Harmen Beurmanjer

98 Chapter 7 Part 2: P harmacological treatment interventions for patients with GHB use disorder Considerations concerning detoxification in patients with GUD In the literature there’s an ongoing discussion regarding the difficulties that come with treating GHB withdrawal. In this thesis we presented the first comparison between two detoxification methods, showing that tapering with pharmaceutical GHB can be considered the preferred option for detoxification when compared to benzodiazepines. This is in line with the limited number of studies in the literature on this topic (Dijkstra et al., 2017; McDonough et al., 2004; Neu, 2018) and could be explained by the effects of GHB on the GHB receptor and GABA-B receptor, compared to the BZD’s only working on the GABA-A receptor (O. C. Snead & Gibson, 2005). While tapering with pharmaceutical GHB can be considered a safe and effective detoxification method, healthy sleep patterns in patients are continuously disturbed due to the short half-life of GHB. It therefore remains important to further optimize GHB detoxification methods. In the next paragraphs I will propose some directions for future studies on improving the treatment for patients with GUD, particularly on the use of baclofen. Considerations concerning pharmacological relapse prevention in patients with GUD A potential substitute for pharmaceutical GHB with a longer half-life could be the GABA-B agonist baclofen. Given the similar pharmacological profiles of GHB and baclofen, future studies should reveal whether baclofen could actually function as a substitute to GHB. Baclofen was found to have positive results as part of GHB relapse management, further study is however needed to confirm these results in an experimental setting. Given the pharmacological similarities between GHB and baclofen, future studies should also focus on the broader potential of baclofen in the treatment patients with GUD. Recently several case-studies have been published that used baclofen in the detoxification of GHB (Coenen, Dijkstra, Batalla, & Schellekens, 2019; Habibian, Ahamad, McLean, & Socias, 2019). While these initial results are positive, there’s no evidence yet that it can be considered a reliable alternative to pharmaceutical GHB tapering. However, if baclofen is able to function as substitute for GHB during detoxification, in a similar way as benzodiazepines are to alcohol, this might be relevant in the detoxification of patients with GUD. First, the frequency of drug administration during detoxification could be drastically decreased in comparison with pharmaceutical GHB. This would allow patients to instantaneously quit GHB, sleep more and decrease the number of staff that is required to constantly monitor them. Second, its potential as relapse management would allow a smooth transition from detoxification to relapse management, where patients continue to use a low dose of baclofen in order to increase treatment retention and abstinence from GHB. Following the principles of contingency management, baclofen could be handed out once a week during psychotherapeutic outpatient treatment. This would