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

174 III. SUBSTANCES OF ABUSE5. Admit the patient to the hospital if he or she is still intoxicated after 6hours.6. Discharge the patient if he or she is clinically well in 6 hours (withplans for follow-up, and a suggestion that therapy may be appropriate).Patients whose breathing is labored should be managed in the intensive careunit. Most patients who overdose on GHB recover completely, if they receiveproper medical attention.Individuals may develop physiological dependence on GHB. The symptomsare similar to those of alcohol withdrawal: anxiety, tremor, insomnia, and“feelings of doom,” which may persist for several weeks after cessation of use(Galloway et al., 1997). There is anecdotal evidence, such as the proliferationof support groups and help lines for GHB-dependent individuals, that the numbersof GHB-dependent individuals is rising.The complex symptoms suggest that benzodiazepines may be useful intreating GHB withdrawal. Because data are lacking, clinicians must exercisetheir most prudent judgment regarding what will be most helpful in a given situation.HALLUCINOGENSHallucinogens produce a wide range of effects depending on the properties, dosage,and potency of the drug, the personality and mood of the drug taker, andthe immediate environment. Visually, perception of light and space is altered,and colors and detail take on increased significance. If the eyes are closed, thedrug taker often sees intense visions of different kinds. Nonexistent conversations,music, odors, tastes, and other sensations are also perceived. The sensationsmay be either very pleasant or very distasteful and disturbing. The natureof this effect is often random and not predictable. The drugs frequently alter thesense of time and cause feelings of emptiness. For many individuals, the separationbetween self and environment disappears, leading to a sense of oneness orholiness.The effects, sometimes referred to as a “trip,” can last from an hour to a fewdays. “Bad trips,” full of frightening images, monsters, and paranoid thoughts,are known to have resulted in accidents and suicides. Flashbacks (unexpectedreappearances of the effects) can occur months later.Physiologically, the drugs act as mild stimulants of the sympathetic nervoussystem, causing dilation of the pupils, constriction of some arteries, a risein blood pressure, and increased excitability of certain spinal reflexes. Manyhallucinogenic drugs share a basic chemical structural unit, the indole ring,which is also found in the nervous system substance serotonin. Mescaline haschemical similarities to both the indole ring and the adrenal hormone epineph-