Harmen Beurmanjer

44 Chapter 3 something participants would like to have help with in order to get their lives back on track. Another problem that participants faced was how to fill the days with activities now that they were abstinent/sober, especially when school was dropped and/or jobs were lost when they were dependent on GHB. Therefore, they expressed the need for help in finding new employment or education. Without proper meaningful daytime activities boredom became a big problem, which tended to lead back to using GHB in order to fill their empty lives. Social problems caused a lot of stress in participants after detoxification. This combination of problems led to the loss of overview making it hard to adhere to, and profit from treatment. Discussion The goal of this study was to get a better understanding of the illness perceptions of people with GHB use disorder, and to identify their treatment needs. Participants in the current study mainly had positive associations with GHB, despite many negative consequences. Participants considered psychological and social problems (e.g. depression and anxiety) their main burden. GHB was mainly seen as a solution to these problems. Concerning treatment needs, participants stated that counsellors should focus on psychological problems instead of talking mainly about GUD and abstinence. Participants wanted to learn to deal with their emotions and anxieties and needed help in getting their lives back on track, by getting daytime activities, normal friends and housing. Interpreting the data in the context of the SRM (H Leventhal et al., 1980; Howard Leventhal et al., 2016) of illness perceptions it becomes clear why many GHB dependent patients get stuck in a loop of relapses. While GHB use was seen as a health threat by clinicians, participants perceived GHB as a solution for other problems that they experienced as health threats. Thus, negative reinforcement was a main driver of continued use of GHB, as also seen in patients with other SUDs. (Kwako & Koob, 2017) From the interview data, we identified three phases in the course of development, which showed similarities to described phases in other SUDs (Volkow, Koob, & McLellan, 2016). Based on the reports of the participants, the first phase can be characterized as positive reinforcement phase. During this phase participants experienced strong rewarding effects of GHB, bigger life satisfaction, no downsides and a gradual increase of GHB use. By combining GHB with stimulants, such as amphetamines, participants tried to extend their parties. Second is the dose escalation phase, in which GHB is used every day of the week and multiple times a day. While some of the first signs of GUD started to emerge, users didn’t connect these to their GHB use. Taking more GHB instantly solved problems of withdrawal. They had to adapt their daily activities to their increased use, because it became harder to function without GHB. This developed into the third phase, which can be categorized as the negative reinforcement phase. GHB had to be used day