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

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Abstract

Background

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.

Aim

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

Method

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.

Results

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.

Conclusion

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.

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Funding

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.

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Author notes

  1. Ronan Conway

    Present address: School of Psychology, University College Dublin, Dublin, Ireland

Authors and Affiliations

  1. School of Psychology, National University of Ireland, Galway and Weight Management Service, St. Columcille’s Hospital, Loughlinstown, County Dublin, Ireland

    Ruth Yoder

  2. School of Psychology, National University of Ireland, Galway, Galway, Ireland

    Padraig MacNeela, Ronan Conway & Caroline Heary

Authors
  1. Ruth Yoder
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  2. Padraig MacNeela
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  3. Ronan Conway
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  4. Caroline Heary
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Corresponding author

Correspondence to Caroline Heary.

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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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Yoder, R., MacNeela, P., Conway, R. et al. How Do Individuals Develop Alcohol Use Disorder After Bariatric Surgery? A Grounded Theory Exploration. OBES SURG 28, 717–724 (2018). https://doi.org/10.1007/s11695-017-2936-7

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  • DOI: https://doi.org/10.1007/s11695-017-2936-7

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