Harmen Beurmanjer

91 Summary and Discussion 7 Summary The aims of this thesis were to 1) further our understanding of the GHB using population and treatment needs of patientswithGUD, 2) test pharmacological treatment interventions in patients with GUD. In this chapter, I will present and discuss the main findings and their implications, starting with a summary of the included chapters, followed by the overall conclusions, clinical implications, general issues and suggestions for further research. Part 1: Understanding the GHB using population Chapter 2 SUB-GROUPS OF PEOPLE WHO USE GHB To get a better overview of people who use GHB we conducted a systematic review of the literature on (sub-)populations of GHB users. The identified GHB-using populations can be roughly categorized by increasing severity level of GHB use as recreational use of GHB without adversities; recreational use of GHB with adversities, and people with GUD. Differences between these populations were mainly related to frequency of GHB use, reasons for GHB use, as well as level of education, work status, and psychiatric comorbidity. The more severe the adversities, the more likely users display higher levels of GHB dose, frequency of use, GHB-induced coma’s, negative reasons for use, co-substance use and psychiatric co-morbidity. Patients with GUD have more often a lower level of education and are more often unemployed, compared to recreational users. Due to the lack of longitudinal studies the trajectory from recreational GHB use, to problematic GHB use and the development of GUD remains unclear. Chapter 3 ILLNESS PERCEPTIONS AND TREATMENT NEEDS IN PATIENTS WITH GUD In order to get a better understanding of patients with GUD we held in depth interviews about illness perceptions and treatment needs. These interviews showed that patients with GUD had mainly positive views toward GHB. They described GHB as a fast-working substance, that makes a person feel confident, with no downsides. There’s no hangover and the temporary GHB-induced coma’s feel harmless, or are not noticed at all. When GHB use becomes more frequent patients keep experiencing mainly strong rewards, despite the start of withdrawal symptoms. Withdrawal symptoms are however not recognized as such and usually lead to more GHB use, starting a downward spiral. As a result, GHB is viewed as the solution to all personal problems, rather than the cause. This positive attitude remains strong in patients, even when GUD becomes more severe. The main expressed treatment needs were related to mood and anxiety symptoms and not towards GHB or abstinence. Other areas that patients requested help with were get proper housing, a supportive social network, and meaningful daytime activities and/or work.