Author Insights: Bariatric Surgery May Lead to Increases in Substance Use

Alexis Conason, PsyD, of New York Obesity Nutrition Research Center in New York City, and colleagues found patients may be at increased risk of substance use (drugs, alcohol, and cigarette smoking) after bariatric surgery. (Image: Jeffrey Truitt)

Although bariatric weight loss surgery is often an effective treatment for severe obesity and may reduce the risk for diabetes and heart disease, the procedure may also increase a patient’s risk for substance use. A study appearing today in the Archives of Surgery found participants reported a significant increase in the frequency of substance use—calculated as a composite of drug use, alcohol use, and cigarette smoking—after bariatric surgery.

The study enrolled 155 participants (132 women) who underwent either Roux-en-Y gastric bypass surgery or adjustable gastric band surgery. Each participant completed questionnaires assessing eating behaviors and substance use prior to the operation and periodically up to 24 months afterward.

The researchers found increased alcohol use was particularly associated with participants who underwent Roux-en-Y bypass surgery. The researchers noted prior studies suggesting patients become intoxicated more quickly and take longer to return to sobriety with less alcohol following Roux-en-Y bypass surgery. They speculated these patients may experience the rewarding emotional aspects of alcohol use sooner and more frequently, which may contribute to increased alcohol use.

Lead author Alexis Conason, PsyD, of New York Obesity Nutrition Research Center in New York City, discusses her team’s findings:

“We were interested in looking at the phenomenon of bariatric surgery and what happens to people after surgery. A lot of people having bariatric surgery engage in emotional eating, and when they can’t use this coping mechanism, we wanted to know what happens to them. The emotions are still there following surgery, but how do people cope with them?

“We found an increase when we looked at the composite measure of substance use. When we looked at each substance individually, we did not find significance, although there were some trends toward significance. Our strongest finding was for the Roux-en-Y patients experiencing a significant increased use of alcohol.

“There is something unique about Roux-en-Y; it actually changes the way the body metabolizes alcohol. We’re hearing of patients feeling more intoxicated quicker with smaller quantities. Our speculation is that people who would not have been drinking heavily prior to surgery now have their 1 drink at dinner, but they feel the effects more, and perhaps they like it and are doing it more and more. Something is going on with the reward pathways. We only looked at substance use and not dependence, although research is emerging suggesting problem drinking after Roux-en-Y.

“The primary thing the physician should do is follow patients closely and discuss substance abuse and ask about alcohol and substance use following surgery. We’re not saying certain people should be excluded, but we know some patients have risk factors for [postsurgery] alcohol abuse such as those with a family or personal history of alcohol abuse. These are the people who should especially be followed.

“Patients should be educated about and aware of what the surgery entails. Surgery is a helpful tool for many, but there’s a risk for complications if there are underlying emotional issues. Patients should be aware that the surgery is the beginning of the journey. Many think it’s the end point, but it’s not, and there’s a lot of emotional work that needs to go on.”

Categories: Bariatric Surgery, Eating Disorders, Obesity, Substance Abuse/Alcoholism