Gastric bypass has helped hundreds of thousands of people combat obesity each year for over a decade. However, in the early 2000s, a pattern seemed to emerge. People were beginning to report an increase in alcohol intake, and at about two years post-surgery, they were reporting symptoms of an alcohol use disorder (AUD).
Many researchers investigated this development, and the connection between gastric bypass surgery and alcohol abuse doesn’t seem to be as clear as people first believed. There appears to be a number of theories with a combination of many factors, starting with the surgery itself.
Gastric Bypass: The Roux-en-Y Procedure
There are many different types of surgeries that assist with weight loss, but one seems to most often be connected with post-surgery alcohol misuse, and that is the gastric bypass surgery, also referred to as the Roux-en-Y procedure.
During the RYGB procedure, the surgeon creates a small pouch at the top of the stomach, approximately the size of a chestnut. This creates a very small space and the person is unable to eat large amounts of food as a result. In addition, the small intestine is reattached to this small pouch, and part of the intestine is not used in order to make calorie absorption more difficult.
Other surgeries, such as the gastric banding did not have the same increase in alcohol misuse as the Roux-en-Y procedure (RYGB). There has not been enough research to determine if the gastric sleeve has the same potential effect as the RYGB procedure, but early studies have shown that there is also increased potential for alcohol abuse post-surgery.
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How The Body And Brain Respond To Alcohol After Gastric Bypass Surgery
The two elements of the RYGB surgery described above are believed to contribute to the increase of alcohol misuse. An enzyme in the stomach lining, called alcohol dehydrogenase, breaks down alcohol. Because the stomach lining is drastically reduced in size, there is less enzyme present and more alcohol can enter the bloodstream.
Studies revealed that people consuming alcohol post-surgery have higher blood alcohol content, reach peak levels faster, and the alcohol remains in their systems longer than people who have not had the surgery. In one specific study, participants reached above legal limits after one drink. Individuals who have had the RYGB procedure have reported feeling the effects of alcohol from very small amounts and feeling intoxicated for longer periods of time. This may impact the way the brain responds to alcohol, and explain the increased potential for an alcohol use disorder.
Researchers have considered that the RYGB procedure may affect more than just weight loss and alcohol levels in the body. It has shown to alter the effect that some foods have on the “reward pathway” in the brain, and it may alter the way alcohol is recognized in the brain. If this pathway becomes more activated when alcohol is consumed, it can lead to an alcohol use disorder.
Drinking Alcohol In Moderation Post-Surgery
The Centers for Disease Control and Prevention (CDC) refers to moderate alcohol drinking as two drinks per day for men and one drink for women. While an occasional drink containing alcohol doesn’t seem to create an issue with someone who has not had a RYGB surgery, it appears to have potentially serious consequences for individuals who have.
In one study, subjects who were three and four years post-surgery, who had no problems with alcohol, were asked to drink one beverage containing alcohol. All of the participants reported they felt the effects of the alcohol before finishing the beverage.
Many surgeons strongly discourage drinking alcohol in any amount after gastric bypass surgery. After the connection between the surgery and alcohol abuse was discovered, there has been continued research in an attempt to discover the cause of this connection. The exact cause has not been clear, although there are some possible pre-surgery factors. Avoiding alcohol altogether seems to be the only way to eliminate the possibility of developing alcohol abuse after surgery.
Risk Factors For Developing Post-Surgery Alcohol Use Disorder
A number of risk factors have been discovered in connection to alcohol misuse after gastric bypass surgery. Studies found that some of these factors are:
- male sex
- young age
- lack of support
- recreational drug use
- regular alcohol consumption
Factors that did NOT appear to influence the likelihood of alcohol misuse after surgery were:
- body mass index (BMI)
- marital status
- employment status
- binge eating
- mental health treatment
Can Gastric Bypass Surgery Lead To Alcohol Addiction?
In some cases of addiction, people stop using one substance and begin abusing another. This process is referred to as transfer addiction. There have been conversations suggesting that individuals who have had gastric bypass surgery have replaced overeating (binge eating) with overusing alcohol.
While researchers cannot completely dismiss this theory, they have stated that it is more likely the physical, chemical, and biological changes that take place as a result of the surgery itself were responsible for contributing to alcohol use disorder in post-surgery individuals.
Addiction transfer does happen, and the following are risk factors to be aware of :
- substance abuse history (self or family)
- long-term use of narcotics (opioids) to treat chronic pain
- history of eating disorders
- past trauma, especially childhood sexual abuse
- regular alcohol use prior to bariatric surgery
- avoiding emotions
- lack of adequate support
- feelings of isolation
- depression, mood, or anxiety disorders
- engaging in self-sabotaging tendencies
These factors may be a cause for concern if you are exploring gastric bypass surgery as a weight loss tool. Be sure to communicate openly with your healthcare provider about any concerns you have regarding these factors. If you believe you are experiencing any symptoms of addiction transfer, there is help available.
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Decreasing Risk For Alcohol Use Disorder After Gastric Bypass
The benefits of gastric bypass are clear, which is why it is still a viable treatment for obesity. However, the risk of developing an AUD after surgery is real, and increases with every risk factor. There are some ways to decrease the risk of alcohol misuse associated with gastric bypass, and they are as follows:
Talk To Your Healthcare Provider
Be honest with your provider about the history of substance abuse and addiction in your family before surgery. Communicate any concerns you have at any point. If your drinking is beyond what is considered moderate drinking (one drink a day for women, two for men), reach out for help today.
Keep Your Appointments
Attend all your regular post-surgery appointments. Alcohol misuse seems to appear around two years after surgery, so keeping all scheduled appointments can help recognize any shifts in regular behaviors. It’s ok to make an appointment if something doesn’t feel right.
Explore And Treat Underlying Causes Of Obesity
If there are underlying causes to your obesity, such as binge eating or emotional eating, therapy for these issues may help in avoiding addiction transfer.
Strong Support System
Having people to talk to, whether family, friends, group therapy, or other support groups of people who can relate to your story is very healing. Using services available to connect you to other people who may be going through similar issues can help you to know you aren’t alone.
Signs Of An Alcohol Use Disorder After Gastric Bypass Procedure
Gastric bypass surgery is a life-changing experience, so the signs of an alcohol use disorder may not be noticeable at first. The following are a list of questions you can ask yourself about the past year, to explore the possibility of a developing AUD:
- Have you spent a lot of time drinking? Or hungover?
- Have you been unable to stop drinking, even when you wanted to?
- Do you have cravings to drink?
- Has drinking interfered with taking care of your responsibilities?
- Have you engaged in reckless behavior while intoxicated?
- Have you stopped participating in activities you enjoyed to drink instead?
- Has drinking caused problems in your relationships?
- Have you drunk to the point that you blacked out (have no memory of events)?
- Have you had to drink more alcohol to get the same effect?
- Do you drink more, or for longer periods of time than you planned?
- Have you had withdrawal symptoms when you tried to stop drinking?
If you can answer yes to two or more of these questions, an alcohol use disorder may be developing. There are services available to help in situations like this. Contact us today, and we can start you on the path to a healthier you in addiction recovery.