Harmen Beurmanjer

95 Summary and Discussion 7 effects of GHB on memory (Carter, Griffiths, et al., 2009). This is supported by the fact that many patients’ scores improved after detoxification. However, a stable environment, with healthy food and improved sleep, could of course also have attributed to cognitive improvements (Garcia & Salloum, 2015; Sinha & Jastreboff, 2013). Still, about a third of patients with GUD had an indication for cognitive impairments after detoxification (see chapter 4). This is a relatively high number compared to other SUDs, especially when taking the young age and short length of GUD into account (Bruijnen, Dijkstra, et al., 2019). Similar to patients with other SUDs our data did not find a relationship between MoCA scores and years of regular use, (GHB) dose, severity of dependence and coma’s (Bruijnen, Dijkstra, et al., 2019). This suggests that other factors might be involved, for instance lack of sleep, malnutrition or other psychiatric/somatic comorbidities. Illness perception of GUD Though the developmental trajectory of GUD seems to follow the classic development of SUDs and its symptoms are similar to other SUD’s, patients with GUD show higher relapse rates than most other groups. Roughly half of the patients relapse within three months after detoxification (Beurmanjer et al., 2018). In chapter 3, patients reported that the way they viewed GHB might have contributed to this. GHB was considered the ultimate drug by most participants. According to them, a small dose of GHB will boost self-esteem, makes stress disappear and all problems to be solved for a moment. On top of this, these upsides don’t have a hangover, and no one seems to notice GHB use. As long as people keep using GHB, they perceive to function normally without downsides of drug use. The absence of this negative feedback loop might contribute to the relatively rapid development of severe SUD at a relatively young age in our study population. Patients with GUD, like other substance use disorders, reported the illusion of control: “I can always quit tomorrow”. While this limited insight in their illness is similar to other SUD’s, the absence of a negative feedback loop is prescribed by users as something unique (Beurmanjer et al., 2019). This could explain why even abstinent patients with GUD keep describing GHB as “the perfect drug” and remain to have very strong positive associations with it. These positive associations could contribute to fast relapse in daily GHB use. Role of stigma in GUD Stigma is common towards patients with SUD’s by both the public and healthcare services (Van Boekel, Brouwers, Van Weeghel, & Garretsen, 2013). However, GHB seems to come with more stigmatisation than other substances (Palamar & Halkitis, 2006). During my research I’ve come across many clinicians who described patients with GUD as “difficult” and sometimes even as the “most difficult group” of patients with SUDs. A mixed-method study from 2011 (Koekkoek, Hutschemaekers, van Meijel, & Schene, 2011) showed that the