ASMBS: Bariatric Patients at Risk of Substance Abuse

MM notes – could have told you so.  Again, have you read Weighty Secrets?

ASMBS: Bariatric Patients at Risk of Substance Abuse

By Charles Bankhead, Staff Writer, MedPage Today
Published: June 30, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor 
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

LAS VEGAS — Some bariatric surgery patients may trade one type of addiction for another, according to a small study of patients who entered substance abuse programs after surgery.

All but a few patients cited "addiction substitution" as a principal contributor to their substance abuse. Three-fourths said weight loss did not resolve underlying psychological issues that led them to overeat.

Though based on a 20-patient sample, the findings have implications for postsurgical management of patients who undergo weight-loss procedures, according to data reported here at the American Society of Metabolic and Bariatric Surgery meeting.

"The implications include a need for increased psychological treatment pre- and postsurgery, with a particular focus on navigating identity shifts, and increased education related to substance abuse risks post-bariatric surgery," Valentina Ivezaj, MS, of Eastern Michigan University, in Ypsilanti, and colleagues concluded in a poster presentation.

The investigators' interest in substance abuse among bariatric surgery patients evolved from their recent discovery that the patients may be over-represented in substance abuse programs. A review of 7,199 patients treated for substance abuse during 2006 to 2009 showed that 2% to 6% had a history of bariatric surgery (Surg Obes Relat Dis 2010; DOI: 10.1016/j.soard.2009.12.008).

To examine the association between bariatric surgery and substance abuse, Ivezaj and colleagues interviewed 20 bariatric surgery patients enrolled in a comprehensive substance abuse treatment program. Participants completed a semistructured interview and a battery of questionnaires. The primary objectives were to determine the patients' perceptions about the etiology of their substance abuse and the patients' recommendations for providers who work with bariatric patients.

Women accounted for about 80% of the participants, whose mean age was 44 and time since bariatric surgery averaged five years. The patients had a mean body mass index of 32 and mean weight loss of 120 lbs.

A review of the data collected showed four predominant themes that patients suggested for the etiology of their substance abuse, reflected in patients' comments:

  • Addiction substitution, 85%: "I gave up love for food and compensated for that by going out and drinking."
  • Unresolved psychological issues, 75%: "After losing weight, I was still left with issues."
  • Faster metabolism/increased effects, 55%: "A slam of wine felt just like a shot of heroin."
  • Increased availability of pain medications, 40%: "Pain pills seemed safe and innocent … I began to act the part of a patient who was in pain in order to get more pills."

The patients had three broad recommendations for professionals who work with bariatric surgery patients before and after surgery:

  • More counseling before and after surgery, 55%: "People need to have therapy while they are losing weight because it is such a big transition. Just getting on a scale is stressful."
  • More education about the risks of substance abuse after surgery, 70%: "There should be required meetings or readings … related to addiction."
  • More honesty on the part of patients and providers, 35%: "Get honest without fear of not getting the surgery."

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