Addiction is a real risk for certain patients after weight loss surgery. At least, that’s according to a new study published in Archives of Surgery and conducted by researchers from the New York Obesity Research Center. Their findings, detailed below, suggest a strong link between substance abuse and a certain type of weight loss surgery.
This on its own wouldn’t be alarming, but when you consider around 36% of the US is obese and an average of 200,000 people undergo weight loss surgery annually…well, the stakes are raised significantly. Alexis Conason, lead researcher of the new study, had the following to say,
“When we looked at each substance (drugs, alcohol, and cigarette smoking) individually, we didn’t see a huge difference, but when you looked at the whole group, we saw a significant increased risk for drug and alcohol use at the two-year point after the surgery…Our findings are important because it raises some concerns about who is at risk.” (WebMD)
Conason went on to suggest a number of reasons for this strange phenomenon. These include underlying mental health issues, relying on external sources to cope with internal problems, and even the type of weight loss surgery itself.
Read on to learn more about Conason’s research and surprising findings.
The Latest Facts on Substance Abuse & Weight Loss
Despite having far-reaching implications, the new study itself was rather small. The participants were 132 women and 23 men who underwent laparoscopic gastric band surgery or Roux-en-Y surgery. They answered questions before surgery, a month after, and again three months, six months, one year, and two years out.
The results were illuminating and revealed a number of psychological issues. According to Conason, these varied from depression to relationship problems to social stress. It’s important to note that these weren’t just observed in study participants, but in the larger population of obese adults receiving weight loss surgery.
Dr. Kelli Friedman, Director of Psychology at the Duke Center for Metabolic and Weight Loss Surgery, believes that long-term care for people who’ve received weight loss surgery is key. She noted that there’s usually an initial boost in mood, but this wanes over time and, if someone believes surgery will fix all their problems, can lead to trouble down the line.
In fact, Dr. Friedman told WebMD that, “…we need to do a better job at long-term follow-up care, not just a few months after surgery.”
She went on to note that individuals are usually more sensitive to alcohol after bariatric surgery. While this is primarily due to the loss of significant body mass (in some cases up to 60%), it can also be attributed to the brain’s reward system.
Dr. Erik Duston, Director of Bariatric Surgery at the Center for Advanced Surgical and Interventional Technology, took this idea one step further. He suggests that if someone who’s an emotional eater gets either lap band or Roux-en-Y surgery and can no longer turn to food, then they’re more likely to turn to drugs or alcohol.
Dr. Duston states,
“It’s referred to in our circles as addiction replacement, which isn’t unique to bariatric surgery…If they’re using food in this way and they undergo bariatric surgery, they can’t go back to eating the way they did, and the brain’s reward system becomes starved” (WebMD).
This type of addiction replacement – called cross addiction in the world of treatment – is common. Think about someone who’s drug of choice is heroin and ends up drinking heavily. Or a cocaine addict who ends up addicted to gambling.
While there are a whole host of reasons for this type of cross addiction, perhaps the most common is something incredibly simple – fixing the problem without treating underlying mental health issues.
Underlying Mental Health Issues
There’s a common recovery saying that goes something like “a sober horse-thief is still a horse-thief.” The idea is that just putting down the drug or drink isn’t enough, rather we need to change ourselves on a fundamental level in order to restore our minds, bodies, and spirits.
I’d wager a guess that getting bariatric surgery is similar. Many people are going to be tempted to get surgery, lose weight, and call it a day. They’re not going to work on themselves and address the reasons they overate in the first place, start a exercise regimen, or anything else.
This will work fine in the short-term, but, like Dr. Friedman noted above, doesn’t do much to address anything long-term or to solve any mental health issues. It also accounts for the findings of Alexis Conason’s study. If someone has an emotional or mental issue and can no longer turn to food, alcohol or drugs start to look like a good alternative.
It’s important to stop here and note that anyone undergoing weight loss surgery is screened by mental health professionals and advised to stay away from booze and tobacco prior to the surgery. They’re also screened for behavioral addictions like eating disorders or self harm and referred to a higher level of care if they’re found to have any.
So, what’s the answer? How can someone lose weight without being at risk for substance abuse? To put it another way, is there a “safe” type of surgery for weight loss?
Is There a “Safe Way” to Get Bariatric Surgery?
The short answer is no. All bariatric surgeries are going to carry a number of risks both large and small. Sometimes these risks are physical, other times they’re emotional or mental, and still other times they’re spiritual.
While we can’t speak about the physical risk of lap band or Roux-en-Y surgery, we can say a little something about the mental and emotional risks.
First, it’s important to understand these risks as very real concerns and not simply afterthoughts. The fact is that cross addiction is a very real thing and not uncommon for people recovering from any type of major lifestyle change. So, be prepared for what may happen once emotional eating is no longer an option.
What do we mean when we say “be prepared?” It’s as simple as having a support system in place. This can be a therapist, supportive and healthy friends, a healthy eating plan, a religious or spiritual avenue for growth, an exercise plan, or any and all of the above.
Next, it’s a good idea to continue through with any therapy or psychological care for a minimum of two years. After all, when an esteemed doctor from Duke recommends long-term monitoring, it’s best to listen. She knows what she’s talking about.
We’ve certainly seen the benefits of long-term care as it relates to addiction recovery here at Malvern. It’s one of many reasons we developed our 90 day model of primary and step down care and recommend ongoing 12-step involvement.
Finally, it’s necessary for people considering bariatric surgery to ask themselves why they want it in the first place. For many, the answer’s going to be an obvious “to be healthy and lose weight.” However, if someone’s primary motive’s to improve their appearance or to boost their self-esteem, it might be better to table the surgery.
There’s no quick outside fix to an inside problem. While it’s tempting to slap the “band-aid” of rapid weight loss on issues of self-esteem, it isn’t the optimal solution. What’s more, as we’ve seen over the course of this article and Alexis Conason’s study – it can lead to a host of unintended side effects.
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