Rates of Problematic Substance Use and Other Excessive
Behaviors in Post-RYGB Patients
M.E. Pulcini1, K. K. Saules1, L. M. Schuh2, D. Creel2, J. Stote2, K.C. Hudson2, B. Cacucci, D. Diaz2, C.M. Evanson2, J.M. Huse2,
M. Inman2, & D. Kaderabek2
1
Eastern Michigan University, Department of Psychology, Ypsilanti, MI
2
St. Vincent Bariatric Center of Excellence, Carmel, IN
Discussion
Results
Introduction
•
Recent research suggests that Roux-en-Y gastric bypass (RYGB) patients
are at an elevated risk for substance use disorder (SUD) in the postoperative
period (King et al., 2012; Saules et al., 2010).
A substantial minority (14.4%) of post-RYGB patients endorsed potential problems
with substance use or behavioral excesses on screening questions at 7.5 ± 1.5 years
postsurgery. Many of these difficulties had not occurred before surgery. Professionals
involved with postoperative bariatric care should, therefore, routinely query about
substance use and other behavioral excesses regardless of presurgical history of
these problems.
Patient Characteristics (N = 362)
Sex (% Female)
80.0%
Race (% Caucasian)
96.0%
Age (yrs)
M = 55.6
Time since surgery (yrs)
M = 7.5; SD = 1.5
•
Most post-bariatric surgery patients are beyond the typical age of SUD
onset. Therefore, new onset of SUD in the postoperative period warrants
study.
Total body weight loss (%)
M = 33.5; SD = 12.2
Limitations of the present study include the lack of a comparable control group. It is not
possible to conclude whether post-RYGB patients are at higher risk for SUD and
behavioral excesses than their non-bariatric surgery counterparts based on these
data. However, results suggest the utility of further study in this area.
•
Postoperative excessive gambling
3.2%
Postoperative abuse of prescription pain,
anxiety, or sleep medication
9.0%
There are a number of hypothesized explanations for an
increased risk of SUD following RYGB surgery, including:
Postoperative marijuana use
2.0%
Postoperative other illegal drug use
0.0%
Postoperative problematic alcohol use
5.7%
Sought substance abuse treatment
during postoperative period
2.0%
Met criteria for ≥ 1 of the above problems
14.4%
Met criteria for ≥ 2 of the above problems
2.5%
•
RYGB patients appear to be at greater risk for SUD in the postoperative
period than Adjustable gastric banding (AGB) patients (Saules et al., 2010;
Suzuki et al., 2012).
Rates of SUD and other excessive behaviors among post-RYGB patients
are not well-established. The present study aimed to add to this body of
literature by determining rates of problematic substance use and other excessive behaviors in a post-RYGB population.
Method
Procedure and Recruitment
Measures
•
Problematic Alcohol Use
The CAGE Questionnaire was used to
screen for alcohol use problems in the
past 30 days, using a cut-off score of
≥ 2.
Patients of the St. Vincent Carmel
Bariatric Center of Excellence
(Carmel, IN) who underwent RYGB
between January 1, 1999 and June
30, 2005 were contacted by Center
staff to complete a survey examining
long term medical and psychological
outcomes.
•
All participants were > 5 years
post-surgery.
•
Initial contact was made via
telephone or during visits to the
Bariatric Center.
• Those agreeing to complete the
survey were offered the opportunity
to do so via an emailed link, postal
mail, telephone, or in person.
• 362 eligible individuals completed
the survey.
New onset problems were defined as
those occurring in the postoperative
period but not during the preoperative
period.
Postoperative excesses
Survey assessing the presence of the
following excesses:
• Excessive Gambling
• Abuse of Prescription Pain,
Anxiety, or Sleep medication
• Illegal drug use
Dramatic decrease in body weight. The effects of many drugs are inversely proportional to body weight and, therefore, a greater effect from the same dose of drug will
be experienced after postsurgical weight loss.
Following bariatric surgery, patients find themselves abruptly confronted with an inability to eat, but perhaps limited resources for managing food urges through other means, which can create conditions that foster drug and/or alcohol dependence.
One study of 19 RYGB patients, however, suggests that RYGB patients adjust for this
effect by consuming significantly less alcohol at 6 months post-surgery (Woodard,
Downey, Hernandez-Boussard, & Morton, 2010).
Altered digestive tract. RYGB surgery drastically alters the digestive tract and, as a
result, alcohol and drug metabolism.
Following bariatric surgery, patients find themselves abruptly confronted with an inability to eat, but perhaps limited resources for managing food urges through other means, which can create conditions that foster drug and/or alcohol dependence.
9.9% (81.8% of which were new onset)
Postoperative Problematic Alcohol Use
Item-level analysis of The CAGE Questionnaire
C criterion (felt need to cut down alcohol
use)
9.9% (81.8% of which were new onset)
A criterion (annoyed by criticism of
alcohol use)
4.7% (75.0% of which were new onset)
G criterion (guilty about alcohol use)
7.1% (80.0% of which were new onset)
E criterion (felt need for morning eye
opener)
1.2% (100.0% of which were new onset)
Presented at the 2012 Annual Meeting of The Obesity Society
Contact information: mpulcini@emich.edu
For example, a study of postsurgical ethanol absorption reported the median time to
peak blood alcohol concentration (BAC) to be 10 minutes in RYGB patients compared
with 30 minutes in weight and age matched controls (Klockhoff, Näslund, & Jones,
2002). Maximum BAC was also found to be significantly higher in the RYGB group
than the control group.
These data are supported by qualitative findngs in which effects of alcohol were
described by post-RYGB patients as being felt more quickly and powerfully than
during the presurgical period (Ivezaj et al., 2010).
Addiction transfer. Addiction transfer is said to occur when an individual exchanges
one compulsive behavior for another (McFadden, 2010). In patients who used food to
regulate mood in the presurgical period, it is unclear as to which method they use to
replace this function.
Several anecdotal reports of addiction transfer in post-bariatric surgery patients have
surfaced in qualitative studies and in the media (Ivezaj et al., 2010; “Suddenly Skinny,”
2006).