdrawal Symptoms, by Dark Wight
Effects of Heavy GHB Use, by Elfstone
1,4 Butanediol Withdrawal Symptoms, by August
GHB Addiction - I was an invalid for a few weeks, by Rev Rob

GHB Addiction & Habituation Reports
1,4B Addiction & Habituation Reports