Weight loss surgery linked to drinking problems

Drug, Alcohol Deaths Soar After Weight-Loss Surgery

Weight loss surgery linked to drinking problems

By Donna Siegfried

HealthDay Reporter

THURSDAY, June 20, 2019 (HealthDay News) — A new study offers some sobering news about weight-loss surgery.

People who undergo a gastric bypass procedure called Roux-en-Y are three times more ly than those in the general population to die of drug- or alcohol-related causes, according to researchers at the University of Pittsburgh.

The reason isn't clear, but laboratory studies have shown that Roux-en-Y surgery changes the way the body reacts to drugs and alcohol.

“The effect is purely physiological, not psychological,” said Dr. John Morton, chief of bariatric and minimally invasive surgery at Yale School of Medicine, who reviewed the findings. “Gastric bypass surgery removes 95% of the stomach. Alcohol receptors exist in the stomach and the liver, so by removing so much of the stomach, people lose the first pass at metabolizing alcohol.”

Morton was not involved in the study but has published research on the topic.

For this study, the Pitt researchers followed nearly 2,500 adults who had weight-loss surgery at one of 10 hospitals across the United States. About eight 10 were women and 86% were white. Their median age was 46, meaning half were older, half younger. The patients were followed for seven years.

During that time, 10 of the study participants died of causes directly related to drug or alcohol use.

That included six accidental drug overdoses; one intentional drug overdose; one overdose where intent was unknown; and two from alcoholic liver disease. All 10 had had a Roux-en-Y bypass, which reduces the stomach size and shortens the intestine.

As with other forms of “bariatric” (weight-loss) surgery, having a smaller stomach makes people feel full sooner, so they lose weight.

To compare patient death rates with those in the general population, researchers used a formula called “person-years.” It measures the number of people studied and number of years each participated in the study.

On average, there were 89 deaths per 100,000 person-years among Roux-en-Y patients, compared to 30.5 per 100,000 in the general population, the investigators found.

Study co-author Wendy King said, “Our study primarily focused on those who had Roux-en-Y gastric bypass surgery; it did not examine differences in drug- and alcohol-related mortality among those who had undergone” another type of weight-loss surgery called sleeve gastrectomy.

“New evidence suggests that sleeve gastrectomy may also alter the way alcohol is metabolized in the body, so there is more work to do,” she added. King is an associate professor in the department of epidemiology at the University of Pittsburgh Graduate School of Public Health.

The nation's most popular weight-loss surgery, sleeve gastrectomy, also removes a portion of the stomach, although not as much as Roux-en-Y gastric bypass. A third type of bariatric surgery is gastric banding, which ties off the upper portion of the stomach.

Because their stomachs hold less, people who undergo bariatric surgery tend to feel the effects of alcohol sooner and after fewer drinks. Researchers said that's why it is important for patients to pay attention not only to how alcohol makes them feel, but also whether it interferes with relationships and daily activities.

The findings highlight the need for more education, diagnosis, treatment and tracking of alcohol and drug use as part of post-surgery care, the study authors said.

The researchers also called on primary-care doctors to be more aware of these risks as they treat patients who have had weight-loss surgery, and for more long-term follow-up. The deaths uncovered in the study occurred about five years after surgery.

Morton underscored the importance of awareness.

“Substance abuse education needs to be embedded in the pre-op process, and more counseling needs to be provided after surgery,” he said. “But people also need to remember that they are having bariatric surgery to lose weight and improve their health, and consuming alcohol doesn't fit with those goals.”

The study was recently published online in the journal Surgery for Obesity and Related Diseases.

SOURCES: Wendy King, Ph.D., associate professor of epidemiology, University of Pittsburgh; John Morton, M.D., vice chair for quality, department of surgery, and division chief of bariatric and minimally invasive surgery, Yale School of Medicine, New Haven, Conn.; June 7, 2019,Surgery for Obesity and Related Diseases, online Copyright © 2013-2018 HealthDay. All rights reserved.

Source: https://www.webmd.com/mental-health/addiction/news/20190620/drug_alcohol_deaths_soar_after_weight-loss_surgery

Alcohol abuse linked to weight-loss surgery – Harvard Health Blog – Harvard Health Publishing

Weight loss surgery linked to drinking problems

For people who are obese, the operation known as gastric bypass surgery has been hailed as something of a miracle. In addition to rapid weight loss, it can reverse diabetes and reduce the risk of heart disease. A new study reveals potential darker side—an increase in alcohol abuse.

In a presentation at yesterday’s annual meeting of the American Society for Metabolic and Bariatric Surgery, researchers reported that almost 11% of nearly 2,000 men and women who underwent gastric bypass surgery (the most common type of obesity surgery) got in trouble with drinking by the second year after surgery. About 7% drank too much before the operation, representing a 50% increase. The results were simultaneously released online by the Journal of the American Medical Association.

This finding shouldn’t steer people who could benefit from gastric bypass surgery away from the procedure. But it should prompt them—and their doctors—to be on the lookout for changes in alcohol use or abuse afterward.

The operation

In a gastric bypass procedure (sometimes called a Roux-en-Y procedure), a surgeon uses staples to create a small pouch in the stomach. This essentially separates the pouch from the rest of the stomach.

The pouch is then connected to a loop of the small intestine that is beyond its first section (see the figure below). The smaller stomach pouch makes a person feel full after eating a small amount of food.

Bypassing the first section of the intestine also makes it more difficult for the body to absorb calories.

A less invasive approach is laparoscopic adjustable gastric banding. Working through small holes in the abdomen, a surgeon wraps an adjustable band around the upper stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. gastric bypass, it makes a person feel full after eating only a small meal or snack. But it does not bypass the stomach.

Alcohol and the stomach

The researchers could not pinpoint why gastric bypass may lead to problems with alcohol. But there are some possible explanations.

The stomach lining contains an enzyme called alcohol dehydrogenase that breaks down alcohol. When alcohol enters only a small stomach pouch, it comes in contact with less alcohol dehydrogenase, and so more of it enters the bloodstream.

This is similar why women are more sensitive to alcohol than men. Women have less alcohol dehydrogenase in their stomach linings than men, so more alcohol makes its way into the bloodstream. That’s why one alcoholic drink for a woman has about twice the effect as one for a man.

Interestingly, women in the study who had gastric bypass did not have a significant increased risk of alcohol use disorder. Men, especially young men, were at highest risk.

Earlier studies linking alcohol problems after gastric bypass surgery had researchers speculating that people were trading their addiction for food for an addiction to alcohol. This study discounts that idea, in large part because people who underwent gastric banding (in whom alcohol came in contact with the full stomach lining) were not more ly to develop alcohol problems.

Looking ahead

If you are a candidate for obesity surgery and are thinking about having the procedure, talk with your doctor about all of the benefits and risks.

If you have a gastric bypass, perhaps the safest thing to do is avoid alcohol completely for the first year. If you’d find that difficult to do, limit your alcohol use to one drink a few times per week.

Be aware of how much alcohol you consume, and whether you feel it is causing problems in your life.

Source: https://www.health.harvard.edu/blog/alcohol-abuse-linked-to-weight-loss-surgery-201206194908

Risk for Alcohol Abuse Intensifies After Bariatric Surgery

Weight loss surgery linked to drinking problems

ORLANDO — Rates of significant alcohol use escalate after Roux-en-Y surgery, laparoscopic gastric banding, and sleeve gastrectomy procedures, a systematic review and meta-analysis of 28 studies reveals.

“After bariatric surgery, patients require close follow-up and evaluation for mental health issues and substance abuse,” said Praneet Wander, MD, a gastroenterology fellow at the North Shore University Hospital in Manhasset, New York.

And the patients who reported drinking problems before surgery “still underwent the procedure,” she added, so we also “need better screening for high-risk behaviors and identification of patients for bariatric surgery.”

Bariatric surgery is associated with improvement of obesity-related comorbidities, including diabetes and hypertension. “But some data suggest that postbariatric surgery patients may be susceptible to alcohol abuse,” Dr Wander said here at the World Congress of Gastroenterology, where the study received the 2017 American College of Gastroenterology Auxiliary Award for trainee research.

Because data in the literature are inconsistent, she and her colleagues searched the MEDLINE and Embase databases for studies of bariatric surgery. They identified 12 prospective and 16 retrospective or cross-sectional studies that involved 15,714 people. Average follow-up was 2.6 years.

Roux-en-Y gastric bypass — the most common procedure — was assessed in 23 studies, laparoscopic gastric banding in 12, and restrictive bariatric procedures in eight.

After bariatric surgery, patients require close follow-up and evaluation for mental health issues and substance abuse.

Overall, 19% of patients reported high-risk drinking before surgery, but “we found that bariatric surgery is associated with an increase in moderate to high-risk alcohol use, with a new-onset incidence of 8% and increased odds of alcohol abuse after surgery,” Dr Wander reported.

Despite the limitations of this analysis — the inadequate availability of data from randomized, controlled studies and of “good quality” prospective studies in the literature, and the variations in follow-up times — “we think there is a lot to learn from this study,” she said.

The association between alcohol use and bariatric surgery could have a physiologic basis. “Alcohol is metabolized differently after bariatric surgery, especially after Roux-en-Y bypass,” Dr Wander explained.

The absorption of alcohol in the small intestine could be accelerated by the rapid emptying of liquids from the gastric pouch. “We see there is accelerated alcohol absorption, higher maximum alcohol concentration in the blood, and it takes a long time to eliminate alcohol after these procedures,” she pointed out.

However, other factors could also play a role. “There is also undiagnosed depression and substance abuse among patients who undergo bariatric surgery,” she said.

High Divorce Rate After Surgery

Changes in relationships after bariatric surgery could also play a role, said David Johnson, MD, from the Eastern Virginia Medical School in Norfolk, who is editor of Medscape Gastroenterology.

“There is a very high divorce rate after bariatric surgery,” he told Medscape Medical News. “The marital discord might explain why some of these people fall off the wagon.”

“After bariatric surgery, there can be a lot of body image changes. And it becomes a functional change that not only impacts them, but their spouses, too,” Dr Johnson explained. “So some of this may be related. They may turn to alcohol dissatisfaction with their life. That to me sounds a fertile area for exploration.”

The bariatric surgery program at his institution features a comprehensive marital counseling arm.

“Clearly, we recognize that after bariatric surgery, there are a number of things that happen,” said Dr Johnson. Bariatric patients can experience nutritional deficiencies and vitamin and mineral defects, so require “lifelong monitoring and lifelong vitamin and mineral supplements. There can also be issues that develop related to motility and bacterial overgrowth.”

“What this study highlights is the proclivity for the increased development of another problem, and it's alcohol related,” he added.

World Congress of Gastroenterology 2017: Abstract 10. Presented October 16, 2017.

Dr Wander and Dr Johnson have disclosed no relevant financial relationships.

Follow Medscape Gastroenterology on @MedscapeGastro and Damian McNamara @MedReporter

Medscape Medical News © 2017  WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this: Risk for Alcohol Abuse Intensifies After Bariatric Surgery – Medscape – Oct 18, 2017.

Source: https://www.medscape.com/viewarticle/887243

Could a Weight-Loss Surgery Lead to Alcohol Abuse?

Weight loss surgery linked to drinking problems

WEDNESDAY, May 17, 2017 (HealthDay News) — After a popular type of weight-loss surgery, nearly 21 percent of patients develop a drinking problem, sometimes years later, researchers report.

The researchers followed more than 2,000 patients who had weight-loss surgery at 10 hospitals across the United States.

Over seven years, more than 1 in 5 who had Roux-en-Y gastric bypass weight-loss surgery developed a problem such as alcohol abuse or alcoholism, compared with around 11 percent of those who underwent gastric banding.

Roux-en-Y gastric bypass is a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine. Gastric banding, another weight-loss option, involves placing an adjustable band around the stomach to reduce the amount of food it can hold.

In recent years, Roux-en-Y gastric bypass has become more popular than gastric banding because it leads to greater weight loss, according to the study authors.

They said their findings indicate that weight-loss (bariatric) surgery patients should receive long-term follow-up to watch for and treat drinking problems.

The study results were published online May 15 in the journal Surgery for Obesity and Related Diseases.

“We knew there was an increase in the number of people experiencing problems with alcohol within the first two years of surgery, but we didn't expect the number of affected patients to continue to grow throughout seven years of follow-up,” said study author Wendy King. She's an associate professor of epidemiology at the University of Pittsburgh's Graduate School of Public Health.

“Because alcohol problems may not appear for several years, it is important that doctors routinely ask patients with a history of bariatric surgery about their alcohol consumption and whether they are experiencing symptoms of alcohol use disorder, and are prepared to refer them to treatment,” King said in a journal news release.

The study doesn't actually prove that Roux-en-Y leads to alcohol abuse. However, other studies have shown that compared to banding, it's associated with higher and quicker elevation of alcohol in the blood, the researchers said.

Moreover, some animal research has suggested that Roux-en-Y may affect areas of the brain associated with reward, possibly increasing alcohol reward sensitivity, the researchers noted.

Although Roux-en-Y gastric bypass patients were nearly four times more ly than gastric banding patients to say they'd received treatment for substance abuse, few study participants said they'd undergone such treatment, the researchers found.

Overall, 3.5 percent of the Roux-en-Y patients reported getting substance abuse treatment, far less than the nearly 21 percent who reported alcohol problems.

“This indicates that treatment programs are underutilized by bariatric surgery patients with alcohol problems,” King said. “That's particularly troubling, given the availability of effective treatments.”

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on weight-loss surgery.

SOURCE: Surgery for Obesity and Related Diseases, news release, May 16, 2017

Last Updated: May 17, 2017

Source: https://consumer.healthday.com/general-health-information-16/alcohol-abuse-news-12/could-a-weight-loss-surgery-lead-to-alcohol-abuse-722753.html

Alcohol Abuse After Bariatric Surgery Common, Concerning

Weight loss surgery linked to drinking problems

BONITA SPRINGS, Florida — Individuals who undergo bariatric surgery, particularly Roux-en-Y gastric bypass (RYGP), have a significantly increased risk of developing a substance use disorder (SUD), in particular alcohol use disorder (AUD), new research shows.

The increased risk is not observed until after the first postoperative year, and risk factors include a preoperative history of substance use, especially alcohol; younger age; male sex; and smoking, said lead investigator Cameron Risma, MD, Pine Rest Christian Mental Health Services, Grand Rapids, Michigan.

In addition, people who chronically used opiates before the surgery tend to continue chronic use after surgery, Risma said.

Dr Cameron Risma

“We got the idea to study substance use disorders after bariatric surgery because we see a lot of it in our detox program at Pine Rest. It's common. People come in years after surgery, and they never realized that this was an issue,” he told Medscape Medical News.

The findings were presented here at the American Academy of Addiction Psychiatry (AAAP) 29th Annual Meeting.

Fivefold Increased Risk

For the study, investigators conducted a PsychINFO and Web of Science search for articles published from 1996 to 2018 on the relationship between gastric bypass surgery and SUD.

They found that a 2013 prospective study that followed more than 4000 obese patients showed those who underwent bariatric surgery were nearly five times more ly to receive a diagnosis of alcohol abuse during a follow-up period of 8 to 22 years.

Another 2012 prospective study that followed almost 2500 bariatric surgery patients showed a significantly increased prevalence of symptoms of AUD during the second postoperative year compared to the first postoperative year (9.6% vs 7.3%).  There was no difference between the year immediately before (7.6%) or after (7.3%) the surgery.

The same study identified preoperative variables independently associated with increased risk of developing an AUD after bariatric surgery.  These included previous AUD, regular alcohol use (defined as >2 drinks per week), smoking, recreational drug use, male sex, RYGB, younger age, and low sense of belonging.

Two systematic reviews showed that approximately 8% of patients were chronic opiate users at the time of surgery, and that most continued using opioids in the year following surgery.

However, use of other substances after bariatric surgery remained unchanged.

Three hypotheses have been proposed to account for the link between bariatric surgery and addiction, Risma said.

“No one really knows exactly why, but one hypothesis is this idea of addiction transfer.  Binge eating can lead to obesity, so you get addicted to food.

But after you have surgery, you can't binge on food anymore so you turn to something else which happens to be a substance, to replace food.

The idea is that you are using a substance to cope with a negative emotional state,” Risma said.

The next hypothesis is neurobiological mechanisms, supported by evidence from PET scans, which have shown similarly reduced D2 receptors in both pathologic obesity and addiction.

“It is possible that reduced striatal D2 receptors predispose an individual to search for strong dopaminergic reinforcement as a compensatory mechanism for dopamine hyposensitivity. This dopamine-based hypothesis is supported by neuroimaging studies showing that a rapid dopamine release is produced both by binge eating and IV alcohol infusion,” the authors write.

The third hypothesis is pharmacokinetic changes after RYGB, leading to a hypersensitivity to alcohol's reinforcing effects.

“This is really interesting,” Risma said. “After Roux-en-Y gastric bypass, you get a hypersensitivity to alcohol's effects, where even a small amount of alcohol can achieve very high blood alcohol concentrations. 

“One drink can put you over the legal limit in less than 15 minutes, so it reaches a higher blood alcohol content and it takes longer for the alcohol to get your system. Some people report that even after a few sips they can feel a buzz. They go back to drinking the same amount, they get more drunk, and they can become addicted that way,” he said.

These changes are only observed in RYGB, and no other bariatric surgeries such as gastric banding or sleeve gastrectomy, Risma said.

“The results of our survey show that it's primarily alcohol that becomes the substance of abuse,” he added. “But clinically, I'll tell you, we see a lot of opiate use in our detox unit.

This is something we would to to investigate going forward, because we are seeing so much of it.

People who have surgery have chronic pain, they can't get off their opioids, and they come to us addicted and needing withdrawal and treatment afterwards.

“We would to work with local bariatric surgical centers and ask how they are identifying people the risk factors we found in our survey, and then once they are identified, ask how they are treating them. Are you offering them classes, are you following up with them more often? We think that's an area where we can make a clinical impact.”

Commenting on the findings for Medscape Medical News, Cornel N. Stanciu, MD, assistant professor of psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, said the number of individuals undergoing bariatric weight loss procedures is expected to grow by 6% to 8% annually in the coming years.

“Positive outcomes can be quite striking. However, there are certain aspects which could worsen or emerge.

With both obesity and addictions being stigmatized and overlooked as disorders of poor self-control, with perhaps common genetic, behavioral, social, neurobiological and pharmacokinetic factors, one emerging issue noted has been the association of bariatric surgery with development of postoperative addictions,” Stanciu said.

Dr Cornel Stanciu

As with other surgeries, the biggest focus has been on limiting opioid use to prevent addictive tendencies, but here the biggest association seems to be with the development of risky alcohol use, he added.

“Some studies report this rate to be as high as 21% when the procedure is done via the RYGB method, and 11% when banding is done,” Stanciu said.

The finding of a delay in developing alcohol abuse patterns a year after surgery has significant implications. Historically, the most rigorous follow-up and aftercare occur immediately after the procedure and tapers off throughout the coming years.

“In an era that is shifting towards the ambulatory setting, providing prolonged aftercare and monitoring may present challenges,” he added.

Identifying factors that predispose individuals to alcohol abuse after their bypass should prompt implementation of additional safety nets, Stanciu said.

“Here, they found [that patients with] a history of alcohol use, undergoing the RYGB type of procedure, young age, male gender, and smokers may be predisposed. It's important to implement better screening focused on these risk factors, as well as a more robust pre- and post-surgical education and closer follow-up.

“Also, because alcohol problems may not appear for years after the procedure, it is critical for all clinicians involved in the care of bariatric surgery patients to proactively assess alcohol consumption and be able to intervene early,” he said.

However, he added, the frequency of RYGB is decreasing, he noted.

“Initially, RYGB was more popular than banding as it led to more drastic weight loss. However, newer approaches such as sleeve gastrectomy and endoscopic modalities are rapidly taking over. Whether these may have a greater association with alcohol and other addictive behaviors is a great unknown at this time,” Stanciu said.

Dr Risma and Dr Stanciu have disclosed no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 29th Annual Meeting: Poster 15. Presented December 9, 2018.

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Medscape Medical News © 2018 

Cite this: Alcohol Abuse After Bariatric Surgery Common, Concerning – Medscape – Dec 17, 2018.

Source: https://www.medscape.com/viewarticle/906643

Gastric Bypass Surgery And Alcohol Abuse

Weight loss surgery linked to drinking problems
Trusted Content

Gastric bypass surgery has been linked to increased risk of alcohol abuse. Treatment for alcohol use disorder is available and can include a number of therapies, medication, and counseling.

Gastric bypass has helped hundreds of thousands of people combat obesity each year for over a decade. However, in the early 2000s, a pattern seemed to emerge. People were beginning to report an increase in alcohol intake, and at about two years post-surgery, they were reporting symptoms of an alcohol use disorder (AUD).

Many researchers investigated this development, and the connection between gastric bypass surgery and alcohol abuse doesn’t seem to be as clear as people first believed. There appears to be a number of theories with a combination of many factors, starting with the surgery itself.

Gastric Bypass: The Roux-en-Y Procedure

There are many different types of surgeries that assist with weight loss, but one seems to most often be connected with post-surgery alcohol misuse, and that is the gastric bypass surgery, also referred to as the Roux-en-Y procedure.

During the RYGB procedure, the surgeon creates a small pouch at the top of the stomach, approximately the size of a chestnut. This creates a very small space and the person is unable to eat large amounts of food as a result. In addition, the small intestine is reattached to this small pouch, and part of the intestine is not used in order to make calorie absorption more difficult.

Other surgeries, such as the gastric banding did not have the same increase in alcohol misuse as the Roux-en-Y procedure (RYGB). There has not been enough research to determine if the gastric sleeve has the same potential effect as the RYGB procedure, but early studies have shown that there is also increased potential for alcohol abuse post-surgery.

How The Body And Brain Respond To Alcohol After Gastric Bypass Surgery

The two elements of the RYGB surgery described above are believed to contribute to the increase of alcohol misuse. An enzyme in the stomach lining, called alcohol dehydrogenase, breaks down alcohol. Because the stomach lining is drastically reduced in size, there is less enzyme present and more alcohol can enter the bloodstream.

Studies revealed that people consuming alcohol post-surgery have higher blood alcohol content, reach peak levels faster, and the alcohol remains in their systems longer than people who have not had the surgery.

In one specific study, participants reached above legal limits after one drink. Individuals who have had the RYGB procedure have reported feeling the effects of alcohol from very small amounts and feeling intoxicated for longer periods of time.

This may impact the way the brain responds to alcohol, and explain the increased potential for an alcohol use disorder.

Researchers have considered that the RYGB procedure may affect more than just weight loss and alcohol levels in the body. It has shown to alter the effect that some foods have on the “reward pathway” in the brain, and it may alter the way alcohol is recognized in the brain. If this pathway becomes more activated when alcohol is consumed, it can lead to an alcohol use disorder.

Drinking Alcohol In Moderation Post-Surgery

The Centers for Disease Control and Prevention (CDC) refers to moderate alcohol drinking as two drinks per day for men and one drink for women. While an occasional drink containing alcohol doesn’t seem to create an issue with someone who has not had a RYGB surgery, it appears to have potentially serious consequences for individuals who have.

In one study, subjects who were three and four years post-surgery, who had no problems with alcohol, were asked to drink one beverage containing alcohol. All of the participants reported they felt the effects of the alcohol before finishing the beverage.

Many surgeons strongly discourage drinking alcohol in any amount after gastric bypass surgery.

After the connection between the surgery and alcohol abuse was discovered, there has been continued research in an attempt to discover the cause of this connection.

The exact cause has not been clear, although there are some possible pre-surgery factors. Avoiding alcohol altogether seems to be the only way to eliminate the possibility of developing alcohol abuse after surgery.

Risk Factors For Developing Post-Surgery Alcohol Use Disorder

A number of risk factors have been discovered in connection to alcohol misuse after gastric bypass surgery. Studies found that some of these factors are:

  • male sex
  • smoking
  • young age
  • lack of support
  • recreational drug use
  • regular alcohol consumption

Factors that did NOT appear to influence the lihood of alcohol misuse after surgery were:

  • race
  • body mass index (BMI)
  • marital status
  • ethnicity
  • income
  • education
  • employment status
  • binge eating
  • mental health treatment

Can Gastric Bypass Surgery Lead To Alcohol Addiction?

In some cases of addiction, people stop using one substance and begin abusing another. This process is referred to as transfer addiction. There have been conversations suggesting that individuals who have had gastric bypass surgery have replaced overeating (binge eating) with overusing alcohol.

While researchers cannot completely dismiss this theory, they have stated that it is more ly the physical, chemical, and biological changes that take place as a result of the surgery itself were responsible for contributing to alcohol use disorder in post-surgery individuals.

Addiction transfer does happen, and the following are risk factors to be aware of :

  • substance abuse history (self or family)
  • long-term use of narcotics (opioids) to treat chronic pain
  • history of eating disorders
  • past trauma, especially childhood sexual abuse
  • regular alcohol use prior to bariatric surgery
  • avoiding emotions
  • lack of adequate support
  • feelings of isolation
  • depression, mood, or anxiety disorders
  • engaging in self-sabotaging tendencies

These factors may be a cause for concern if you are exploring gastric bypass surgery as a weight loss tool. Be sure to communicate openly with your healthcare provider about any concerns you have regarding these factors. If you believe you are experiencing any symptoms of addiction transfer, there is help available.

We can help you overcome addiction and get your life back. Your calls are always free and 100% confidential.

(888) 966-8973

Decreasing Risk For Alcohol Use Disorder After Gastric Bypass

The benefits of gastric bypass are clear, which is why it is still a viable treatment for obesity. However, the risk of developing an AUD after surgery is real, and increases with every risk factor. There are some ways to decrease the risk of alcohol misuse associated with gastric bypass, and they are as follows:

Talk To Your Healthcare Provider

Be honest with your provider about the history of substance abuse and addiction in your family before surgery. Communicate any concerns you have at any point. If your drinking is beyond what is considered moderate drinking (one drink a day for women, two for men), reach out for help today.

Keep Your Appointments

Attend all your regular post-surgery appointments. Alcohol misuse seems to appear around two years after surgery, so keeping all scheduled appointments can help recognize any shifts in regular behaviors. It’s ok to make an appointment if something doesn’t feel right.

Explore And Treat Underlying Causes Of Obesity

If there are underlying causes to your obesity, such as binge eating or emotional eating, therapy for these issues may help in avoiding addiction transfer.

Strong Support System

Having people to talk to, whether family, friends, group therapy, or other support groups of people who can relate to your story is very healing. Using services available to connect you to other people who may be going through similar issues can help you to know you aren’t alone.

Signs Of An Alcohol Use Disorder After Gastric Bypass Procedure

Gastric bypass surgery is a life-changing experience, so the signs of an alcohol use disorder may not be noticeable at first. The following are a list of questions you can ask yourself about the past year, to explore the possibility of a developing AUD:

  • Have you spent a lot of time drinking? Or hungover?
  • Have you been unable to stop drinking, even when you wanted to?
  • Do you have cravings to drink?
  • Has drinking interfered with taking care of your responsibilities?
  • Have you engaged in reckless behavior while intoxicated?
  • Have you stopped participating in activities you enjoyed to drink instead?
  • Has drinking caused problems in your relationships?
  • Have you drunk to the point that you blacked out (have no memory of events)?
  • Have you had to drink more alcohol to get the same effect?
  • Do you drink more, or for longer periods of time than you planned?
  • Have you had withdrawal symptoms when you tried to stop drinking?

If you can answer yes to two or more of these questions, an alcohol use disorder may be developing. There are services available to help in situations this. Contact us today, and we can start you on the path to a healthier you in addiction recovery.

Written by Addiction Campuses Editorial Team

© 2020 AddictionCampuses.com. All rights reserved.

This page does not provide medical advice.

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Source: https://www.addictioncampuses.com/alcohol/gastric-bypass/

Alcohol-use disorders after bariatric surgery: The case for targeted group therapy

Weight loss surgery linked to drinking problems

Maladaptive alcohol use has emerged as a risk for a subset of individuals who have undergone weight loss surgery (WLS); studies report they are vulnerable to consuming alcohol in greater quantities or more frequently.

1,2 Estimates of the prevalence of “high-risk” or “hazardous” alcohol use after WLS range from 4% to 28%,3,4 while the prevalence of alcohol use meeting DSM-IV-TR5 criteria for alcohol use disorders (AUDs) hovers around 10%.


Heavy alcohol users or patients who have active AUD at the time of WLS are at greater risk for continuation of these problems after surgery.2,6 For patients with a long-remitted history of AUD, the evidence regarding risk for post-WLS relapse is lacking, and some evidence suggests they may have better weight loss outcomes after WLS.7

However, approximately two-third of cases of post-WLS alcohol problems occur in patients who have had no history of such problems before surgery.5,8,9 Reported prevalence rates of new-onset alcohol problems range from 3% to 18%,6,9 with the modal finding being approximately 7% to 8%.

New-onset alcohol problems appear to occur at a considerable latency after surgery. One study found little risk at 1 year post-surgery, but a significant increase in AUD symptoms at 2 years.

6 Another study identified 3 years post-surgery as a high-risk time point,8 and yet another reported a linear increase in the risk for developing alcohol problems for at least 10 years after WLS.10

This article describes a group treatment protocol developed specifically for patients with post-WLS substance use disorder (SUD), and explores:

  • risk factors and causal mechanisms of post-WLS AUDs
  • weight stigma and emotional stressors
  • the role of specialized treatment
  • group treatment the Health at Every Size® (HAES)-oriented, trauma-informed and fat acceptance framework.

Post-WLS patients with alcohol problems may be a distinct phenotype among people with substance abuse issues. For this reason, they may have a need to address their experiences and issues specific to WLS as part of their alcohol treatment.


Risk factors. Empirical findings have identified few predictors or risk factors for post-WLS SUD. These patients are more ly to be male and of a younger age.

6 Notably, the vast majority of individuals reporting post-WLS alcohol problems have undergone Roux-en-Y gastric bypass (RYGB), rather than other WLS procedures, such as the laparoscopic adjustable gastric band,6,11 suggesting some physiological mechanism specific to RYGB.

Other potential predictors of postoperative alcohol problems include a pre-operative history of depression, generalized anxiety disorder, smoking, and/or recreational drug use.

3,6 wise, patients with depression or anxiety disorder symptoms after surgery also may be at higher risk for postoperative alcohol problems.4 The evidence of an association between postoperative weight outcomes and post-WLS alcohol problems is mixed.

3,12 Interestingly, patients who had no personal history of substance abuse but who have a family history may have a higher risk of new-onset alcohol problems after surgery.9,12

Causal mechanisms. The etiology of post-WLS alcohol problems is not well understood.

If anything, epidemiological data suggest that larger-bodied individuals tend to consume lower levels of alcohol and have lower rates of AUD than individuals in the general population with thinner bodies.

13 However, an association has been found between a family history of SUD, but not a personal history, and being large.14 This suggests a shared etiological pathway between addiction and being “overweight,” of which the onset of AUD after RYGB may be a manifestation.

Human and animal studies have shown that WLS may affect alcohol use differently in specific subgroups.

Studies have shown that wild-type rats greatly increase their consumption of, or operant responding for, alcohol after RYGB,15 while genetically “alcohol-preferring” rats decrease consumption of, or responding for, alcohol after RYGB.

16 A human study wise found some patients decreased alcohol use or experienced improvement of or remission of AUD symptoms after WLS.4 Combined with the finding that a family history of substance abuse is related to risk for post-operative AUD, these data suggest a potential genetic vulnerability or protection in some individuals.

Turning to potential psychosocial explanations, the lay media has popularized the concepts of “addiction transfer,” or “transfer addiction,”12 with the implication that some patients, who had a preoperative history of “food addiction,” transfer that “addiction” after surgery to substances of abuse.

However, the “addiction transfer” model has a number of flaws:

  • it is stigmatizing, because it assumes the patient possesses an innate, chronic, and inalterable pathology
  • it relies upon the validity of the controversial construct of “food addiction,” a construct of mixed scientific evidence.17

Source: https://www.mdedge.com/psychiatry/article/126520/addiction-medicine/alcohol-use-disorders-after-bariatric-surgery-case