The Experience and Meaning of Problematic ‘G’ (GHB/GBL) Use in an Irish Context: an Interpretative Phenomenological Analysis

  • Niamh Joyce
  • Pádraig MacNeela
  • Kiran Sarma
  • Graham Ryall
  • Eamon Keenan
Original Article


The problematic use of psychoactive substances has adverse consequences for people’s lives and requires on-going investigation of experiences of onset, course and resolution in order to better inform theoretical understanding, particularly with regard to the use of club drugs and novel psychoactive substances. In turn, this may influence treatment approaches. GHB/GBL, frequently termed ‘G’, is one such substance, with problematic use resulting in increased presentations at A&E departments and at substance dependence clinics across Europe. The aim of the present study was to explore problematic G use as experienced by people who had presented for treatment, in Ireland, using interpretative phenomenological analysis (IPA). IPA was selected in recognition of the lack of previous research on the experience of problematic use of G and in the context of an evolving understanding of what constitutes problematic substance use. A purposive and homogenous sample of seven people, five gay males and two straight females, who had presented for treatment for ‘G’ substance use disorder to a community-based drug team, participated in semi-structured interviews. Three superordinate themes reflecting the participants chronological development of problematic ‘G’ use and early recovery were fully developed and presented—(1) early use: “I was part of that gang that took G”; (2) daily use: “It’s like insidious; it just weaves into your everyday life”; and (3) early recovery: “my priorities are changing”. This study supports the interactive role of community, self-identity, personal vulnerability and substance effects in the development, maintenance and recovery from problematic G use. Findings are discussed in the context of gay community health, the role of chemsex in problematic substance use and the need for public health providers to engage with novel psychoactive substance use and the health and well-being effects of chemsex.


Addiction Problematic substance use GHB GBL Interpretative phenomenological analysis (IPA) 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. Abdulrahim, D., Bowden-Jones, O., & (on behalf of the Neptune Expert Group). (2015). Guidance on the clinical management of acute and chronic harms of club drugs and novel psychoactive substances. London: Neptune.Google Scholar
  2. Anderson, P., Rehm, J., & Room, R. (Eds.). (2015). The impact of addictive substances and behaviours on individual and societal well-being (1st ed.). Oxford: Oxford University Press.Google Scholar
  3. APA. (2013). Diagnostic and statistical manual of mental health disorders (5th ed.). Arlington: American Psychiatric Publishing, Inc.Google Scholar
  4. Bell, J., & Collins, R. (2011). Gamma-butyrolactone (GBL) dependence and withdrawal. Addiction, 106(2), 442–447.Google Scholar
  5. BMJ. (2015). The BMJ press release: “chemsex” needs to become a public health priority. BMJ.Google Scholar
  6. Bourne, A., Reid, D., Hickson, F., Tores Rueda, S., & Weatherburn, P. (2014). The Chemsex study: drug use in sexual settings among gay and bisexual men in Lambeth. London: Southwark & Lewisham.Google Scholar
  7. Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., & Weatherburn, P. (2015). Illicit drug use in sexual settings (“chemsex”) and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study. Sexually Transmitted Infections, Online.
  8. Bracchi, M., Stuart, D., Castles, R., Khoo, S., Back, D., & Boffito, M. (2015). Increasing use of “party drugs” in people living with HIV on antiretrovirals: a concern for patient safety. AIDS (London, England), 29(13), 1585–1592. Editorial. Scholar
  9. Brunt, T., van Amsterdam, J. J. G. C., van den Brink, W., Brunt, T. M., van Amsterdam, J. J. G. C., & van den Brink, W. (2014). GHB, GBL and 1,4-BD addiction. Current Pharmaceutical Design, 20(25), 4076–4085 Journal Article, Review.CrossRefPubMedGoogle Scholar
  10. Buffin, J., Roy, A., Williams, H., & Winter, A. (2011). Part of the picture: lesbian, gay and bisexual people’s alcohol and drug use in England (2009–2011).Google Scholar
  11. Busardo, F. P., & Jones, A. W. (2015). GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Current Neuropharmacology, 13(1), 47–70.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Busardo, F. P., Kyriakou, C., Napoletano, S., Marinelli, E., & Zaami, S. (2015). Clinical applications of sodium oxybate (GHB): from narcolepsy to alcohol withdrawal syndrome. European Review for Medical and Pharmacological Sciences, 19(23), 4654–4663 Journal Article.PubMedGoogle Scholar
  13. Cain, M. (2015). The rise of gay “chemsex” parties involving libido-enhancing drugs. The Independent. London.Google Scholar
  14. Cochran, S. D., Ackerman, D., Mays, V. M., & Ross, M. W. (2004). Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population. Addiction (Abingdon, England), 99(8), 989–998. Scholar
  15. Corkery, J. M., Loi, B., Claridge, H., Goodair, C., Corazza, O., Elliott, S., & Schifano, F. (2015). Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): a literature review with a focus on UK fatalities related to non-medical use. Neuroscience and Biobehavioral Reviews, 53, 52–78 ELEC.Google Scholar
  16. Daskalopoulou, M., Rodger, A., Phillips, A. N., Sherr, L., Speakman, A., Collins, S., … Lampe, F. C. (2014a). Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. The Lancet. HIV, 1(1), e22–31. Journal Article.
  17. Daskalopoulou, M., Rodger, A., Thornton, A., Phillips, A., Sherr, L., Gilson, R., et al. (2014b). Sexual behaviour, recreational drug use and hepatitis C co-infection in HIV-diagnosed men who have sex with men in the United Kingdom: results from the ASTRA study. Journal of the International AIDS Society, 17(4 Suppl 3), 19630 Journal Article.CrossRefPubMedPubMedCentralGoogle Scholar
  18. de Weert-van Oene, G. H., Schellekens, A. F. A., Dijkstra, B. A. G., Kamal, R., & de Jong, C. A. J. (2013). Detoxification of patients with GHB dependence. Tijdschrift voor Psychiatrie, 55(11), 885–890 English Abstract, Journal Article.PubMedGoogle Scholar
  19. Dines, A. A. M., Wood, D. M. D. M., Yates, C., Heyerdahl, F., Hovda, K. E. K. E., Giraudon, I., et al. (2015). Acute recreational drug and new psychoactive substance toxicity in Europe: 12 months data collection from the European Drug Emergencies Network (Euro-DEN). Clinical Toxicology, 53(9), 893–900. JOUR. Scholar
  20. Durgahee, S., Allen, G., & Williams, H. (2014). The “G” men: A profile of GBL/GHB users in an area of high drug-related mortality. Irish Journal of Psychological Medicine, 31(4), 275–280.Google Scholar
  21. Elliott, R., Fischer, C. T., & Rennie, D. L. (1999). Evolving guidelines for publication of qualitative research studies in psychology and related fields. The British Journal of Clinical Psychology, 38, 215–229. Scholar
  22. EMCDDA. (2015). European drug report trends and developments 2015.Google Scholar
  23. EMCDDA. (2016). European drug report 2016.Google Scholar
  24. EMIS Network. (2013). The European men-who-have-sex-with-men internet survey. Findings from 38 countries (2010). Stockholm.Google Scholar
  25. Gell, L., Holmes, J., Bühringer, G., Allamani, A., Anderson, P., Stirling, K., … Behrendt. (2014). Determinants of harmful substance use and harmful gambling: an interdisciplinary review. (ALICE RAP WA3: WP8).Google Scholar
  26. Gell, L., Bühringer, G., McLeod, J., Forberger, S., Holmes, J., Lingford-Hughes, A., & Meier, P. (Eds.). (2016). What determines harm from addictive substances and behaviours (1st ed.). Oxford: Oxford University Press.Google Scholar
  27. Giorgetti, R., Tagliabracci, A., Schifano, F., Zaami, S., Marinelli, E., & Busardò, F. P. (2017). When “chems” meet sex: a rising phenomenon called “ChemSex”. Current Neuropharmacology, 15(5), 762–770.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Halkitis, P. N., & Palamar, J. J. (2008). Multivariate modeling of club drug use initiation among gay and bisexual men. Substance Use & Misuse, 43(7), 871–879. Scholar
  29. Halkitis, P. N., Palamar, J. J., & Mukherjee, P. P. (2007). Poly-club-drug use among gay and bisexual men: a longitudinal analysis. Drug and Alcohol Dependence, 89(2–3), 153–160. Scholar
  30. Hennessy, M. (2015). London “chemsex” parties face gay club scene with HIV fears. Dublin: The Irish Times.Google Scholar
  31. Herman, J. L. (2001). Trauma and recovery. From domestic abuse to political terror. London: Pandora.Google Scholar
  32. Higgins, A., Doyle, L., Downes, C., Murphy, R., Sharek, D., DeVries, J., … Smyth, S. (2016). The LGBT Ireland report: national study of the mental health and wellbeing of lesbian, gay, bisexual, transgender and intersex people in Ireland. Dublin.Google Scholar
  33. Hill, J. V., & Leeming, D. (2014). Reconstructing “the alcoholic”: recovering from alcohol addiction and the stigma this entails. International Journal of Mental Health and Addiction, 12(6), 759–771 ELEC.CrossRefGoogle Scholar
  34. Holt, M. (2014). Sex, drugs and HIV: let’s avoid panic. The Lancet. HIV, 1, e4–e5. Scholar
  35. Jackson-Roe, K., Murray, C., & Brown, G. (2015). Understanding young offenders’ experiences of drinking alcohol: an interpretative phenomenological analysis. Drugs: Education, Prevention & Policy, 22(1), 77–85 ELEC.Google Scholar
  36. Kirby, T., & Thornber-Dunwell, M. (2013). High-risk drug practices tighten grip on London gay scene. The Lancet, 381(9861), 101–102 JOUR.CrossRefGoogle Scholar
  37. Knapton, S. (2015). Chemsex: the alarming new trend of 72 hour drug-fuelled sex sessions. London: The Telegraph.Google Scholar
  38. Lea, T., Prestage, G., Mao, L., Zablotska, I., de Wit, J., Holt, M., … (2013). Trends in drug use among gay and bisexual men in Sydney, Melbourne and Queensland, Australia. Drug and Alcohol Review, 32(1), 39–46. JOUR.
  39. Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress in lesbian, gay, and bisexual young adults in Australia: associations with psychological distress, suicidality, and substance use. Archives of Sexual Behavior, 43(8), 1571–1578. Scholar
  40. Marlatt, G., Larimer, M., & Witkiewitz, K. (2012). Harm reduction: pragmatic strategies for managing high-risk behaviors (2nd ed.). New York: Guilford.Google Scholar
  41. Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., et al. (2008). Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction, 103(4), 546–556. Scholar
  42. McCown, D., & Reibel, D. (2010). Mindfulness and mindfulness-based stress reduction. In D. A. Monti & B. D. Beitman (Eds.), Integrative psychiatry (pp. 289–238). New York: Oxford.Google Scholar
  43. Measham, F., Wood, D., Dargan, P., & Moore, K. (2011). The rise in legal highs: prevalence and patterns in the use of illegal drugs and first and second generation “legal highs” in south London gay dance clubs. Journal of Substance Use, 16(4), 263–272. Scholar
  44. Merikangas, K. R., Mehta, R. L., Molnar, B. E., Walters, E. E., Swendsen, J. D., Aguilar Gaziola, S., … Kessler, R. C. (1998). Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology. Addictive Behaviours, 23(6), 893–907.Google Scholar
  45. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing. Preparing people for change (2nd ed.). New York: Guilford.Google Scholar
  46. Moos, R. H. (2007). Theory-based active ingredients of effective treatments for substance use disorders. Drug Alcohol Dependency, 88(2–3), 109–121.CrossRefGoogle Scholar
  47. Nutt, D. J., King, L. A., & Phillips, L. D. (2010). Drug harms in the UK: a multicriteria decision analysis. The Lancet, 376(9752), 1558–1565. Scholar
  48. Orford, J. (2008). Asking the right questions in the right way: the need for a shift in research on psychological treatments for addiction. Addiction, 103(6), 875–885. Scholar
  49. Rodriguez, L., & Smith, J. A. (2014). “Finding your own place”: an interpretative phenomenological analysis of young men’s experience of early recovery from addiction. International Journal of Mental Health and Addiction, 12(4), 477–490 ELEC.CrossRefGoogle Scholar
  50. Rosenberg, H., & Davis, A. K. (2014). Differences in the acceptability of non-abstinence goals by type of drug among American substance abuse clinicians. Journal of Substance Abuse Treatment, 46(2), 214–218. Scholar
  51. Sarma, K. (2007). Recreational drug taking among LGBT young adults in Ireland results of an exploratory study. Youth Studies Ireland, 2(2), 35–49 Scholar
  52. Schep, L. J., Knudsen, K., Slaughter, R. J., Vale, J. A., & Megarbane, B. (2012). The clinical toxicology of gamma-hydroxybutyrate, gamma-butyrolactone and 1,4-butanediol. Clinical Toxicology, 50(6), 458–470. JOUR. Scholar
  53. Shinebourne, P., & Smith, J. A. (2009). Alcohol and the self: an interpretative phenomenological analysis of the experience of addiction and its impact on the sense of self and identity. Addiction Research & Theory, 17(2), 152–167 ELEC.CrossRefGoogle Scholar
  54. Smith, J (2011). Evaluating the contribution of interpretative phenomenological analysis. Health Psychology Review, 5(1), 9–27.
  55. Smith, J., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis. Theory, method and research. London: Sage.Google Scholar
  56. Stoll, L., & Anderson, P. (2015). Well-being as a framework for understanding addictive substances. In P. Anderson, J. Rehm, & R. Room (Eds.), The impact of addictive substances and behaviours on individual and societal well-being (1st ed.). Oxford: Oxford University Press.Google Scholar
  57. Stuart, D. (2013). Sexualised drug use by MSM: background, current status and response. HIV Nursing, (Spring), 6–10.Google Scholar
  58. Thombs, D. L. (2006). Introduction to addictive behaviours (3rd ed.). New York: Guilford.Google Scholar
  59. van Amsterdam, J., Brunt, T., Pennings, E., van den Brink, W., Pennings, E., & van den Brink, W. (2015a). Risk assessment of GBL as a substitute for the illicit drug GHB in the Netherlands. A comparison of the risks of GBL versus GHB. Regulatory Toxicology and Pharmacology, 70(2), 507–513. JOUR. Scholar
  60. Van Amsterdam, J., Nutt, D., Phillips, L., & Van Den Brink, W. (2015b). European rating of drug harms. Journal of Psychopharmacology, 29(6), 655–660 JOUR.CrossRefPubMedGoogle Scholar
  61. Vangeli, E., & West, R. (2012). Transition towards a “non-smoker” identity following smoking cessation: an interpretative phenomenological analysis. British Journal of Health Psychology, 17(1), 171–184. Scholar
  62. Watson, L., & Parke, A. (2011). Experience of recovery for female heroin addicts: an interpretative phenomenological analysis. International Journal of Mental Health and Addiction, 9(1), 102–117.CrossRefGoogle Scholar
  63. West, R., & Brown, J. (2013). Theory of addiction (2nd ed.). Chichester: Wiley.CrossRefGoogle Scholar
  64. WHO. (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines (10th ed.). Geneva: World Health Organisation.Google Scholar
  65. Winstock, A. (2015). New health promotion for chemsex and gamma-hydroxybutyrate (GHB). BMJ (Clinical Research Ed.). Letter, England.Google Scholar
  66. Winstock, A. R., & Mitcheson, L. (2012). New recreational drugs and the primary care approach to patients who use them. BMJ, 344(e288), 1–10. Scholar
  67. Wood, D. M., Warren-Gash, C., Ashraf, T., Greene, S. I., Shather, Z., Trivedy, C., … Dargan, P. I. (2008). Medical and legal confusion surrounding gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD). QJM: Monthly Journal of the Association of Physicians, 101(1), 23–29.
  68. Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health, 15(2), 215–228. Scholar
  69. Zvosec, D. L., Smith, S. W., Porrata, T., Strobl, a. Q., & Dyer, J. E. (2011). Case series of 226 Gammahydroxybutyrate-associated deaths: Lethal toxicity and trauma. American Journal of Emergency Medicine, 29(3), 319–332.

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© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.School of PsychologyNational University of Ireland, GalwayGalwayIreland
  2. 2.National Drug Treatment Centre, McCarthy CentreDublin 2Ireland
  3. 3.Rialto Community Drug TeamDublin 8Ireland

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