Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

May 22, 2017Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Alcohol and drug use after weight loss surgery: evidence from a large U.S. patient group

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Abstract

One-fifth of participants reported incident alcohol use disorder (AUD) symptoms within 5 years post-Roux-en-Y gastric bypass (RYGB).

The year-5 cumulative incidence of AUD symptoms was 20.8% after RYGB and 11.3% after laparoscopic adjustable gastric banding (LAGB).
Illicit drug use was reported at 7.5% post-RYGB and 4.9% post-LAGB at year 5.
SUD treatment was sought by 3.5% of those who underwent RYGB compared to 0.9% after LAGB.
RYGB was associated with a higher risk of developing AUD symptoms (adjusted hazard ratio 2.08) than LAGB.
The risk of illicit drug use was also greater after RYGB (adjusted hazard ratio 1.76).
Participants undergoing RYGB had a significantly higher likelihood of requiring SUD treatment (adjusted hazard ratio 3.56).

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BACKGROUND: Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited.

OBJECTIVE: To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes.

SETTING: 10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to 7 years through January 2015.

RESULTS: Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age: 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95% confidence interval (CI): 18.5-23.3), 7.5% (95% CI: 6.1-9.1), and 3.5% (95% CI: 2.6-4.8), respectively, post-RYGB, and 11.3% (95% CI: 8.5-14.9), 4.9% (95% CI: 3.1-7.6), and .9% (95% CI: .4-2.5) post-LAGB. Undergoing RYGB versus LAGB was associated with higher risk of incident AUD symptoms (adjusted hazard ratio or AHR = 2.08 [95% CI: 1.51-2.85]), illicit drug use (AHR = 1.76 [95% CI: 1.07-2.90]) and SUD treatment (AHR = 3.56 [95% CI: 1.26-10.07]).

CONCLUSIONS: Undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.

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Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

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