Bariatric surgery linked to increased substance use

By Sarah Guy, medwireNews Reporter

Individuals undergoing bariatric weight loss surgery may be at increased risk for substance use and should be screened for this outcome at postoperative follow-up visits with medical professionals, report researchers.

The frequency of composite substance use (drug and alcohol use and cigarette smoking) in the cohort followed a J-shaped curve, note Alexis Conason (St Luke's-Roosevelt Hospital Center, New York, USA) and co-investigators, with an initial drop in frequency at 1 month after surgery, followed by a significant increase at 24 months.

They suggest the finding is a result of patients tending to adhere to postsurgical dietary recommendations more closely immediately following surgery but less so as postoperative time increases.

In addition, the team observed a significant increase in alcohol use over time among patients who underwent laparoscopic Roux-en Y gastric bypass (LRYGB) surgery, but did not find the same outcome among their counterparts treated with laparoscopic adjustable gastric bands (LAGBs).

"Because patients have a reduced tolerance for alcohol after RYGB surgery, they may experience the rewarding aspects of alcohol use sooner and more frequently, which may contribute to the increase in frequency of alcohol use after LRYGB surgery," they write in the Archives of Surgery.

A total of 155 weight loss surgery patients took part in the study, 100 of whom were treated with LRYGB and 55 with LAGB. They completed two questionnaires at baseline before surgery and at each follow up (1, 3, 6, 12, and 24 months), detailing their eating and weight measurements as well as compulsive behaviors.

The frequency of any (alcohol, drug, cigarette) substance use decreased significantly between baseline and 1 month postsurgery, remained stable at 3 months, and then was significantly increased by 24 months compared with the 1-, 3- and 6-month follow ups, report Conason et al.

The trend of alcohol use specifically followed a similar pattern, but from the 1-month follow up rather than from baseline.

Type of surgery showed significant interactions with alcohol use, say the authors, with significant decreases in use after 1 and 3 months among patients who underwent LRYGB surgery. Conversely, alcohol use increased significantly between the 1- and 3-month follow ups and the 12- and 24-month ones, as well as between the 6- and 24-month follow ups. No such association was noted for LAGB patients.

The researchers hypothesize that the observations could result from substitution theory, whereby "the successful elimination of a particular symptom without treating the underlying cause will result in the appearance of a substitute symptom."

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