New Study – Gastric Bypass Increases Risk for New-Onset Alcohol Abuse (Now You Tell Us?)

I recently came across this article.   It’s from a presentation at the 2011 Obesity Conference in Orlando, Florida about the phenomena of new-onset alcohol abuse after gastric bypass surgery

I actually did appreciate this article, because this was one of the few articles that did not just summarily dismiss this as a psychological transfer issue.   The fact that new-onset alcohol abuse is in fact an extreme behavioral change seems to have finally caught the attention of some scientists.  They have begun to investigate this and ask some important questions – such as when the onset began? how quickly the abuse progresses? whether or not there was a history of alcohol abuse prior to surgery?  the average age of the person when the abuse sets it, etc.,

Some of the questions I would still would like to know are, did all of these people have the Roux-en-Y, or do these findings hold true for Duodenal Switch and Sleeve Gastrectomy?

Here is the text from the article from Medscape by Steven Fox:

Gastric Bypass Increases Risk for New-Onset Alcohol Abuse

Steven Fox

The poster was presented at Obesity 2011: The Obesity Society’s 29th Annual Scientific Meeting.

“Our data underscore the need for asking patients during their preop evaluation about their use of alcohol, and again when following up after surgery,” presenter Stephanie Sogg, PhD, told Medscape Medical News. Dr. Sogg is a clinical staff psychologist at the Massachusetts General Hospital Weight Center in Boston.

Dr. Sogg said that several years ago she began hearing from patients that not only was alcohol having a far greater effect on them after surgery than before, but also that some were developing full-blown alcoholism after surgery — even if they had never had a previous problem with drinking.

And what was most intriguing, Dr. Sogg said, was that many of the people who were becoming alcoholics were middle-aged. That is long after most people begin to have alcohol-related problems. Data from the National Institute on Alcohol Abuse and Alcoholism indicate that the mean age of onset of alcohol abuse is 22 years.

“Although there’s not much in the literature on the subject of alcohol abuse following Roux-en-Y surgery, there’s quite a lot of discussion among weight loss specialists — anecdotal evidence — that this is a problem,” she said.

To find out more about a possible link, Dr. Sogg and her colleagues conducted telephone interviews with 340 patients who had undergone RYGB surgery at Massachusetts General Hospital in Boston. All procedures had been carried out at least 18 months before the survey.

About three quarters of the patients were female, and 91% were white. Mean age at the time of surgery was 46 years, and the mean time since surgery was 57 months.

Surveyors asked patients to quantify their preoperative and postoperative alcohol intake. Patients were also asked about how alcohol affected them both before and after surgery.

“We decided to ask about quantity and frequency rather than specific symptoms of alcohol abuse,” Dr. Sogg said. “That’s because we felt patients would be more comfortable reporting quantitative data rather than answering more subjective questions about their drinking.”

More than two thirds of participants said they were affected more by alcohol after surgery than before, she said.

Problem drinking was defined as consuming at least 3 drinks per day on at least 4 days per week, or having 5 or more drinks on at least 2 days per month.

“We found a significant increase in risk of new-onset postsurgical alcohol abuse among these patients,” Dr. Sogg said.

They defined “remote” problem drinking as problem drinking that had ceased more than 6 months before surgery. If patients were having drinking problems within the 6 months before surgery, that was defined as “immediate” problem drinking, Dr. Sogg explained.

About 21% of participants reported having drinking problems at some point before surgery. In all, 15% reported a remote history and 6.5% reported having an immediate problem.

Approximately 9% of participants reported a period of problem drinking after their surgery. Problem drinking after surgery was associated with younger age (P = .040), longer time since surgery (P = .001), and a higher baseline body mass index (P = .049).

“Drinking problems within 6 months prior to surgery strongly predicted problem drinking after surgery,” Dr. Sogg said. The odds ratio was 6.59 (P = .0005).

However, a remote history of problem drinking was not associated with having drinking problems after surgery (odds ratio, 1.01; P = .99), she noted.

Of particular note, Dr. Sogg said, was that 7% of patients surveyed reported new-onset problem drinking after RYGB.

However, no clinical or demographic variables were identified as predictors of new-onset drinking problems.

“In the population as a whole about 90% of alcohol problems develop before the mid-30s,” Dr. Sogg said. “The mean age of our sample was 46. So it’s troubling to find how relatively common new-onset alcohol problems were in this population of patients.”

Another observation Dr. Sogg said she has made over the years — but didn’t include in the present study — is how quickly drinking problems seem to progress in post-surgery patients. “Alcohol abuse is usually a gradual-onset problem, but in many of our patients who develop drinking problems, it seems to rapidly ramp up, escalating very quickly.”

On the basis of her study results, Dr. Sogg said clinicians need to increase their focus on the potential of alcohol-related RYGB complications. “That means better patient education, better screening, and better efforts at prevention, both before and after surgery,” she said.

“I think what this study clearly tells us is that alcohol can be a problem after surgery for some of these patients. And we especially need to watch people who had problems with drinking up to the time of surgery,” said Leslie Heinberg, PhD, director of behavioral sciences at the Bariatric and Metabolic Institute, Cleveland Clinic, Ohio, in an interview with Medscape Medical News.

She emphasized, however, that patients in the study who reported a remote history of alcohol problems before surgery were not at increased risk for postoperative drinking problems.

Dr. Heinberg, who is also associate professor at the Cleveland Clinic Lerner College of Medicine, said that in their program she and her colleagues are very careful to counsel all their patients about the physiologic changes that take place during surgery and how those changes will make patients permanently more susceptible to alcohol.

“We make sure they understand that if increased susceptibility is something that’s likely to create problems for them, they might want to reconsider having the surgery,” she said.

Dr. Sogg and Dr. Heinberg have disclosed no relevant financial relationships.

Obesity 2011: The Obesity Society 29th Annual Scientific Meeting; Abstract #21-OR. Presented October 5, 2011



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2 responses to “New Study – Gastric Bypass Increases Risk for New-Onset Alcohol Abuse (Now You Tell Us?)

  1. Wow…I’m sorry that no one spoke to you about this before, if you are a bariatric patient (which is not a far-fetched assumption 🙂

    I had my surgery almost three years ago, and with it, my surgeon and his staff ( provide a free five-years of follow up appointments and support groups. But prior to the surgery we were required by the staff to attend the meetings, which cover everything from the “starvation mode” and deficiencies experienced following the surgery, food menus/meal ideas, all the way to psychology.

    The “now they tell us” part of your title makes me concerned that it is “surprising” to you, from yet another assumption on my part…our support groups often focus on psychology following the surgery and how fast and easy we are susceptible to drink / gamble / work too much / etc. following the surgery…considering food was an addiction to so many of us. Myself, even AFTER attending these meetings prior to my surgery in 2009, struggled with addiction first to benzos (primarily Xanax, which calmed anxiety I used to “fix” by binging on comfort food) and then crystal meth and other amphetimenes that I excused to myself and others by saying “I had no energy and it gave me the energy I needed to be functional.” In reality, I was lazy about vitamin supplements and drinking protein shakes on a regular basis, which are two crucial energy-enhancing events.

    It’s been almost a year since doing those harmful addiction-crossovers, but I never claimed to have all the answers and NEVER expected to feel the loss I did when I suddenly couldn’t eat to feel happy/better/normal.

    Sorry for the tangent, but I felt that the title you chose may paint a picture to some that surgeons and their staff habitually do not warn bariatric patients about these risks (studies recently have shown our suicide rate post-op hovers around 15%, compared to 7% national average). One speaker at a support session made a statement that succinctly sums it up, in my opinion. For a large majority of people IN the situation demanding such serious action as surgery, obesity was a causal reality due to existing depression that we “fixed” by our food addictions, and asked if some foods should be illegal to certain people. I feel that goes too far in terms of privacy and such, but it was not a literal question merely hypothetical…it is not any surprise to me that alcoholism is high in bypass patients as we can get extremely drunk off extremely little for extremely long, and in many, that taste sets off the “happy comfort” addiction-feeding chemicals we previously fed with food addiction. I still haven’t tried alcohol, but as previously stated, had my own demons. Now I am not pointing fingers at anyone but myself..and if your surgeon didn’t touch on these psychological/addiction/alcoholism statistics at all perhaps you should say something to them, or find a support group that WILL help you deal…rather than posting “now they tell us.”

    I’m Dara, by the way. Nice to meet you 🙂

    • Thank you for the comment Dara.

      One of the reasons that most facilities now address transfer addiction is because of the alarming number of addiction issues that developed in the mid-2000s. These surgeons and facilities were reacting to a phenomena that should not and could not be ignored.

      My ex-husband developed an addiction to alcohol about 12 months post-op after his surgery in 2001. The term transfer addiction in relation to gastric bypass was not really a part of the vernacular at the time. In fact they had not yet shown alcohol did in fact make you drunker (like we know now). We did contact our surgeon and while concerned, seemed to be at a loss as to the cause or what to do. We were given no heads-up that this was something to even be on the lookout for.

      We know so much more now than we did then so I hope you consider that in 5-10 years time we may know quite a bit more about this surgery that would have been helpful. While it sounds like you had prior education about this issue, I do stand by my title (in our case).

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