Harmen Beurmanjer

22 Chapter 2 of an individual’s SUD is qualified as mild, moderate, or severe, when scoring met between two to eleven diagnostic criteria (American Psychiatric Association, 2013). A major complexity in GUD patients is the GHB withdrawal syndrome, due to high risk for agitated delirium and epileptic seizures (Wood, Brailsford, & Dargan, 2011). Furthermore, prospective studies show dramatically high relapse rates among patients with GUD after detoxification, of up to 65% within three months (Dijkstra et al., 2017). Most studies on GHB use focus on specific GHB-using populations, like partygoers, patients presenting at emergency department with GHB intoxication, or GUD patients presenting at addiction care. As a result, literature is inconclusive concerning demographic characteristics and typical GHB-user patterns. From a public health perspective, an overview of different populations using GHB is urgently needed, especially given the potential risks associated with GHB use. Better understanding of the differences between user groups is necessary in order to design adequate prevention, treatment and harm reduction policies. The aim of this review was to obtain an overview of different profiles of GHB-using populations described in the available literature. We describe demographic characteristics and GHB use patterns (amount, frequency, function, and social context) in these studies, and explore differences in psychosocial aspects and psychiatric comorbidity between these populations. Methods Search strategies We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Liberati et al., 2009). Articles published from January 1997 up to October 2019 were considered for inclusion in the review. Databases Pubmed, PsycINFO, Embase, Cochrane, Web of Science, and CINAHL were searched using the following strategy: [Sodium Oxybate [MeSH] OR GHB OR gamma-­ hydroxybutyrate OR gamma-hydroxybutyric acid OR 4-hydroxybutanoic acid OR 4 hydroxy­ butyrate sodium OR gammabutyrolactone OR sodium gamma hydroxybutyrate OR sodium oxybutyrate OR somsanit OR xyrem OR sodium oxybate OR gamma-butyrolactone OR GBL OR 1,4-butanediol OR 1,4-BD] AND [behavior, addictive [MeSH] OR substance-related disorders [MeSH] OR addiction [MeSH] OR Drug dependence [MeSH] OR substance use disorder * OR drug use disorder * OR abuse * OR dependence OR addicti * OR use pattern* ]. MESH headings might differ slightly for each database. References from different articles were also reviewed, including review articles that were removed from the search. Study selection Original observational studies focusing on GHB use, misuse, dependence or addiction that were published in the English or Dutch language were included. Qualitative, narrative,