Obesity Surgery

, Volume 28, Issue 3, pp 717–724 | Cite as

How Do Individuals Develop Alcohol Use Disorder After Bariatric Surgery? A Grounded Theory Exploration

  • Ruth Yoder
  • Padraig MacNeela
  • Ronan Conway
  • Caroline HearyEmail author
Original Contribution



Bariatric surgery is the most effective treatment for severe obesity. However, following Roux-en-Y gastric bypass (RYGB) surgery, a small minority of patients develop new-onset alcohol use disorder (AUD), the aetiology of which is poorly understood.


The aim is to construct a theory to explain the development of AUD among a sample of individuals who reported problematic drinking following RYGB.


Semi-structured interviews were conducted with eight RYGB patients diagnosed with AUD attending a multi-disciplinary outpatient weight management service at a public hospital in the Republic of Ireland. A constructivist grounded theory methodology was used to analyse interview transcripts.


Participants’ main concern was identified as ‘unresolved psychological issues’ which were managed by ‘external coping mechanisms’, namely, ‘eating to cope’. After RYGB, comfort eating was no longer possible to the same extent. Following a ‘honeymoon period’, participants’ need for an external coping mechanism resurfaced. ‘Filling the void’ provides a framework to explain how participants managed the symptoms of their unresolved psychological issues through ‘behavioural substitution’, that is, drinking alcohol instead of eating.


The theoretical framework of ‘filling the void’ adds to contemporary research that conceptualises AUD behavioural substitution as ‘addiction transfer’ by describing the process by which the phenomenon occurs as well as the characteristics of participants. The clinical implication of this research is to advocate for a reshaping of treatment of RYGB patients, with increased psychological input following surgery.


Grounded theory Alcohol use disorder Bariatric surgery Unresolved psychological issues 



The first author gratefully acknowledges the Education Committee of St. Columcille’s Hospital for the receipt of 75% of the academic tuition fees for the degree of D.Psych.Sc., for which this research forms partial fulfilment. No other funding was received.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.School of PsychologyNational University of Ireland, Galway and Weight Management Service, St. Columcille’s HospitalLoughlinstownIreland
  2. 2.School of PsychologyNational University of Ireland, GalwayGalwayIreland
  3. 3.School of PsychologyUniversity College DublinDublinIreland

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