There are times on the road to wellness, when the only thing one can say is, “No fair.” I remember thinking no fair when six months sober, a long dormant eating disorder popped up like the head of a Hydra. Just when I had my alcohol use disorder (AUD) licked, another trial presented itself. And at the time, it seemed insurmountable.
Watching the Trends at Sanford Behavioral Health
I am acutely aware of those moments of “unfairness” during mental health recovery. And I know that feeling frustrated and blindsided can derail the best laid plans. So when we began to see a trend toward alcohol use disorder and bariatric surgery at Sanford, it was important to get the word out. As the old saying goes, forewarned is forearmed.
First, what is Bariatric Surgery?
Bariatrics is the branch of medicine that deals with the study and treatment of obesity. Bariatric surgical procedures cause weight loss in higher weight individuals. The American Society for Metabolic & Bariatric Surgery (ASMBS) says bariatric surgery is accomplished by, “restricting the amount of food the stomach can hold, causing malabsorbsion of nutrients, or by a combination of both gastric and malabsorbsion”.
Most weight loss surgeries today, such as gastric bypass, sleeve gastrectomy, etc., are performed using laparoscopic, minimally invasive surgery. And bariatric surgery is considered the most effective and lasting treatment for life-threatening obesity. Further, bariatric surgery is accompanied by therapy, because after weight loss surgery patients still require life-long behavioral change in order to successfully lose and maintain weight.
The Connection Between Bariatric Surgery and AUDs…
I know from experience, there is a connection between eating disorders and substance use disorders. And it stands to reason. If one is filling the emotional void with alcohol, quitting drinking could induce an unhealthy relationship with food. It also seems the opposite is true.
There is significant ‘cross addiction’ between eating disorders and substance use disorders. And Studies suggest that if an individual has an eating disorder, she/he has a higher likelihood of an addiction. Perhaps by as much as 50%. It’s also true that one in five higher-weight individuals have disordered eating. This is something bariatric surgery itself will not ‘cure’. If that individual has used food to regulate mood in the past, other compulsive behaviors may appear or increase post surgery. This includes use of substances, compulsive gambling and internet use.
Gail Hall, LMSW, DCSW, CEDS-S Executive Director – Sanford Comprehensive Treatment for Eating Disorders
The NIH Weighs in on Bariatric Surgery
According to the National Institutes of Health (NIH), only a few studies have “examined alcohol use disorders pre and post bariatric surgery”. However, the NIH cautions that “safety concerns” remain. And there is evidence that some bariatric surgical procedures alter the movement of drugs within the body.
What to Watch For – Post Bariatric Surgery
The overall benefits of weight loss surgery cannot be denied when health is at risk. Consequently, psychological assessments are conducted pre/post surgery to determine readiness. These assessments are similar to an addiction treatment assessment. And they help to identify strengths such as family support and motivation post surgery. It can also “red flag” areas such as a history of depression or triggers to past emotional eating.
Even so, based on current studies, gastric bypass surgery is associated with:
A higher risk of an alcohol use disorder
Faster absorption of alcohol
A higher maximum concentration of alcohol in the system
And a longer amount of time to eliminate alcohol from the body
Also, patient surveys have revealed changes in alcohol sensitivity following gastric bypass surgery…feeling intoxicated more rapidly, after drinking less, for longer… as well as more difficulty controlling postoperative alcohol intake. National Institutes of Health
Reducing the Risk
Things to think about if you have undergone/plan to have bariatric surgery:
1. Be honest with your doctor, family and therapist
This is not the time to under-report, tell on yourself! Talk openly about family history of addiction. Also about your own drug or alcohol use; the underlying reason for the surgery; and the emotional triggers that may lead to unhealthy choices or cross addictions.
2. Potential problems are sure to arise if you use food or alcohol to “self-medicate” or alter your mood.
Speak to a professional and learn to control the response. Replace the dopamine rush of a bottle of wine with a walk in nature, art lessons or volunteerism.
3. Find a network, connection and support
Look outside of the box for support groups that encourage wellness. Similarly, be accountable and allow your loved ones to bolster your success and strengthen your vulnerable moments.
4. Follow up and seek treatment
Studies show that most alcohol use disorders develop approximately two-years after bariatric surgery. Get regular checkups and seek treatment if drinking becomes unmanageable.
Forewarned is Forearmed…
In fact, self-improvement is rough. Some might even say the trials and tribulations are “unfair”. But at Sanford Behavioral Health, we believe education and preparedness is key. And making the decision to improve your life and your health is worth the effort. As in all of life’s journeys, honest self-reflection, the support of loved ones and professionals, and a solid understanding of the desired outcome, will increase success outcomes.