Harmen Beurmanjer

99 Summary and Discussion 7 allow patients to slowly taper off, as well as allowing them to learn new skills aimed at preventing a relapse in GHB use, before baclofen is fully tapered off. The potential effects of baclofen could also be used to develop new harm reduction strategies for those patients who repeatedly relapse, in a similar fashion as with methadone programs developed for opioid use disorder patients. Given the prolonged half-life, baclofen could be used to stabilize and structure patients and their environments before starting a new treatment cycle aimed at full recovery. However, further studies are needed to explore these potential benefits of baclofen in the treatment of patients with GUD. These studies should focus on establishing effectiveness, finding the optimal therapeutic dose, and monitoring for potential risks and side effects in patients with GUD. Considerations for psychosocial interventions in patients with GUD Besides pharmacological interventions, patients with GUD also require non-pharmaco- logical interventions, though these were not studied as part of this thesis. As concluded in part 1 of this discussion, GUD should be considered a regular SUD. Therefore, existing evidence-based treatment programs for SUD should be considered for GUD patients as well. However, there are a few issues that should be taken into consideration. First, we showed frequent cognitive impairment, especially when patients are still using GHB (chapter 4). These cognitive impairments will likely result in patients having trouble overseeing their situation, planning accordingly for their recovery, and memorizing what is discussed in psychotherapy sessions. This suggests that patients with GUD might benefit from adjusted treatment approaches, taking these cognitive impairments into account, for instance by providing support in planning, cognitive training, and more frequent therapy sessions with sufficient repetition (Rensen et al., 2019; Verdejo-Garcia, Garcia-Fernandez, & Dom, 2019). Second, we observed little ambivalence towards GHB in GUD patients (chapter 4). This will require a strong focus on motivational interviewing to create engagement in patients (Diclemente, Corno, Graydon, Wiprovnick, & Knoblach, 2017). This should be supported by psycho-education, perhaps in collaboration with former patients that are now part of peer support groups. Third, the increased feelings of anxiety as observed in chapter 3 might need special (non-pharmacological) attention. Preparing patients what they are going to experience in combination with learning behavioural strategies how to deal with feelings of anxiety could make it easier for them to endure the first phase of abstinence. To further help the recovery process, I recommend to include (healthy) significant others and/or family/ friends that can provide support to the patient during treatment, especially outside the therapeutic program. A healthy support network that is aware of the vulnerabilities of the patient might be able to provide support during difficult situations.