Harmen Beurmanjer

14 Chapter 1 Recently there’s also been an interest in prescribing the GABA-B agonist baclofen to patients with GUD after detoxification to prevent relapse (Kamal, Schellekens, De Jong, & Dijkstra, 2015). Baclofen and GHB show many similarities in working mechanism, mainly activating GABA-B receptors, with the added benefit that baclofen ( T ½ =2–6 h) has a longer half-life than GHB ( T ½ =30–60 min). There’s some evidence that baclofen could help in limiting craving and anxiety, and subsequently increase abstinence rates in patients with alcohol use disorder (G. Addolorato et al., 2002; Giovanni Addolorato et al., 2007), and also in patients with GUD (Kamal, Loonen, Dijkstra, & De Jong, 2015). However, at the start of thesis, this had not been studied in larger populations of patients with GUD. Aims and outline of this thesis The main purpose of this thesis is two-fold, 1) to further our understanding of the GHB using population and treatment needs of patients with GUD, and 2) to evaluate the two existing pharmaceutical GHB interventions: GHB detoxification and baclofen relapse management. The specific research questions are: Part 1: Understanding the GHB using population 1. Which different profiles of GHB-using populations, including GUD, are described in the literature? (chapter 2) 2. How do patients with GUD perceive their GHB use and what do they need from treatment? (chapter 3) 3. To what extent do patients with GUD show cognitive impairment, and is there a relationship with GHB-induced coma’s and relapse? (chapter 4) Part 2: Evaluating existing GHB specific interventions 4. How does detoxification with pharmaceutical GHB compare with detoxification with benzodiazepines in patients with GUD in terms of withdrawal severity, craving levels and occurrence of adverse events? (chapter 5) 5. What is the effect of prescribing baclofen to patients with GUD after detoxification on relapse rates? (chapter 6) Part 1: Understanding the GHB using population Chapter 2 aims to create an overview of the different subpopulations of GHB users and their characteristics regarding demographics, substance use and psychosocial aspects. For this purpose, a systematic review was conducted, which describes the results of 51 studies on different GHB user groups. Chapter 3 focusses on the problem that patients with GUD often leave treatment prematurely and show high relapse rates. This qualitative cross-sectional observational