Harmen Beurmanjer

96 Chapter 7 ‘difficult’ patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. Typically, patients with multiple problems, like patients with GUD, lack one clear diagnosis or are eligible for many diagnoses. The ‘difficult’ patient-label may be easily given in such cases, obscuring a more useful or valid diagnosis, and possibly harming the patient (Koekkoek et al., 2011). In contrast, it was reported that a clear psychiatric diagnosis ‘protects’ patients from professional pessimism, especially one with a perceived neurobiological basis. The status of ‘difficult’ patient is easily reinforced by subsequent patient and professional behaviour, turning initial help-seeking behaviour into ‘difficult’ or ineffective chronic illness behaviour, and ineffective professional behaviour (Koekkoek et al., 2011). The relative novelty of GHB and the lack of studies into treatment modalities for this population could make them extra vulnerable to be misunderstood and labelled as difficult. This underlines the need for continued research and dissemination of the results among (mental)healthcare professionals. This will likely help preventing patients being labelled as difficult and the stigma that comes with it. In order to achieve this, guidelines have been developed, seminars and webinars have been organised over the past years, including post academic training programs for psychologists, psychiatrists, and addiction physicians. More importantly, recently the first comprehensive GUD treatment guideline (Joosten et al., 2020) was developed and distributed open access among mental healthcare workers. This guideline includes the results from this thesis and an extensive overview of all available relevant information regarding the treatment of patients with GUD that is currently known. Considerations for Policy interventions to prevent GHB use-related harm Based on the studies in this thesis, several recommendations can be made to prevent GHB use-related harm. While many people who use GHB view the substance as innocent, it is evident from the literature that this is not the case. Prevention policies should be put in place to draw attention for potential risks of GHB use. For instance, GHB-induced coma’s might feel innocent, but there is sufficient evidence to suggest these can lead to cognitive problems and accidents. Furthermore, we’ve seen that GUD can evolve fast and that initial signs of GUD can easily be overlooked by the patient until it is too late. Phan and colleagues (Phan et al., 2020) have done several suggestions regarding prevention and harm-minimalization strategies aimed at GHB users in Australia. For instance, making several short screenings lists for healthcare professionals, as well as compact harm-minimalization advice aimed at people who are using GHB. The latter is drawn up following the acronym STAYING SAFE (see table 1) and could function as simple and basic information that prevention workers can give to GHB users. Future studies should however determine if providing this information actually prevent adverse events in people using GHB.