Harmen Beurmanjer

46 Chapter 3 network and meaningful daytime activities and/or work. Previous studies also showed that a lack of these basic needs predicts relapse in both alcohol and drug dependent patients (McLellan et al., 2000). A review of treatment effects in patient with SUD and co morbid disorders showed that motivational interviewing is effective in establishing a therapeutic alliance, personal goals and subsequent treatment retention. Highly structured therapy programs with intensive outpatient treatments, case management and contingency management are most effective for complex groups of patients (Kelly, Daley, & Douaihy, 2012). Given the complexity which is seen often in patients with GUD a similar approach in treating both GUD and co-morbid problems could be considered. It is important that the treatment goals are personal and not necessarily directly aimed towards abstinence. Besides psychosocial treatment, pharmacotherapy might also support patients during the process of recovery. Recently studies (Harmen Beurmanjer, Kamal, de Jong, Dijkstra, & Schellekens, 2018; Kamal, Loonen, et al., 2015) prescribing baclofen to GHB dependent patients after detoxification showed promising results in lowering relapse and increasing treatment adherence. The current qualitative study was the first in which illness perception in GHB dependent users was studied. All participants had prior treatment for GUD, and 90% was abstinent at the time of the interview. This suggests selection bias towards a sample of participants motivated for and able to reach abstinence. Participants had a GHB use history of two to ten years and had been admitted for GHB treatment with an average of four times. All participants had also received treatment for other disorders, mainly anxiety, (unipolar) mood and personality disorders This corresponds to GHB dependent patients in treatment, as relapse rates, treatment consumption and treatment re-enrolment are high. (Dijkstra et al., 2017; M. S. van Noorden et al., 2017) This makes the group likely a good representation of the treatment seeking patients with GUD. However the results cannot be extrapolated to the entire GUD population, as non-treatment seeking GUD users were not included in the study. A recall bias should also be taken into account as participants had to remember what they thought and felt during a period of almost permanent intoxication. In future studies a longitudinal approach, where participants are interviewed during use, treatment and after treatment could solve this issue. Most participants used multiple substances, making it hard to classify certain effects as GHB specific. Differences were clarified as much as possible during the interview, in order to pinpoint which effects were GHB specific. Future studies should explore differences in illness perceptions and treatment needs between patients with different SUD’s.