SUBSTANCE USE TRAJECTORIES OF POST-BARIATRIC SURGERY PATIENTS
ENROLLED IN SUBSTANCE ABUSE TREATMENT
Ashley A. Wiedemann¹, Karen K. Saules¹, John A. Hopper2, Joyce Foster-Hartsfield3, Valentina Ivezaj¹,
Summar Reslan¹, Alisha Serras¹, Lorrianne Kuykendall¹, Randi Nguyen¹ & Daniel Wood.¹
Contact: awiedema@emich.edu
Eastern Michigan University¹, St. Joseph Mercy Hospital2, Brighton Hospital3
Introduction
Results
In 2006, Brighton Hospital, a comprehensive substance
abuse treatment facility, began observing increasing
admissions who reported histories of bariatric surgery
(Saules et al., in press). It is unknown, however, whether
substance use problems typically precede or arise
subsequent to bariatric surgery. Furthermore, it is
unknown what variables may contribute to the onset of
new substance use following bariatric surgery.
The sample was predominantly White (82.4%), female (71.6%), with
a mean age of 44.64 ± 9.34, mean BMI of 30.99 ± 6.55 (obese), and
mean post-surgical weight loss of 161.18 ± 60.24 lbs. The average
patient underwent bariatric surgery at age 39.95 ± 9.42. Many
(30.1%) had no prior substance use treatment. The majority sought
treatment for dependence on alcohol (60.8%). The remainder
sought treatment for alcohol plus another drug (9.5%), opiates
(14.9%), benzodiazepines (6.9%), multiple drugs (6.8%). Only one
participant sought treatment for amphetamines.
Method
PROCEDURES/PARTICIPANTS:
The sample for this report includes electronic medical
record data of any case identified with “intestinal
bypass” or “bariatric bypass.” Data were obtained from
74 chart reviews of patients admitted to Brighton
Hospital’s rehabilitation, detoxification, and partial
hospital between April 16, 2006 through January 14th
2010. Two participants were not included in the final
analysis due to a missing date of surgery and another
subject did not have dates of heavy drug/alcohol use.
Χ2 (1, N = 53) = 6.36, p <.05
Discussion
Data Analysis
Participants were classified based on age of bariatric
surgery relative to the age of first engaging in heavy
drug/alcohol use. Participants were categorized as:
One-sample chi-square analysis with expected values set as equal
(a conservative approach) revealed significant differences
between Relapsers and New Onset Users for rates of heavy opiate,
Χ2 (1, N = 29) = 4.12, p <.05 and benzodiazepine use, Χ2 (1, N = 24) =
10.67, p <.001 but no difference for alcohol use Χ2 (1, N = 58) = 1.72,
p =.19. A 2 X 2 chi –square analysis (ever used, yes/no) indicated
that Relapsers were significantly more likely to have used alcohol
Χ2 (1, N = 72) = 5.53, p <.05 and THC, Χ2 (1, N = 72) = 6.59, p <.05.
Results yield unexpectedly high rates of new onset
substance abuse among adults, which is uncommon
(Kalaydjian et al., 2009). Results from ongoing qualitative
interviews suggest that some bariatric patients with a
history of heavy substance use prior to surgery (i.e.,
Relapsers) undergo an extended period of sobriety before
receiving surgery, and consequently relapse after surgery.
Future research should examine these trajectories and
variables that may pose post-surgical risks among this
population. Educating all patients about post-surgical risks
is warranted.
Bariatric surgery patients with a family history of mental
illness may have an increased risk for alcohol abuse. Such
patients may be vulnerable to what some refer to as
“addiction transfer,” which suggests patients who receive
successful treatment for one addiction (e.g., food
•“New Onset Users” had no evidence of a prior
addiction) may subsequently develop another to replace
substance abuse history and spontaneously developed a
When examining only heavy alcohol users, New Onset Users were
the former (e.g., substance use). In light of the high rate of
drug/alcohol problem after surgery (40.3%).
significantly more likely to have a family history of mental illness,
relapse, these preliminary results highlight the need for
Chi-square (including one-sample chi-square) and T- yet groups did not differ on family history of substance use, as the
comprehensive pre-surgical screening of substance use,
Tests were conducted to explore differences among majority of the sample had a family history of use (83.6%).
particularly among those with a history of substance use.
Relapsers and New Onset Users.
Presented at the 2010 Annual Meeting of the Society of Behavioral Medicine
•“Relapsers” had a history of heavy drug/alcohol use
prior to bariatric surgery and returned to some form of
alcohol/drug use post-surgery (59.7%).