Information for Doctors & Employers:
Gastric Bypass and Addiction
Recently the relationship between bariatric surgery, specifically gastric bypass, and its co-occurrence with the development of addictive disorders has been springing up in professional and public media journals. Whether or not there is a relationship is still under investigation. Studies looking at the rate of patients seeking bariatric surgery and their lifetime history of substance use have yielded mixed results. Some studies indicate a higher rate, while others report lower rates within this population; some even indicate that there is no difference when compared against the general public.
Despite this variation in the findings, both the popular media and a small group of scientific researchers have begun to investigate the relationship more closely. In October of 2006, the talk show “Oprah” ran an hour long program dedicated to the increased use of alcohol in persons recovering from bariatric surgery. The relationship between bariatric surgery and alcohol consumption has generated talk within internet chat rooms as well. Government bodies have taken interest including the National Institute of Drug Abuse which spent over $1.4 million on obesity research during 2005.
Estimates for the development of addictions post bariatric surgery range from 5% to 30% of surgery patients. Each year about 140,000 bariatric surgeries are performed in the US with gastric bypass (75%) and lap banding (20%) procedures being the two most prevalent.
It is important to note that those who receive bariatric surgery are not created equal. There is a significant gender disparity among patients receiving bariatric surgery. Men have composed about 19.4% of bariatric surgery patients while women represent a far greater number—72.6% of surgical patients.
Two theories have emerged regarding the relationship between bariatric surgery and the development of addictive disorders. The first theory views development of the addiction more in terms of the patient’s failure to adapt to their new physical and physiological limitations in regard to the consumption of substances. Weight loss following bariatric surgery is drastic, usually averaging between 20-40% of original body weight within the first 1-2 years. Physiologically the impacts of bariatric surgery include:
- Significant change in weight that may hinder the patients’ ability to adjust drinking habits to their new reduced body mass.
- The physical change in the gastro-intestinal system post-operatively that may result in increased sensitivity to alcohol consumption.
The second theory in the literature is based on “addiction transfer” from pre-existing behaviors into new manifestations. This term refers to the proposed phenomena that some individuals seeking bariatric surgery have an addiction to food and post operation that addiction manifests itself around other types of addictions such as alcoholism, substance use, gambling, compulsive shopping, and sex addiction. The problem with this theory is that it is grounded in a symptom-substitution model which has not been empirically supported; there is still debate among scientific researchers that “food” addiction is even a true addiction.
The relationship between bariatric surgery and addiction is clearly a topic that needs to be discussed, especially among women with chemical dependency. While increased interest has resulted in small studies predominantly funded and conducted by bariatric surgery centers, there has been no exploration into this matter from the perspective of an alcohol and drug treatment facility to date. As a result, Residence XII has now included questions in their intake packet asking women if they have undergone bariatric surgery, which type of surgery they had, and whether they would be open to sharing their experience with a Residence XII staff member. Residence XII continues to be committed to investigating issues pertaining to women in recovery.
If you have any questions or comments, please feel free to contact Allison Kristman-Valente, MSW, our Research Coordinator, at 425-823-8844. References used in the above article are available upon request.