POST-BARIATRIC SURGERY PATIENTS VERSUS CONTROLS IN SUBSTANCE ABUSE TREATMENT
3
Hopper ,
4
Foster-Hartsfield ,
Daniel
John A.
Joyce
Ashley
Valentina
1
1
1
1
1
Summar Reslan , Alisha Serras , Daniel Wood , Randi Nguyen , & Lorrianne Kukendall
1Eastern
Michigan University, Ypsilanti, MI
3St. Joseph Mercy Hospital, Ypsilanti, MI
of Michigan, Ann Arbor, MI
4Brighton Hospital, Brighton, MI
Results
Bariatric surgery candidates tend to report very low rates
(1.7%) of substance use disorders at the time of pre-surgical
assessment (Kalarchian et al., 2007). Evidence from our laboratory,
however, demonstrates high rates of substance abuse
treatment admissions among individuals who have had
bariatric surgery. Specifically, we estimate that between 26% of substance abuse treatment admissions have had
bariatric surgery (Saules et al., in press). Preliminary evidence
suggests that for a considerable number of
such
individuals, onset of heavy substance use and associated
problems began at some point after bariatric surgery (see
Wiedemann et al., 2010). Understanding how post-bariatric patients
are presenting to substance abuse treatment and how they
may differ from their non-bariatric counterparts may yield
important implications for prevention and treatment.
Comparison of Bariatric versus Non-Bariatric Cases in the
Full Sample: Relative to non-bariatric substance abuse
treatment patients, those with bariatric surgery histories
were significantly more likely to be female, Χ2 (1, N = 7,196)
= 28.9, p < .001. With respect to admission diagnoses,
bariatric and non-bariatric cases were equally likely to have
been diagnosed with alcohol dependence, but bariatric
patients were significantly more likely to also carry a
diagnosis of alcohol withdrawal, Χ2 (1, N = 7,199) = 8.2,
p < .01. Rates of diagnoses for other drug dependence
categories, anxiety, and depression did not differ as a
function of bariatric surgery history.
Male
Method
Alcohol-related Diagnoses by
Bariatric History Status
Alcohol Dependence
Female
PARTICIPANTS: Chart review data from 54 post-bariatric
substance abuse treatment admissions were compared with
that from their matched 54 controls. Each group included 38
females and 16 males, with a mean age of 44.6 (± 9.1) years.
50
75
70.4
64.7
35.3
29.6
75
Percentage
Percentage
PROCEDURES: De-identified demographic and diagnostic
information was exported from the electronic medical
records of all patients admitted to Brighton Hospital’s
rehabilitation, detoxification, and partial hospitalization
programs between April 16, 2006 through May 31, 2009. The
sample of post-bariatric cases was identified through a
database search for the terms “intestinal bypass” or
“bariatric bypass.” Matched control cases were randomly
selected from the master database of 7,199 cases, matched
on age (within two years), gender, and time of admission
(often on the same day, but at most, within two months, to
control for seasonal or cohort effects).
75
Alcohol Withdrawal
100
100
25
0
0
Bariatric Hx Bariatric Hx
Neg
Pos
Χ 2(1, N = 7,196) = 28.9, p <.001
60.3
61.1
50.8
50
25
1
Ivezaj ,
2University
Introduction
Gender by Bariatric
History Status
1
Wiedemann ,
Bariatric Hx
Neg
Bariatric Hx
Pos
Χ 2(1, N = 7,199) = 8.2, p <.01
Comparison of Bariatric versus Non-Bariatric Matched
Controls: Self-reported alcohol consumption per day was
typically reported by patients as a range, e.g., “a pint to a
fifth of vodka a day.” Therefore, the low and high end of
each patient’s daily range was converted to minimum and
maximum number of standard drinks per drinking day. On
average, bariatric patients reported a higher minimum
number of drinks per drinking day (13.1 ± 9.9 vs. 9.3 ± 6.7
drinks, t (97) = 2.2, p < .05), and, as shown, this effect was
more pronounced among patients diagnosed with alcohol
dependence.
Presented at the 2010 Annual Meeting of the Society of Behavioral Medicine
Control cases were more likely to be seeking treatment for
opiate and polydrug abuse, while bariatric cases were more
likely to be seeking treatment for problems related to
alcohol, alcohol-plus-drug, and benzodiazepine abuse.
Alcohol Consumption per
Drinking Day for Alcohol
Dependent Patients
Min Drinks/Day
Bariatric Hx Neg
Bariatric Hx Pos
100
Max Drinks/Day
19.1
20
15
Reason for Treatment by
Bariatric History Status
15
75
16.3
Percentage
2
Schwarz ,
Drinks per day
Karen K.
1
Saules ,
11
10
57.4
61.1
50
24.1
25
5
9.3
0
0
0
Bariatric Hx Bariatric Hx
Neg
Pos
t (78) = 3.3, p <.01 for minimum drinks per day;
t (78) = 2.4, p<.05 for maximum drinks per day.
14.8
7.4
1.9
13
0 1.9
3.7
0
5.6
Χ 2(6, N = 108) = 12.65, p<.05
Discussion
Of most direct relevance to substance abuse treatment
considerations, bariatric patients were more likely to carry
a diagnosis of alcohol withdrawal and were consuming
greater quantities of alcohol per drinking day. This finding
takes on additional significance in light of evidence that
bariatric patients reach higher peak BALs than controls,
reach this level faster, and take longer to return to baseline
(Hagedorn et al. 2007; Klockhoff et al., 2002). Faster absorption of
ethanol and higher peak concentration in post-bypass
patients would suggest that alcohol may serve as a stronger
reinforcer among the bariatric population, thereby
contributing to higher levels of alcohol intake and, by
extension, putting bariatric patients at greater risk of
developing alcohol problems. This heightened abuse
liability could complicate the efforts of bariatric patients to
achieve and maintain sobriety. Therefore, more in depth
assessment of pre-surgical alcohol use and patient
education regarding potential post-surgical risks is
warranted.
Contact: ksaules@emich.edu