Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008.  JAMA. 2010;303(3):235-24120071471PubMedGoogle ScholarCrossref
Buchwald H, Estok R, Fahrbach K,  et al.  Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.  Am J Med. 2009;122(3):248-256, e519272486PubMedGoogle ScholarCrossref
Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis.  J Am Coll Surg. 2004;199(4):543-55115454136PubMedGoogle ScholarCrossref
Sjöström L, Narbro K, Sjöström CD,  et al; Swedish Obese Subjects Study.  Effects of bariatric surgery on mortality in Swedish obese subjects.  N Engl J Med. 2007;357(8):741-75217715408PubMedGoogle ScholarCrossref
Flum DR, Belle SH, King WC,  et al; Longitudinal Assessment of Bariatric Surgery (LABS) Consortium.  Perioperative safety in the longitudinal assessment of bariatric surgery.  N Engl J Med. 2009;361(5):445-45419641201PubMedGoogle ScholarCrossref
Sogg S. Alcohol misuse after bariatric surgery: epiphenomenon or “Oprah” phenomenon?  Surg Obes Relat Dis. 2007;3(3):366-36817452022PubMedGoogle ScholarCrossref
Mitchell JE, Lancaster KL, Burgard MA,  et al.  Long-term follow-up of patients' status after gastric bypass.  Obes Surg. 2001;11(4):464-46811501356PubMedGoogle ScholarCrossref
Ertelt TW, Mitchell JE, Lancaster K, Crosby RD, Steffen KJ, Marino JM. Alcohol abuse and dependence before and after bariatric surgery: a review of the literature and report of a new data set.  Surg Obes Relat Dis. 2008;4(5):647-65018420465PubMedGoogle ScholarCrossref
Suzuki J, Haimovici F, Chang G. Alcohol use disorders after bariatric surgery.  Obes Surg. 2012;22(2):201-20721188544PubMedGoogle ScholarCrossref
Hagedorn JC, Encarnacion B, Brat GA, Morton JM. Does gastric bypass alter alcohol metabolism?  Surg Obes Relat Dis. 2007;3(5):543-54817903777PubMedGoogle ScholarCrossref
Klockhoff H, Näslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery.  Br J Clin Pharmacol. 2002;54(6):587-59112492605PubMedGoogle ScholarCrossref
Maluenda F, Csendes A, De Aretxabala X,  et al.  Alcohol absorption modification after a laparoscopic sleeve gastrectomy due to obesity.  Obes Surg. 2010;20(6):744-74820358306PubMedGoogle ScholarCrossref
Woodard GA, Downey J, Hernandez-Boussard T, Morton JM. Impaired alcohol metabolism after gastric bypass surgery: a case-crossover trial.  J Am Coll Surg. 2011;212(2):209-21421183366PubMedGoogle ScholarCrossref
Buffington CK. Alcohol use and health risks: Survey results.  Bariatric Times. 2007;4(2):1, 21-23Google Scholar
Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Arch Gen Psychiatry. 2007;64(7):830-84217606817PubMedGoogle ScholarCrossref
Belle SH, Berk PD, Courcoulas AP,  et al; Longitudinal Assessment of Bariatric Surgery Consortium Writing Group.  Safety and efficacy of bariatric surgery: Longitudinal Assessment of Bariatric Surgery.  Surg Obes Relat Dis. 2007;3(2):116-12617386392PubMedGoogle ScholarCrossref
Barbor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care.  2nd ed. Geneva, Switzerland: World Health Organization; 2001
Reinert DF, Allen JP. The alcohol use disorders identification test: an update of research findings.  Alcohol Clin Exp Res. 2007;31(2):185-19917250609PubMedGoogle ScholarCrossref
King WC, Engel SG, Elder KA,  et al.  Walking capacity of bariatric surgery candidates.  Surg Obes Relat Dis. 2012;8(1):48-5921937285PubMedGoogle ScholarCrossref
Brookings JB, Bolton B. Confirmatory factor analysis of the Interpersonal Support Evaluation List.  Am J Community Psychol. 1988;16(1):137-1473369379PubMedGoogle ScholarCrossref
Ware JE Jr, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36), I: conceptual framework and item selection.  Med Care. 1992;30(6):473-4831593914PubMedGoogle ScholarCrossref
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression.  Arch Gen Psychiatry. 1961;4:561-57113688369PubMedGoogle ScholarCrossref
Schuckit MA, Smith TL. The relationships of a family history of alcohol dependence, a low level of response to alcohol and six domains of life functioning to the development of alcohol use disorders.  J Stud Alcohol. 2000;61(6):827-83511188488PubMedGoogle Scholar
Molenberghs G, Kenward MG. Terminology and framework. In: Missing Data in Clinical Studies. Chichester, UK: John Wiley & Sons Ltd; 2007:27-38
Naimi TS, Brewer RD, Mokdad A, Denny C, Serdula MK, Marks JS. Binge drinking among US adults.  JAMA. 2003;289(1):70-7512503979PubMedGoogle ScholarCrossref
Substance Abuse and Mental Health Services Administration.  Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Accessibility verified May 29, 2012
Peltzer K, Davids A, Njuho P. Alcohol use and problem drinking in South Africa: findings from a national population-based survey.  Afr J Psychiatry (Johannesbg). 2011;14(1):30-3721509408PubMedGoogle Scholar
Kleiner KD, Gold MS, Frost-Pineda K, Lenz-Brunsman B, Perri MG, Jacobs WS. Body mass index and alcohol use.  J Addict Dis. 2004;23(3):105-11815256347PubMedGoogle ScholarCrossref
Dawson DA, Grant BF, Stinson FS, Chou PS. Psychopathology associated with drinking and alcohol use disorders in the college and general adult populations.  Drug Alcohol Depend. 2005;77(2):139-15015664715PubMedGoogle ScholarCrossref
Odom J, Zalesin KC, Washington TL,  et al.  Behavioral predictors of weight regain after bariatric surgery.  Obes Surg. 2010;20(3):349-35619554382PubMedGoogle ScholarCrossref
Holt PR. Changes in alcohol metabolism after gastric bypass surgery.  Lancet. 2011;378(9793):767-76821872743PubMedGoogle ScholarCrossref
Livingston EH. The incidence of bariatric surgery has plateaued in the US.  Am J Surg. 2010;200(3):378-38520409518PubMedGoogle ScholarCrossref
Thavorncharoensap M, Teerawattananon Y, Yothasamut J, Lertpitakpong C, Chaikledkaew U. The economic impact of alcohol consumption: a systematic review.  Subst Abuse Treat Prev Policy. 2009;4:2019939238PubMedGoogle ScholarCrossref
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).  4th ed. Washington, DC: American Psychiatric Association; 1994
Black DW, Goldstein RB, Mason EE. Psychiatric diagnosis and weight loss following gastric surgery for obesity.  Obes Surg. 2003;13(5):746-75114627470PubMedGoogle ScholarCrossref
Rosenberger PH, Henderson KE, Grilo CM. Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: a cross-sectional study using structured interview-based diagnosis.  J Clin Psychiatry. 2006;67(7):1080-108516889451PubMedGoogle ScholarCrossref
Sarwer DB, Cohn NI, Gibbons LM,  et al.  Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates.  Obes Surg. 2004;14(9):1148-115615527626PubMedGoogle ScholarCrossref
Kalarchian MA, Marcus MD, Levine MD,  et al.  Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status.  Am J Psychiatry. 2007;164(2):328-33417267797PubMedGoogle ScholarCrossref
Mühlhans B, Horbach T, de Zwaan M. Psychiatric disorders in bariatric surgery candidates: a review of the literature and results of a German prebariatric surgery sample.  Gen Hosp Psychiatry. 2009;31(5):414-42119703634PubMedGoogle ScholarCrossref
National Institutes of Health Consensus Development Conference Statement.  Gastrointestinal surgery for severe obesity. Accessibility verified May 18, 2012
Mechanick JI, Kushner RF, Sugerman HJ,  et al; American Association of Clinical Endocrinologists; Obesity Society; American Society for Metabolic & Bariatric Surgery.  American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient [published correction appears in Obesity (Silver Spring). 2010;18(3):649].  Obesity (Silver Spring). 2009;17:(suppl 1)  S1-S70, v19319140PubMedGoogle ScholarCrossref
Dixon JB, Dixon ME, O’Brien PE. Pre-operative predictors of weight loss at 1-year after Lap-Band surgery.  Obes Surg. 2001;11(2):200-20711355027PubMedGoogle ScholarCrossref
Clark MM, Balsiger BM, Sletten CD,  et al.  Psychosocial factors and 2-year outcome following bariatric surgery for weight loss.  Obes Surg. 2003;13(5):739-74514627469PubMedGoogle ScholarCrossref
Heinberg LJ, Ashton K. History of substance abuse relates to improved postbariatric body mass index outcomes.  Surg Obes Relat Dis. 2010;6(4):417-42120655025PubMedGoogle ScholarCrossref
Kalarchian MA, Marcus MD, Levine MD, Soulakova JN, Courcoulas AP, Wisinski MS. Relationship of psychiatric disorders to 6-month outcomes after gastric bypass.  Surg Obes Relat Dis. 2008;4(4):544-54918514586PubMedGoogle ScholarCrossref
Lieber CS. Metabolism of alcohol.  Clin Liver Dis. 2005;9(1):1-3515763227PubMedGoogle ScholarCrossref
Original Contribution
June 20, 2012

Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery

Author Affiliations

Author Affiliations: Departments of Epidemiology (Dr King) and Biostatistics (Ms Chen), Graduate School of Public Health, and Department of Psychiatry, School of Medicine (Dr Kalarchian), University of Pittsburgh, Pittsburgh, Pennsylvania; Neuropsychiatric Research Institute, Fargo, North Dakota (Drs Mitchell, Steffen, and Engel); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Courcoulas); Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina (Dr Pories); and Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (Dr Yanovski).

JAMA. 2012;307(23):2516-2525. doi:10.1001/jama.2012.6147

Context Anecdotal reports suggest bariatric surgery may increase the risk of alcohol use disorder (AUD), but prospective data are lacking.

Objective To determine the prevalence of preoperative and postoperative AUD, and independent predictors of postoperative AUD.

Design, Setting, and Participants A prospective cohort study (Longitudinal Assessment of Bariatric Surgery-2) of adults who underwent bariatric surgery at 10 US hospitals. Of 2458 participants, 1945 (78.8% female; 87.0% white; median age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011.

Main Outcome Measure Past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (indication of alcohol-related harm, alcohol dependence symptoms, or score ≥8).

Results The prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6% vs 7.3%; P = .98), but was significantly higher in the second postoperative year (9.6%; P = .01). The following preoperative variables were independently related to an increased odds of AUD after bariatric surgery: male sex (adjusted odds ratio [AOR], 2.14 [95% CI, 1.51-3.01]; P < .001), younger age (age per 10 years younger with preoperative AUD: AOR, 1.31 [95% CI, 1.03-1.68], P = .03; age per 10 years younger without preoperative AUD: AOR, 1.95 [95% CI, 1.65-2.30], P < .001), smoking (AOR, 2.58 [95% CI, 1.19-5.58]; P = .02), regular alcohol consumption (≥ 2 drinks/week: AOR, 6.37 [95% CI, 4.17-9.72]; P < .001), AUD (eg, at age 45, AOR, 11.14 [95% CI, 7.71-16.10]; P < .001), recreational drug use (AOR, 2.38 [95% CI, 1.37-4.14]; P = .01), lower sense of belonging (12-item Interpersonal Support Evaluation List score per 1 point lower: AOR, 1.09 [95% CI, 1.04-1.15]; P = .01), and undergoing a Roux-en-Y gastric bypass procedure (AOR, 2.07 [95% CI, 1.40-3.08]; P < .001; reference category: laparoscopic adjustable gastric band procedure).

Conclusion In this cohort, the prevalence of AUD was greater in the second postoperative year than the year prior to surgery or in the first postoperative year and was associated with male sex and younger age, numerous preoperative variables (smoking, regular alcohol consumption, AUD, recreational drug use, and lower interpersonal support) and undergoing a Roux-en-Y gastric bypass procedure.