Following gastric bypass surgery, there are many tribulations, but also many trials that a patient may encounter.  One of the challenges that has become apparent is the increased risk of alcohol abuse that has been observed in this population.

There are several important aspects to consider regarding the risk of alcohol abuse after gastric bypass surgery:

1.  Food addiction looking for a new outlet.  For some people who struggle with their weight,  one of the central issues at hand is a true food addiction.  Research has shown us that some people truly feel an euphoria or a ‘high’ after eating, particularly from eating calorie laden, tasty foods.  This euphoria is caused in part by a high release of, or robust response to, opioids and other neurotransmitters in the brain, and parallels the response seen in people addicted to other substances.

After gastric bypass surgery, the capacity to eat is greatly diminished, and food preferences may change as well.  The euphoric sensation and response is often decreased or lost, such that many people find a significant decrease in the satisfaction they get from eating.  The hormone and neurotransmitter alterations that occur can result in something that can psychologically even feel like a drug withdrawal.
Thus, without being able to satisfy their food addiction after surgery, some people turn to other forms of addiction and self-medication, and a common place to turn is unfortunately alcohol (or other drugs).

2.  Need for a coping mechanism.  Big changes happen in the life of an individual who’s had gastric bypass surgery.  Many of these changes are for the better, no doubt, but there can be struggles as well.  Depression can ensue for a host of reasons, ranging from the loss of food as a coping mechanism, to negative feelings about the excess skin that becomes apparent after substantial weight loss, to changes in that person’s relationship with their spouse or family (which are not always good changes).  Some may turn to alcohol or other substances as a way to cope with these changes.

3.  Alcohol absorbs faster.  Because alcohol reaches the small intestine faster after gastric bypass surgery, there is a high and swift peak in blood alcohol levels.  While this effect is uncomfortable for many patients, others may find it enjoyable, and may find them searching for more.

The number one way to minimize the risk of alcohol abuse after gastric bypass surgery is knowledge and education about the potential risk, both on the part of the patient, as well as on the part of all of the health care providers that are involved in the pre and post operative care of the patient.

Having a psychologist closely involved every step of the way is absolutely essential.  Any food addiction or tendency towards addictive behaviors must be assessed and managed prior to surgery.  The risks vs benefits of surgery must (as always) be carefully weighed; surgery may not be the best choice for patients with a true food addiction that has proven difficult to break.

Patients must be followed and supported closely postoperatively, as they undergo often dramatic changes both physically and psychologically.   Multidisciplinary follow up must continue long term, often for a lifetime, to provide ongoing support and assistance.  In this way, any difficulties encoutered can be met swiftly with support and appropriate interventions, to help these individuals stay on the right track of a successful long term outcome and a healthy long term lifestyle!

Dr. Sue © 2011

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