Why Is Gastric Bypass Surgery Causing Addiction, Alcoholism and Suicide but the Lap-Band Procedure Isn’t?

There was a study done by Dr. Magdalena Plecka Ostlund of the Karolinska Institutet in Stockholm showing that those people that had weight loss surgeries that bypassed the intestines had much higher rates of problems with addiction, depression, alcoholism and attempted suicide than those that had the Lap-Band (or similar type).

“The gastric bypass surgery cohort had higher Hazard Ratios (HR) than the restrictive surgery cohort for substance abuse (HR, 3.8), suicide attempt (HR, 4.1), alcohol abuse (HR, 4.0), and depression (HR, 2.4). For the restrictive surgery cohort, these HRs were, respectively, 1.4, 2.4, 1.2, and 1.8, she said.”

This report has been getting quite a bit of newspaper attention regarding the alcoholism component, and though indeed alcohol abuse is a big problem, there are also significantly large increases in problems in substance abuse, depression and suicide attempts. However, the important element in this story seems to be getting lost, Why isn’t this happening to the Lap Band group? I now would like to ask, can the data be further broken down among folks that had the sleeve gastrectomy without intestinal bypass? Would the Hazard Ratios still hold then? How about for duodenal switch?

Another factor is that the data is reported using Hazard Ratios. I don’t know about you, but I wasn’t exactly familiar with the term Hazard Ratios and what they meant in medical reporting, so of course I had to look it up. How I’ve come to understand hazard ratios is that after gastric bypass surgery, there would now be a 3.8 times increase in your risk of developing substance abuse over the control group (ie., those that didn’t have surgery). A Hazard Ratio of 1 would be the equal to the control group. So, the Lap Band group is only slightly greater than the normal population with regards to risk of alcoholism and substance abuse but not nearly like the gastric bypass group is.

For those suffering from any of these, I think it certainly bears more scrutiny as to why there is such a difference between procedures, both for the sake of prevention and treatment. If the cause could be pinpointed and studied, then perhaps the tragedies could be avoided.

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8 Comments

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8 responses to “Why Is Gastric Bypass Surgery Causing Addiction, Alcoholism and Suicide but the Lap-Band Procedure Isn’t?

  1. Lori

    I had a gastric bypass 8 years ago. A year ago I started drinking for the first time in my life at the age of 45. Within 6 months I was in full blown alcoholism. I have been nothing but ticked when I hear of the addiction transfer theory. If I was going to transfer my addiction, I think the transfer would have happened earlier than 7 years post op. I ended up in a treatment center and had to listen to a doctor feed me that line of bull when I knew there was no way it was possible. This article reads that they should screen patients. I never drank. There was no indication that I would ever have an addiction problem. If anything, I wish they had warned me to NEVER drink. I knew I could never have sugar, never drink a soft drink, I can’t eat steak… I could handle all of that. I could have followed the never drink alcohol too. They just didn’t give me that warning label. Now I am left with a disease that wants to kill me, a lifetime membership in Alcoholics Anonymous, and a family that can’t figure out what happened.

    • Lisa

      Hi Lori,

      I’m in the same boat. But I have not found AA helpful (maybe hurtful) and I won’t go back unless I have to as part of treatment. I would like to start an Alcohol Abuse treatment/support program for post-ops. Would love to hear your thoughts re: AA and it’s appropriateness or lack thereof for u.

      • Hi Lisa,
        Thank you for your comment and sorry to hear this has happened yet again. AA was never intended to be treatment but rather support, in much the same way diabetics or cancer sufferers might get together to discuss the difficulties of their disease. But support should not be confused with treatment which I think is what has been done with addiction, largely because of the lack of effective treatment. And that’s the sad part. There aren’t many actual treatments yet for addiction except for some medications such as naltrexone (and its long acting injection Vivetrol), topiramate, baclofen, and perhaps anta-abuse. The illegal hallucinagen Ibogaine has been used in Mexico and Canada to treat opiate and other addiction but because of its illegal status there has been little study in the US to support its efficacy and safety. We need to focus as much money and energy on developing actual treaments for the disease of addiction as we have on the failed War on Drugs.

  2. I couldn’t agree with you more and thank you for sharing. I am so sorry to hear this tragedy has happened yet again. Pre-surgical screening is going to have little not no effect on this issue because it is a direct result of the surgery itself and the propensity to develop it will not be evident prior to surgery, In fact all of the people that have shared their story had no past history that would make them concerned that they would develop this. Some had either never drank or only drank 1-2 times a year. I’m wondering if you recall if you had any uncomfortable physical symptoms (anxiety, insomnia, depression..) that led you to take that first drink or if it was more of a serendipity type thing and you happened to have a drink and because of the altered anatomy it just provided a better buzz so to speak?

    Again, thank you for sharing and good luck.

  3. Lori

    My husbands doctor recommended a glass of red wine at night to help his high cholesterol. I thought having a glass of wine was romantic. Before I knew it, he was having a glass at night and I was having, then hiding a bottle.

    Thank you so much for your informative website. I am sharing this information with some of my treatment counselors.

  4. Lori

    Are you aware of the this recent study Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery http://jama.jamanetwork.com/article.aspx?articleid=1185618

    • Absolutely. I wrote to Dr. King about my theory and she was kind enough reply that they actually had not considered pre- or post-op nutrient status as a consideration…. They just aren’t looking for it. She did tell me they will be following up on this group for a longer term study out to 5-years as well as another study looking at addictions in general (not just alcohol). If you would like to backup data she sent me, just let me know. Thank you for commenting and sharing.

  5. Lori

    I would love it! Thank you so much! I am also sharing this information with the treatment centers where I sought treatment. My doctors and counselors are very open and interested in these studies.

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