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Detoxification for patients with GUD often takes place in an inpatient setting, due to the potential fulminant course of GHB withdrawal. As memory problems were also frequently observed by the nursing staff in patients with GUD who applied for detoxification, we included patients referred to these clinics. Based on both the literature and clinical observations that GHB use and repeated GHB-induced coma’s seem associated with cognitive impairments a new study was proposed. To our knowledge no studies on the relationship between cognitive impairment and relapse in patients with GUD have been published to date. Therefore, cognitive impairment might result from repeated comas due to excessive GHB use and can potentially be an important factor in the high relapse rates observed in patients with GUD. GHB-induced comas are common in patients with GUD, with 84% having experienced GHB-induced comas at least once and often even on a daily basis. Moreover, in this cross-sectional study repeated GHB-induced comas were also associated with alterations in long-term memory networks and lower hippocampus/lingual gyrus activity while performing memory tasks. Recent studies also suggest that repeated GHB-induced comas are associated with (verbal) memory impairments, impulsivity, anxiety, depression, and stress in patients with GUD, all of which are predictors of relapse in patients with SUD.
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For instance, a double blind, placebo controlled study with healthy volunteers showed that GHB intoxication temporarily impaired working- and episodic memory, in a dose dependent manner. While research on cognitive impairment in GUD is limited, several studies suggest negative effects of GHB on cognition.
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Patients with cognitive impairments are also showing poorer treatment compliance and cognitive impairment has been associated with relapse in several SUDs, e.g., alcohol, cocaine and opioids. This can prohibit patients from acquiring effective strategies in coping with their SUD. In general, cognitive impairments in patients with SUD have a negative impact on the patients’ ability to engage in therapeutic programmes. One aspect that might be particularly relevant in the context of relapse in patients with GUD, cognitive impairment, has not been studied yet for this population. The absence of a relationship between the severity of GUD, level of GHB use, the number of GHB-induced comas, and cognitive impairment suggest that other factors may also contribute to the observed cognitive impairment. Discussion: Cognitive impairment seems highly prevalent among patients with GUD, possibly related to the risk of relapse. Logistic regression analysis showed that only the memory score independently predicted relapse. Cognitive impairment was not related to the severity of GUD or number of GHB-induced comas. Impairment on the MoCA memory domain was most frequent (58.8%). Results: A substantial number of patients with GUD screened positive for cognitive impairment before (56.3%) and after (30.6%) detoxification. The follow-up duration for the assessment of relapse in GHB use was 3 months. The Montreal Cognitive Assessment (MoCA) was used to screen for cognitive impairments before and after detoxification. Methods: In these secondary analyses of a prospective cohort study, a consecutive series of patients with GUD ( n = 103) admitted for detoxification were recruited at six addiction care facilities in the Netherlands. Since relapse rates are high in GUD and cognitive impairment has been associated with relapse in other substance use disorders, we aimed to (1) investigate the prevalence of cognitive impairment before and after detoxification, (2) analyse the relationship between GHB use, comas, and cognitive impairment, and (3) explore the association between cognitive impairment and relapse after detoxification in GUD patients. Several studies suggest negative effects of GHB use or related comas on cognition. Background: The recreational use of gamma hydroxybutyrate (GHB) is associated with frequent overdoses, coma and the risk of developing GHB use disorder (GUD).