Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

8. Marijuana, Hallucinogens, and Club Drugs 171(Bubser Keseberg, Notz, & Griffiths, 1992), and this is likely the cause of itsability to reinforce and cause dependence. Furthermore, persisting memory deficitshave been demonstrated (Curran & Monaghan, 2001).TreatmentThe most dangerous effects of ketamine are behavioral. Individuals maybecome withdrawn, paranoid, and physically sloppy. In the event of dealingwith an individual who is intoxicated on ketamine, the physician must treatthe individual symptomatically. Calm reassurance and a low-stimulation environmentare usually most helpful. The patient should be placed in a part of theclinic or emergency room with the least amount of light and stimulation. Ifnecessary, the patient may be given benzodiazepines to control the associatedanxiety (Graeme, 2000). Neuroleptics should be avoided, because the sideeffectprofile may cause discomfort and possibly exacerbate the patient’s agitatedstate.Ketamine is an addictive drug. There are numerous reports of individualswho have become dependent on the drug and use it daily (Galloway et al.,1997; Jansen, 1990). Such dependence should be treated in the same manner asany other chemical dependence. The clinician should do a careful evaluation inorder to discern other psychological conditions. These should be dealt with inthe most clinically expeditious manner.HistoryGHBGHB was first synthesized in the mid-1970s by Dr. H. Laborit, a Frenchresearcher interested in exploring the effects of gamma-aminobutyric acid(GABA) in the brain. Laborit was attempting to manufacture a GABA-likeagent that would cross the blood–brain barrier (Vickers, 1969). During the1980s, GHB was widely available in health food stores. It came to the attentionof authorities in the late 1980s as a drug of abuse, and the Food and DrugAdministration (FDA) banned it in 1990, after reports of several poisoningswith the drug (Chin, Kreutzer, & Dyer, 1992). In the past decade, it hasbecome more widely known as a drug of abuse associated with nightclubs andraves.GHB is known as “liquid Ecstasy,” and in Great Britain as GBH, or “grievousbodily harm.” It can be found, occurring naturally, in many mammaliancells. In the brain, the highest amounts are found in the hypothalamus andbasal ganglia (Gallimberti et al., 1989). It is likely that it is itself a neurotransmitter(Galloway et al., 1997). GHB is closely linked to GABA and is both aprecursor and a metabolite of GABA (Chin et al., 1992).