Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

Abstract

Background Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) following bariatric surgery is limited. Objective To report SUD-related outcomes following RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. Setting Ten US hospitals. Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to seven years through January 2015. Results Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95%CI, 18.5-23.3), 7.5% (95%CI, 6.1-9.1), and 3.5% (95%CI, 2.6-4.8), respectively, post-RYGB, and 11.3% (95%CI, 8.5-14.9), 4.9% (95%CI, 3.1-7.6), and 0.9% (95%CI, 0.4-2.5) post-LAGB. Undergoing RYGB vs. LAGB was associated with higher risk of incident AUD symptoms (AHR=2.08 [95%CI, 1.51-2.85]), illicit drug use (AHR=1.76 [95%CI, 1.07-2.90]) and SUD treatment (AHR=3.56 [95%CI, 1.26-10.07]). Conclusions Undergoing RYGB vs. LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.

Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

“…Most factors related to substance use disorder that were examined (i.e., sex, age, income, social support, depressive symptoms, mental quality of life, psychiatric hospitalization, antidepressant medication, smoking, alcohol consumption, illicit drug use and surgical procedure(7;25)) were not related to continued or post-surgery initiated opioid use. An exception was that continued benzodiazepine use, which may be suggestive of addictive behavior(36) and increase risk of opioid overdose(37), was associated with an increased risk of continued opioid use.…”

“…Sociodemographics, psychiatric hospitalizations, binge eating, loss of control eating, substance use (smoking, alcohol intake, symptoms of alcohol use disorder and illicit drug use), back, hip, knee and ankle surgeries, and subsequent bariatric procedures (i.e. revisions, reversals, new procedures) were determined with study-specific forms (23;24;25). The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) assessed physical and mental health(26), with scores transformed to a mean of 50 and standard deviation of 10 in the general U.S. population(27); a lower score indicates worse function.…”

Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity

“…Moreover, reduced alcohol tolerability is considered a complication from bariatric surgery, and empirical evidence indicates that gastric bypass increases the risk of developing both alcohol use disorders and substance use disorders [5, 6]. One study showed that alcohol use disorder more than doubled from 7% prior to surgery to 16% 7 years after surgery [5]. …”

Problematic Alcohol Use and Associated Characteristics Following Bariatric Surgery

“…(3) Furthermore, a subgroup of individuals develop de novo AUDs (3.5–7.0%) (4–6) and non-alcohol substance use disorders (SUDs). (7) Moreover, many bariatric surgery centers instruct their patients to avoid alcohol after surgery, (8) although prior research suggests most patients with pre-surgery alcohol use problems report continued problematic alcohol use following surgery.…”

“…Extant evidence suggests that the RYGB procedure, male sex, younger age, preoperative AUDs or regular alcohol use, and preoperative drug use are associated with postoperative AUDs. (3) While evidence has been somewhat inconsistent, other research found depression, dysregulated eating (i.e., preoperative food addiction, postoperative nocturnal eating, subjective hunger), family history of substance abuse, poor coping, life stressors, and poorer quality of life were related to initiation of substance use post-surgery, (7) with some findings being specific to RYGB patients. (13) …”