Substance Misuse Following Roux-en-Y Gastric Bypass Surgery

Abstract

Post-bariatric surgery patients are overrepresented in substance abuse treatment, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The severity of the substance use disorder (SUD; i.e., warranting inpatient treatment) and related consequences necessitate a better understanding of the variables associated with post-RYGB SUDs. This investigation assessed factors associated with post-RYGB substance misuse. Post-RYGB patients (N = 141; at least 24 months postsurgery) completed an online survey assessing variables hypothesized to contribute to post-RYGB SUDs. Fourteen percent of participants met criteria for postoperative substance misuse. Those with a lower percent total weight loss (%TWL) were more likely to endorse substance misuse. Family history of substance misuse was strongly associated with postoperative substance misuse. Eating-related variables including presurgical food addiction and postsurgical nocturnal eating, subjective hunger, and environmental responsiveness to food cues were also associated with a probable postoperative SUD. These findings have clinical utility in that family history of substance misuse can be easily assessed, and at-risk patients can be advised accordingly. In addition, those who endorse post-RYGB substance misuse appear to have stronger cognitive and behavioral responses to food, providing some support for the theory of behavioral substitution (or “addiction transfer”).

Keywords :

• substance use disorders
• alcohol
• bariatric surgery
• roux-en-Y
• weight loss
• food addiction

THE AUTHORS

Summar Reslan, MS, is a doctoral candidate in the Department of Psychology at Eastern Michigan University in Ypsilanti, Michigan, USA. Her research interests are bariatric surgery outcomes, eating- and weight-related disorders, addictive behaviors, and the interaction of addictive and eating behaviors. Her clinical interests include neuropsychology and rehabilitation psychology, and she teaches courses on quantitative methods in psychology.

Karen Saules, PhD, works at Eastern Michigan University (Ypsilanti, MI, USA), where she is Professor of Psychology and the Psychology Clinic Director. She teaches courses on clinical supervision, consultation, and teaching of psychology. Her research interests broadly encompass the intersection of eating and addictive behaviors, with a recent focus on bariatric surgery outcomes.

Mark Greenwald, PhD (Professor) is Director of the Substance Abuse Research Division, its Human Pharmacology Laboratory and treatment research clinic in the Dept. of Psychiatry and Behavioral Neurosciences at the Wayne State University School of Medicine in Detroit, Michigan. Dr. Greenwald conducts clinical research that focuses on pharmacological, environmental and individual difference determinants of drug seeking and relapse behavior; developing medication treatments for substance use disorders; and using brain-imaging techniques to understand in vivo neurochemistry of substance use disorders. The National Institute on Drug Abuse has continuously funded his research since 1996. Dr. Greenwald has served on many NIH and VA grant review panels, and regularly reviews manuscripts for substance abuse related journals. He is a former President of Division 28 of the American Psychological Association (Psychopharmacology and Substance Abuse).

Leslie M. Schuh, PhD, is Research Scientist at the St. Vincent Carmel Bariatric Center of Excellence in Carmel, Indiana, USA. Dr. Schuh conducts clinical research focusing on surgical and nonsurgical weight management in a multidisciplinary treatment program. Her research interests include medical and psychological outcomes after bariatric surgery including substance abuse, optimizing success of bariatric and nonsurgical weight management, enhancing physical activity in weight management patients, and weight management in children.