Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2012; 307(23):2516-25. DOI: 10.1001/jama.2012.6147
Source: PubMed


Anecdotal reports suggest bariatric surgery may increase the risk of alcohol use disorder (AUD), but prospective data are lacking.
To determine the prevalence of preoperative and postoperative AUD, and independent predictors of postoperative AUD.
A prospective cohort study (Longitudinal Assessment of Bariatric Surgery-2) of adults who underwent bariatric surgery at 10 US hospitals. Of 2458 participants, 1945 (78.8% female; 87.0% white; median age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011.
Past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (indication of alcohol-related harm, alcohol dependence symptoms, or score ≥8).
The prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6% vs 7.3%; P = .98), but was significantly higher in the second postoperative year (9.6%; P = .01). The following preoperative variables were independently related to an increased odds of AUD after bariatric surgery: male sex (adjusted odds ratio [AOR], 2.14 [95% CI, 1.51-3.01]; P < .001), younger age (age per 10 years younger with preoperative AUD: AOR, 1.31 [95% CI, 1.03-1.68], P = .03; age per 10 years younger without preoperative AUD: AOR, 1.95 [95% CI, 1.65-2.30], P < .001), smoking (AOR, 2.58 [95% CI, 1.19-5.58]; P = .02), regular alcohol consumption (≥ 2 drinks/week: AOR, 6.37 [95% CI, 4.17-9.72]; P < .001), AUD (eg, at age 45, AOR, 11.14 [95% CI, 7.71-16.10]; P < .001), recreational drug use (AOR, 2.38 [95% CI, 1.37-4.14]; P = .01), lower sense of belonging (12-item Interpersonal Support Evaluation List score per 1 point lower: AOR, 1.09 [95% CI, 1.04-1.15]; P = .01), and undergoing a Roux-en-Y gastric bypass procedure (AOR, 2.07 [95% CI, 1.40-3.08]; P < .001; reference category: laparoscopic adjustable gastric band procedure).
In this cohort, the prevalence of AUD was greater in the second postoperative year than the year prior to surgery or in the first postoperative year and was associated with male sex and younger age, numerous preoperative variables (smoking, regular alcohol consumption, AUD, recreational drug use, and lower interpersonal support) and undergoing a Roux-en-Y gastric bypass procedure.

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    • "Rates of AUDs among a large sample of bariatric surgery patients enrolled in the Longitudinal Assessment Bariatric Surgery 2 (LABS-2) study have been reported (King et al., 2012). Among 1945 participants, the prevalence of AUDs as assessed by the Alcohol Use Disorders Identification Test (AUDIT) did not differ between presurgery (7.6%) and 1 year postsurgery (7.3%). "
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    ABSTRACT: Bariatric surgery is currently the most effective intervention for significant and sustained weight loss in obese individuals. While patients often realize numerous improvements in obesity-related comorbidities and health-related quality of life, a small minority of patients have less optimal outcomes following bariatric surgery. The literature on the emergence of alcohol use disorders (AUDs) following bariatric surgery has grown in the past several years and collectively provides convincing evidence that a significant minority of patients develop new-onset AUDs following bariatric surgery. Rouxen-Y gastric bypass (RYGB) has generally been associated with the risk of developing an AUD, while laparoscopic adjustable gastric banding generally has not, in several large studies. One theory that has been discussed at some length is the idea of ‘addiction transfer’ wherein patients substitute one ‘addiction’ (food) for a new ‘addiction’ (alcohol) following surgery. Animal work suggests a neurobiological basis for increased alcohol reward following RYGB. In addition, several pharmacokinetic studies have shown rapid and dramatically increased peak alcohol concentrations following RYGB. The prevalence of alcohol and other addictive disorders and potential etiological contributors to post-operative AUDs will be explored. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 10/2015; DOI:10.1002/erv.2399 · 2.46 Impact Factor
    • "These include medical comorbidity improvement or resolution, quality of life and psychosocial adjustment and functioning. Increasing reports of potential psychosocial complications of WLS, such as body image dissatisfaction due to excess skin (Biörserud, Olbers, & Fagevik Olsén, 2011), maladaptive eating patterns (de Zwaan et al., 2010), new or recurring addictions (King et al., 2012) and even suicide (Peterhansel, Petroff, Klinitzke, Kersting, & Wagner, 2013), have also contributed to a more holistic and comprehensive view of what comprises a successful surgical 'outcome'. "
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    ABSTRACT: A thorough and specialized pre-operative psychosocial assessment is an important part of a comprehensive bariatric treatment protocol. Over time, the presurgical psychosocial evaluation has evolved from a cut-and-dried process of recommending whether a patient should or should not undergo surgery to a more nuanced and multifaceted process that serves multiple functions. In this article, we review the many ways in which the pre-operative psychosocial evaluation can enhance patient outcomes and adjustment and even the functioning of the interdisciplinary bariatric surgery team. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 08/2015; DOI:10.1002/erv.2395 · 2.46 Impact Factor
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    • "In a recent imaging study, we found that a sub-set of high fat dietary obese rats, those that maintained weight loss at higher level following RYGB, showed an increased activation of brain reward areas in response to cues associated with highly stimulating treats (Thanos et al., 2015). These, and other data, collectively suggest a greater risk for some patients to engage in alternative excessive behavior (Goldstein et al., 2007; Kalivas and Volkow, 2005; Volkow and Baler, 2013; Wang et al., 2004a), and they fit well the clinical observations of increased risk among RYGB patients for substituting food with alcohol (Ertelt et al., 2008; Hsu et al., 1998; King et al., 2012; Suzuki et al., 2012) or use of other substances (Conason et al., 2013; Dutta et al., 2006). The 'symptom "
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    ABSTRACT: Roux-en-Y gastric bypass (RYGB) surgery is a commonly performed and very effective method to achieve significant, long-term weight loss. Opioid analgesics are primarily used to manage postoperative pain as fewer alternative medication options are available for bariatric surgery patients than for the general population. Recent clinical studies support a greater risk for substance use following bariatric surgery, including an increased use of opioid medications. The present study is the first to study morphine self-administration in a rat model of RYGB. High fat diet-induced obese (HFD-DIO) rats underwent RYGB (n=14) or sham-surgery with ad libitum HFD (SHAM, n=14) or a restricted amount that resulted in weight matched to the RYGB cohort (SHAM-WM, n=8). An additional normal-diet (ND, n=7), intact (no surgery) group of rats was included. Two months after the surgeries, rats were fitted with jugular catheters and trained on a fixed ratio-2 lick task to obtain morphine intravenously. Both morphine-seeking (number of licks on an empty spout to obtain morphine infusion) and consumption (number of infusion) were significantly greater in RYGB than any control group beginning on Day 3 and reached a two-fold increase over a period of two weeks. These findings demonstrate that RYGB increases motivation for taking morphine and that this effect is independent of weight loss. Further research is warranted to reveal the underlying mechanisms and to determine whether increased morphine use represents a risk for opioid addiction following RYGB. Identifying risk factors preoperatively could help with personalized postoperative care to prevent opioid abuse and addiction. Copyright © 2015. Published by Elsevier Inc.
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