Carolien Zeetsen

Abstract The recreational use of Gamma–hydroxybutyrate (GHB) is associated with frequent overdoses, coma and the risk of developing GHB use disorder (GUD). Several studies suggest negative effects of GHB use or related comas on cognition. Since relapse rates are particularly high in GUD, and cognitive impairment has been associated with relapse in other substance use disorders, we aim to investigate the relationship between GHB use, self–reported comas and cognitive impairment, and the role of cognitive impairment in relapse into GHB use after detoxification in GUD patients. In this prospective cohort study a consecutive series of patients with GUD ( n = 137) admitted for detoxification were recruited at six addiction care facilities in the Netherlands. The Montreal Cognitive Assessment (MoCA) was used to screen for cognitive impairments before and after detoxification. Follow–up for the assessment of relapse in GHB use was after three months. A substantial number of patients with GUD screened positive for cognitive impairment before (56.3%) and after (30.6%) detoxification. Most patients showed impairment on the MoCA domain memory (58.8%). Cognitive impairment was not related to the severity of GUD or number of GHB–induced comas. Proportionately more patients who relapsed performed under the cut–off of the MoCA before detoxification than those who remained abstinent. Regression analysis showed that only performance on the MoCA domain memory predicted relapse. Cognitive impairment seems highly prevalent among patients with GUD, possibly related to the risk of relapse. 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. Current findings warrant clinical attention for cognitive impairment in patients with GUD, for instance by screening for cognitive impairment using the MoCA, and a full neuropsychological assessment after detoxification.