title: Decision rules for GHB (γ-hydroxybutyric acid) detoxification: a vignette study.
abstract: BACKGROUND
  GHB dependent patients can suffer from a severe and sometimes life-threatening withdrawal syndrome. Therefore, most of the patients are treated within inpatient settings. However, some prefers an outpatient approach to treatment. The aim of this study was to develop decision rules for addiction physicians to determine whether an outpatient or inpatient setting should be chosen for a safe GHB detoxification.
  
  
  METHODS
  A prospective vignette study was performed. Forty addiction medicine specialists from various treatment settings and residents of the Addiction Medicine postgraduate Master training were asked to contribute vignettes of GHB dependent patients. A focus group of 15 psychiatrists and addiction medicine specialists was asked to recommend an outpatient or inpatient setting for GHB detoxification treatment per vignette. Finally, five addiction medicine specialists, experts in GHB dependence treatment in the Netherlands, assessed the bio-psychosocial reasons for the choices of the focus group and formulated the recommended criteria.
  
  
  RESULTS
  Based on the bio-psychosocial state of twenty vignette patients, addiction physicians and psychiatrists established the criteria and conditions recommended for the indication of an outpatient GHB detoxification. Intensity of addiction (GHB dose ≤32 g/d and frequency of abuse ≤2 h) was stated as the primary criterion in determining the setting as well as the complexity of the psychiatric comorbid disorders. The importance of a stable support system was emphasised.
  
  
  CONCLUSIONS
  The vignette study resulted in a set of criteria with which addiction medicine specialists can make a weighted decision as to an outpatient or inpatient setting for GHB detoxification.
authors.affiliation: Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 ED Nijmegen, The Netherlands; Novadic-Kentron Addiction Care Network, 5260 AE Vught, The Netherlands. Electronic address: rama.kamal@novadic-kentron.nl.
authors.forename: Rama M
authors.initials: RM
authors.lastname: Kamal
authors.affiliation: Dimence Mental Health Care, 8012 EN Zwolle, The Netherlands.
authors.forename: Sjacco
authors.initials: S
authors.lastname: van Iwaarden
authors.affiliation: Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 ED Nijmegen, The Netherlands; Novadic-Kentron Addiction Care Network, 5260 AE Vught, The Netherlands.
authors.forename: Boukje A G
authors.initials: BA
authors.lastname: Dijkstra
authors.affiliation: Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 ED Nijmegen, The Netherlands.
authors.forename: Cornelis A J
authors.initials: CA
authors.lastname: de Jong
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000175:diagnosis* / Q000628:therapy; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D006885:Hydroxybutyrates; D008297:Male; D011446:Prospective Studies; D011570:Psychiatry / Q000379:methods; D016320:Substance Abuse Treatment Centers / Q000379:methods; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult
chemical_list: D006885:Hydroxybutyrates; C111420:4-hydroxybutyric acid
keywords: Detoxification; GHB; Gamma-hydroxybutyric acid; Outpatient; Vignette study