EMU team investigates link between bariatric surgery, substance abuse

by Pamela Young, Published May 04, 2011

"Things were just different after surgery. At first, things were going great. I had good support, and my eating, lifestyle and diet were under control for years. Then, one night, I had this tiny little glass of wine, and it made me feel so good. I don't know how a normal person would react to alcohol, but to me, it was an amazing feeling. That's what started it.

"After that first taste of wine, I just started drinking more and more. I think it was about two months from my first drink to having a bottle a day...before long, I was up to two bottles of wine a day. I was passing out and when I tried to detox myself, I started hallucinating. One day, my son said ,"Daddy, Mommy's passed out again" (sobs)... and that was just it for me...I knew I needed help."

     - Bariatric surgery patient in a substance abuse rehabilitation program

Everywhere you look, there are ads for pills, exercise equipment and special programs designed to help Americans lose weight. For the morbidly obese, it's not that simple. That's where bariatric surgery comes in, helping them lose a significant amount of weight by reducing the size of the stomach.

Although most patients do well after this type of surgery, an Eastern Michigan University team has identified a significant complication.  A number of bariatric patients become addicted to pills or alcohol after surgery.

In 2006, doctors at Brighton Hospital, a comprehensive addiction treatment center in Livingston County, first noticed that an increasing number of patients who had bariatric surgery were seeking treatment for substance use problems. The hospital's medical director mentioned the trend to Karen Saules, an EMU psychology professor and an expert in the intersection of eating and addictive behavior.

In 2009, with the help of EMU psychology students, Saules began to investigate. After examining 7,200 medical records, the team confirmed that two percent to six percent of patients admitted for substance abuse treatment from 2006-2009 had previously undergone bariatric surgery. Saules and her students began a more systematic approach by collecting data directly from post-bariatric patients themselves, using interviews and questionnaires.
The team's initial research found that:

•    Patients face social, psychological and medical realities after bariatric surgery, which may contribute to addiction. Thus, bariatric patients may need extra help in handling the emotional challenges and unexpected changes of their post-surgical lives.

•    Traditionally, people in substance abuse programs have a long drug-abuse history with a variety of drugs and are more likely to be men. Bariatric patients in the study, however, were more likely to be women, and more than half had no history of substance abuse before their surgeries. Alcohol and pain pills were almost exclusively their drugs of choice.

•    Bariatric patients absorb and experience the effects of alcohol and drugs very quickly and intensely. Once they begin using alcohol or drugs, use escalates quickly, and problems can develop very rapidly.

•    Although psychologists have traditionally been involved in the pre-surgical assessment process, they might have a more important role in the post-surgical phase, to help patients manage the dramatic shifts that can occur in self-image, relationships and responses to alcohol and drugs.

"It's something of a 'perfect storm,'" Saules said. "You're suddenly unable to find satisfaction from food after surgery; then you have to manage some pretty major shifts in how you look and feel, and then you find that alcohol or drugs make you feel really good...So good that you can't stop using and life rapidly becomes unmanageable."

Saules recognized that many people struggling with addiction never seek inpatient treatment. She now is now trying to fully understand how common it is for bariatric patients to experience alcohol and drug problems. 

"People in trouble don't necessarily go to rehab," Saules said. "We talk to people and they tell us, 'I can tell you five other people who are experiencing the same thing. They just haven't checked themselves into treatment.' "

The Eastern Michigan team has presented its findings to the Society for Behavioral Medicine in 2010 and 2011, and to the American Society for Medical and Bariatric Surgery. Preliminary findings are published in the medical journal, "Surgery for Obesity and Related Disorders," (Nov. 2010, Vol. 6, No.6).


Pamela Young

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