Harmen Beurmanjer

29 Review on the GHB using Population 2 GHB is often used in combination with other substances. GHB overdoses were related to both dose and frequency of regular GHB use (Cappetta & Murnion, 2019; Grund et al., 2018; Korf, Nabben, Benschop, Ribbink, & van Amsterdam, 2014; Miotto et al., 2001). The risk of a GHB overdose might also be related to the co-use of other (sedating) substances, like alcohol and benzodiazepines (Grund et al., 2018). The most reported substances used besides GHB across all groups were alcohol (21–58%), stimulants (15–77%), and cannabis (8–50%). There are indications that GHB is often combined with stimulants (mainly cocaine and amphetamines), in order to counteract sedative effects of GHB (Beurmanjer et al., 2019; Brunt, van Amsterdam, & van den Brink, 2014). If people become dependent on GHB, the reason for their use shifts from using for euphoric effects to prevent withdrawal and to forget problems (Brunt et al., 2013; Dijkstra et al., 2017). Patients with GUD are more often unemployed than people using GHB recreationally. Frequent use of GHB and other substances is likely to interfere with employment. Vice-versa, a lack of job perspective could contribute to increased substance use and faster progression into GUD. The level of education among patients with GUD seems comparable to patients with alcohol use disorder, but lower compared to patients with cannabis, cocaine, amphetamine, and opioid use disorders (van Laar et al., 2019). In parallel with the development of GUD over time, patients with GUD report increasing use of sedatives in order to prevent GHB withdrawal and counteract insomnia (Beurmanjer et al., 2019). A study among Dutch patients with GUD in addiction care reported sedative use in 42% of patients (de Weert-van Oene, Schellekens, Dijkstra, Kamal, & de Jong, 2013). Patients with GUD reported a history of psychiatric problems in 30% to 78% of cases (Choudhuri, Cross, Dargan, Wood, & Ranjith, 2013; Durgahee et al., 2014; Kamal, Dijkstra, de Weert-van Oene, van Duren, & de Jong, 2017). Information about sexual minorities was found in six studies in which people were recruited from the general population (Anderson, Kim-Katz, Dyer, & Blanc, 2010; Brown University Digest of Addiction Theory and Application, 2007; Degenhardt & Dunn, 2008; Degenhardt et al., 2002, 2003; Kim et al., 2008; Kim, Anderson, Dyer, Barker, & Blanc, 2007; Sumnall et al., 2008), three studies about patients in addiction care (Bell & Collins, 2011; Cappetta & Murion, 2019; Durgahee et al., 2014), one study about GHB related deaths (Corkery, Loi, Claridge, Goodair, & Schifano, 2018), and two studies in a sample of gay and bisexual men (Halkitis & Palamar, 2006; Hammoud et al., 2018). Most studies including sexual minority groups only describe sexual orientation without further analyses of motives for GHB use. Yet, several studies do show that among sexual minorities people mainly use GHB for its sexually stimulating effects.