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: 30.39). 06/2012; 307(23):2516-25. DOI: 10.1001/jama.2012.6147
Source: PubMed

ABSTRACT 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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    • "King et al. [12] conducted the first large scale longitudinal follow-up study of alcohol usage after bariatric surgery. Almost two thousand (n = 1945) patients were followed prospectively for two years postsurgery . "
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    ABSTRACT: Objective To describe the clinical phenotype of alcohol use disorder (AUD) treatment-seeking patients with Roux-en-Y Gastric Bypass Surgery (RYGB) history; and to compare it to AUD obese non-RYGB controls. Methods Retrospective study of electronic medical records for all patients 30-60 years treated at the Mayo Clinic Addiction Treatment Program, between June, 2004 and July, 2012. Comparisons were performed with consumption patterns pre-RYGB and at time of treatment; excluding patients with AUD treatments pre-RYGB. Results Forty-one out of 823 patients had a RYGB history (4.9%); 122 controls were selected. Compared to controls, the RYGB group had significantly more females [n = 29 (70.7%) vs. n = 35 (28.7%) p < 0.0001]; and met AUD criteria at a significantly earlier age (19.1 ± 0.4 vs. 25.0 ± 1 years old, p = 0.002). On average, RYGB patients reported resuming alcohol consumption 1.4 ± 0.2 years post-surgery, meeting criteria for AUD at 3.1 ± 0.5 years and seeking treatment at 5.4 ± 0.3 years postoperatively. Pre-surgical drinks per day were significantly fewer compared to post-surgical consumption [2.5 ± 0.4 vs. 8.1 ± 1.3, p = 0.009]. Prior to admission, RYGB patients reported fewer drinking days per week vs. controls (4.7 ± 0.3 vs. 5.5 ± 1.8 days, p = 0.02). Neither RYGB, gender, age nor BMI were associated with differential drinking patterns. Conclusion The results of this study suggest that some patients develop progressive AUD several years following RYGB. This observation has important clinical implications, calling for AUD-preventive measures following RYGB. Further large-scale longitudinal studies are needed to clarify the association between RYGB and AUD onset.
    Journal of Psychosomatic Research 09/2014; 78(3). DOI:10.1016/j.jpsychores.2014.06.019 · 2.84 Impact Factor
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    • "In consideration of this preclinical and clinical literature on associations between overeating and addiction, we hypothesized that endorsing symptoms of " food addiction " before surgery and specific eatingrelated variables after surgery would be associated with substance misuse after RYGB surgery. Several studies have investigated the preoperative factors related to postoperative substance use problems (e.g., King et al., 2012) but, to our knowledge, this is one of the first to examine the association between pre and postoperative eating-related variables and post-RYGB substance use, thereby adding to our understanding of the risk factors for this potential outcome following RYGB. "
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    ABSTRACT: Post-bariatric surgery patients are overrepresented in substance abuse treatment, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The severity of the substance use disorder (SUD; i.e., warranting inpatient treatment) and related consequences necessitate a better understanding of the variables associated with post-RYGB SUDs. This investigation assessed factors associated with post-RYGB substance misuse. Post-RYGB patients (N = 141; at least 24 months postsurgery) completed an online survey assessing variables hypothesized to contribute to post-RYGB SUDs. Fourteen percent of participants met criteria for postoperative substance misuse. Those with a lower percent total weight loss (%TWL) were more likely to endorse substance misuse. Family history of substance misuse was strongly associated with postoperative substance misuse. Eating-related variables including presurgical food addiction and postsurgical nocturnal eating, subjective hunger, and environmental responsiveness to food cues were also associated with a probable postoperative SUD. These findings have clinical utility in that family history of substance misuse can be easily assessed, and at-risk patients can be advised accordingly. In addition, those who endorse post-RYGB substance misuse appear to have stronger cognitive and behavioral responses to food, providing some support for the theory of behavioral substitution (or "addiction transfer").
    Substance Use &amp Misuse 10/2013; 49(4). DOI:10.3109/10826084.2013.841249 · 1.23 Impact Factor
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    • "It is worth noting, however, that if patients are selected for the intervention based solely on these criteria, then there may be a subset of patients who are at risk for post-WLS AUD but who are not receiving adequate prevention efforts, as some patients with no history of substance misuse before surgery go on to develop new-onset AUD afterward. For instance, in the King et al. study [4], the investigators found that there is a substantial risk for AUD even in patients who had no history of such problems before surgery and, conversely, that about 60% of those participants who reported AUD after surgery had not had such problems beforehand. Our own research group, examining a large sample of patients from our center, obtained very similar findings [5], as have other investigators [7] [8]. "
    Surgery for Obesity and Related Diseases 02/2013; 9(3). DOI:10.1016/j.soard.2013.02.001 · 4.94 Impact Factor
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