Substance use disorder (SUD) may develop de novo for a subgroup of weight loss surgery patients, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The present study examined the rate of SUD in a broad sample of RYGB patients and identified associated behavioral and psychological factors.
Participants included 143 RYGB patients; the majority were women (n = 120; 83.9 %) and white (n = 135; 94.4 %). Participants completed a web-based survey assessing retrospective accounts of presurgical substance use, eating pathology, family history, and traumatic history, postsurgical substance use, life stressors, and global trait-like measures (emotion dysregulation, impulsivity, sensation-seeking, and coping skills).
A subgroup (n = 28, 19.6 %) of post-RYGB patients met criteria for probable SUD; however, the majority of those who met SUD criteria postsurgery (n = 19, 68 %) did not report a pre-RYGB SUD history. Family history of substance abuse, poor coping skills, and potential life stressors were related to post-RYGB SUD, particularly for the new-onset group. Additionally, the majority of those who met criteria for pre-RYGB SUD (n = 21, 70 %) did not continue to meet SUD criteria following RYGB.
Findings highlight a subgroup of post-RYGB patients reporting new-onset SUD, which is unexpected among middle-aged women. Importantly, findings also indicate that many patients with presurgical SUD did not relapse postsurgery. Assessing for family history of SUD and coping skills at the presurgical evaluation is recommended. Future research should identify psychological and physiological risk factors for SUD postsurgery and examine protective factors of those who discontinue substance use postsurgery.
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Conason A, Teixeira J, Hsu C, et al. Substance use following bariatric weight loss surgery. JAMA Surg. 2013;148(2):145–50.
Ertelt TW, Mitchell JE, Lancaster K, et al. Alcohol abuse and dependence before and after bariatric surgery: a review of the literature and report of a new data set. Surg Obes Relat Dis. 2008;4(5):647–50.
Fogger SA. McGuinness. The relationship between addictions and bariatric surgery for nurses in recovery. Perspect Psychiatr Care. 2012;48(1):10–5.
King WC, Chen J-Y, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307(23):2516–25.
Odom J, Zalesin KC, Washington TL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56.
Ostlund MP, Backman O, Marsk R, et al. Increased admission for alcohol dependence after gastric bypass surgery compared with restrictive bariatric surgery. JAMA Surg. 2013;148(4):374–7.
Saules KK, Wiedemann A, Ivezaj V, et al. Bariatric surgery history among substance abuse treatment patients: prevalence and associated features. Surg Obes Relat Dis. 2010;6(6):615–21.
Hajnal A, Zharikov A, Polston JE, et al. Alcohol reward is increased after Roux-en-Y gastric bypass in dietary obese rats with differential effects following ghrelin antagonism. PLoS One. 2012;7(11):e49121.
Thanos PK, Subrize M, Delis F, et al. Gastric bypass increases ethanol and water consumption in diet-induced obese rats. Obes Surg. 2012;22(12):1884–92.
Wiedemann AA, Saules KK, Ivezaj V. Emergence of new onset substance use disorders among post-weight loss surgery patients. Clin Obes. 2013;3(6):194–201.
Hagedorn JC, Encarnacion B, Brat GA, et al. Does gastric bypass alter alcohol metabolism? Surg Obes Relat Dis. 2007;3(5):543–8.
Steffen KJ, Engel SG, Pollert GA, et al. Blood alcohol concentrations rise rapidly and dramatically after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(3):470–3.
Raebel MA, Newcomer SR, Reifler LM, et al. Chronic use of opioid medications before and after bariatric surgery. JAMA. 2013;310(13):1369–76.
Ivezaj V, Saules KK, Wiedemann AA. “I didn’t see this coming”.: why are postbariatric patients in substance abuse treatment? Patients’ perceptions of etiology and future recommendations. Obes Surg. 2012;22(8):1308–14.
Reslan S, Saules KK, Greenwald MK, et al. Substance misuse following Roux-en-Y gastric bypass surgery. Subst Use Misuse. 2014;49(4):405–17.
Spitzer R, Yanovski S, Marcus M. The Questionnaire of Eating and Weight Patterns-Revised (QEWP-R). New York: New York State Psychiatric Institute; 1993.
Arnow B, Kenardy J, Agras S. The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating. Int J Eat Disord. 1995;18(1):79–90.
Selzer ML. The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument. Am J Psychiatry. 1971;127(12):1653–8.
Westermeyer J, Yargic I, Thuras P. Michigan Assessment-Screening Test for Alcohol and Drugs (MAST/AD): evaluation in a clinical sample. Am J Addict. 2004;13(2):151–62.
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.
Norbeck JS. Modification of recent life event questionnaires for use with female respondents. Res Nurs Health. 1984;7(1):61–71.
Sarason IG, Johnson JH, Siegel JM. Assessing the impact of life changes: development of the Life Experiences Survey. J Consult Clin Psychol. 1978;46(5):932–46.
Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav. 2004;26(1):41–54.
Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol. 1995;51(6):768–74.
Hoyle RH, Stephenson MT, Palmgreen P, et al. Reliability and validity of a brief measure of sensation seeking. Personal Individ Differ. 2002;32(3):401–14.
Carver CS. You want to measure coping but your protocol’s too long: consider the Brief COPE. Int J Behav Med. 1997;4(1):92–100.
Green BL. Psychometric review of Trauma History Questionnaire (Self-report). In: Stamm BH, Varra EM, editors. Measurement of stress, trauma and adaptation. Lutherville: Sidran; 1996.
Wee CC, Mukamal KJ, Huskey KW, Davis RB, Colten ME, Bolcic-Jankovic D. et al (2014) High-risk alcohol use after weight loss surgery. Surg Obes Relat Dis.
Davis JF, Schurdak JD, Magrisso IJ, et al. Gastric bypass surgery attenuates ethanol consumption in ethanol-preferring rats. Biol Psychiatry. 2012;72(5):354–60.
Cooper ML, Russell M, George WH. Coping, expectancies, and alcohol abuse: a test of social learning formulations. J Abnorm Psychol. 1988;97(2):218–30.
Cooper R, Hildebrandt S, Gerlach AL. Drinking motives in alcohol use disorder patients with and without social anxiety disorder. Anxiety Stress Copin. 2014;27(1):113–22.
Thomas SE, Randall CL, Carrigan MH. Drinking to cope in socially anxious individuals: a controlled study. Alcohol Clin Exp Res. 2003;27(12):1937–43.
This work was performed at Eastern Michigan University and St. Vincent Bariatric Center of Excellence, USA. Preparation of this manuscript was supported by the Eastern Michigan University Department of Psychology, the EMU Graduate School, the Blue Cross Blue Shield Michigan Foundation, and St. Vincent Bariatric Center of Excellence. We would like to acknowledge members of the first author's dissertation committee. The committee chair was second author, Dr. Karen K. Saules, and committee members included Drs. Anne Eshelman, Tamara Loverich, and Kenneth Rusiniak. We would like to also acknowledge Katharine Hudson and Dr. David Creel for their assistance in participant recruitment.
Conflict of Interest
The authors declare no conflicts of interest.
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Ivezaj, V., Saules, K.K. & Schuh, L.M. New-Onset Substance Use Disorder After Gastric Bypass Surgery: Rates and Associated Characteristics. OBES SURG 24, 1975–1980 (2014). https://doi.org/10.1007/s11695-014-1317-8
- Alcohol use disorders
- Bariatric surgery
- Gastric bypass
- Substance use disorders
- Weight loss surgery