Programs & Services

Weight Loss Surgery and Addiction

Weight Loss Surgery

and Addiction Transfer

Weight loss surgery is a an intervention for the disease of morbid obesity that is growing by leaps and bounds throughout the world. With success rates for improved quality of life, improved or resolved co-morbid conditions, and long-term weight loss that out paces every other obesity treatment, there is no question why this particular strategy is growing.

Every surgical procedure and major lifestyle change is accompanied by its own set of risks that patients, family, friends and supporters should be aware of. The topic of "Addiction Transfer" often comes up as one of those potential risks with Weight Loss Surgery. This page is designed to offer information on the topic of addiction transfer after weight loss surgery.

There is one caveat: There are currently no findings in the medical literature that either confirm or deny the existence of addiction transfer. Data that we do have are anecdotal. However, medical professionals and patients have seen (or experienced) the onset or the transfer of addiction(s) after weight loss surgery; enough so to warrant discussion.

Useful Information and Resources About WLS and Addiction

Power Point Presentation

Click here to see a slide

presentation on addiction transfer

Articles Related to Alcohol Use or Addiction after WLS

After weight-loss surgery, some find new addictions

Tuesday, July 18, 2006 By Jane Spencer, The Wall Street Journal

On the heels of a five-year boom in weight-loss surgeries, researchers are observing an unusual phenomenon: Some patients stop overeating -- but wind up acquiring new compulsive disorders such as alcoholism, gambling addiction or compulsive shopping.

Awareness of the issue is just beginning to surface. Some bariatric-surgery centers say they are starting to counsel patients about the issue. Substance-abuse centers, including the Betty Ford Center in Rancho Mirage, Calif., say they are seeing more bariatric-surgery patients checking in for help with new addictions. And alcoholuse has become a topic of discussion on bariatric-surgery-support sites, such as Weight Loss Surgery Center, wlscenter.com.

"NEW ADDICTIONS" Continued:

Some psychologists describe it as a type of "addiction transfer," an outcome of substance-abuse treatment whereby patients swap one compulsive behavior for another. At the Betty Ford Center, about 25 percent of alcoholics who relapse switch to a new drug, such as opiates.

The behavior has long been explained as a psychological phenomenon as patients seek new strategies for filling an inner void. But as substance-abuse experts learn to decode the brain's addiction pathways, some researchers are coming to believe that swapping behaviors may have a neurological basis. A new wave of research suggests that the biochemical causes of compulsive eating are extremely similar to those underlying other self-destructive addictions, such as alcohol or cocaine addiction. Alcohol use in particular is a concern for bariatric patients because some versions of the surgery can change the way patients metabolize alcohol, making it far more powerful.

Exploring the overlaps between compulsive eating and other addictions is a growing focus at the National Institute on Drug Abuse, which spent $1.4 million on obesity research last year. Researchers at NIDA hope to piggyback on the drug industry's extensive research on obesity in an effort to find new compounds that might treat multiple types of impulse-control disorders at once.

"The potential is extraordinary," says Nora Volkow, NIDA director. "A drug that could condition craving behavior -- whether it's for chocolate or cocaine -- would be a gigantic market." Dozens of clinical trials on addiction treatments are under way at the National Institutes of Health. Topiramate, an epilepsy drug marketed by Ortho-McNeil Neurologics under the name Topamax, is currently being studied for binge eating, alcohol dependence, cocaine addiction and compulsive gambling.

Bupropian, marketed by GlaxoSmithKline as the antidepressant Wellbutrin and the smoking-cessation drug Zyban, is currently being studied as a treatment for gambling, obesity, nicotine dependence and alcoholism. And Rimonabant, made by Sanofi-Aventis is being reviewed by the Food and Drug Administration as a treatment for obesity and associated health problems, but it is also being studied as a treatment for alcoholism.

Estimates on the prevalence of new addictions after weight-loss surgery vary widely. Philip Schauer, director of bariatric surgery at the Cleveland Clinic and current president of the American Society for Bariatric Surgery, estimates that only about 5 percent of bariatric-surgery patients develop a new compulsive behavior after surgery, such as alcoholism, compulsive shopping or smoking. He adds there is no evidence that the new addictions have any direct link to the surgery.

At U.S. Bariatric, a weight-loss surgery center with offices in Orlando and Fort Lauderdale, Fla., therapists estimate that roughly 20 percent of patients acquire new addictive behaviors. Melodie Moorehead, a psychologist who spoke at a session during the American Society for Bariatric Surgery Association annual meeting last month, cited preliminary data suggesting that roughly 30 percent of bariatric-surgery patients struggle with new addictions after surgery. But she says the issue requires further study.

One possible reason for the disparity in estimates is that alcohol problems can surface several years after the surgery, when surgeons are no longer tracking patients as closely. And some patients may not see a link between their drinking and the surgery, or report their problem to a surgeon. Roughly 140,000 bariatric surgeries are performed in this country each year.

Some bariatric doctors dismiss the issue as pure coincidence. "People don't become alcoholics as a side effect of the surgery," says Neil Hutcher, past president of the American Society for Bariatric Surgery. "They become alcoholics for the same reasons anyone becomes an alcoholic. The surgery is not a cure-all for everything transpiring in the patient's life."

For a variety of reasons -- including the fact that alcohol is high in calories -- bariatric-surgery patients are often advised not to drink alcohol for the first six months to a year after surgery. In addition, most bariatric centers screen patients for heavy alcohol use, and exclude patients who exhibit signs of alcohol dependence. "The surgery creates profound changes in people, both physical and mental," says Dr. Schauer. "Even though they're good changes, they could ignite problems in people with active substance-abuse problems."

Gastric bypass surgery, which accounts for 75 percent of all bariatric surgeries in the U.S., involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine. As a result, alcohol passes rapidly into the intestine where it is quickly absorbed into the bloodstream. "You shorten the time to the brain so much that if you liked alcohol before, you'll love it now," says Mark Gold, professor of psychiatry and neuroscience at the University of Florida College of Medicine. (Lap-band procedures, which account for 20 percent of U.S. weight-loss surgeries, don't have the same impact. The procedure involves restricting part of the stomach with a silicon band, but doesn't change the absorption process.)

The issue is a sensitive one for the bariatric-surgery community following a series of major studies raising questions about the long-term health benefits of the procedure. A large study of 60,000 gastric-bypass patients published in the Journal of the American Medical Association last October, found that 40.4 percent of patients who had the surgery were readmitted to a hospital at least once during the three years after surgery, double the 20.2 percent rate of hospitalizations in the three years prior to surgery. Some in the field hope the concerns about substance abuse will add to the growing interest in psychological counseling of patients.

Some research suggests that obesity might offer some protection against other types of addictions, including alcohol. A study of 9,125 adults published earlier this month in the Archives of General Psychiatry found that obese people had a 25 percent decrease in likeliness for substance abuse. And in 2004, researchers at the University of Florida, Gainesville, published an study of 298 women showing that obese women have lower rates of alcohol use than the general population. The researchers theorize that food and alcohol trigger the same reward sites in the brain. Some people may feed their addictive cravings with food; others with alcohol.

Neuroimaging studies suggest that obese people and substance abusers have abnormal levels of dopamine in the brain, contributing to cravings. "They always feel something is lacking, and in order for them to feel OK, they need to use something that boosts the dopamine in brain," says Gene-Jack Wang, chairman of the Medical Department Brookhaven National Laboratory. Bankole Johnson, chairman of the department of psychiatric medicine at the University of Virginia, says gastric-bypass surgery provides a mechanical solution that leaves the underlying neurobiological problem untreated. "It's like a thirst," says Dr. Johnson. If you're thirsty -- and there's no water -- you'll drink lemonade."

Preventing Addiction Transfer after Weight Loss Surgery

Science is currently seeking ways, from behavioral to pharmaceutical inventions, to prevent addiction transfer from occurring after weight loss surgery.

Ensuring patients undergo adequate psychological screening before bariatric surgery is a potentially preventive measure that is getting more attention lately. These screenings can help ensure that people undergoing these procedures have a low level of addictive behavior. Physicians should also emphasize the need for ongoing behavioral counseling to prevent the development of new undesirable behaviors. People need to understand what drove them to overeat initially and learn new skills to deal with underlying issues like loneliness, stress, traumas, and so forth.

In addition to counseling, support groups have proven to be beneficial because they put people into contact with others like themselves who are able to ease some of the isolation and shame they feel regarding their predicament. Participants also feel encouraged by the progress others are making. There are several support groups that deal with food and drinking addictions.

Overeaters Anonymous (O.A.)
Food Addicts Anonymous (F.A.A.) 
Food Addicts in Recovery Anonymous (F.A.) 
Alcoholics Anonymous (A.A.)

Clinical trials examining the effectiveness of various drug therapies are also underway. Topomax, a drug originally developed to treat epilepsy, has shown some promise as a treatment for alcohol abuse and compulsive overeating. The antidepressant Wellbutrin and the smoking cessation drug Zyban have demonstrated potential as treatments for gambling, overeating, and nicotine dependence. Many other drugs specifically designed to treat compulsive behaviors are currently under development and testing.

Weight loss surgery does not cause addictions. Instead, people who are addicted to food may find a new compulsion once they are unable to overeat. The lesson to be learned from addiction transfer is that to lose weight successfully and keep the weight off, you must find a way to treat the cause of your food addiction.

Dieting and surgery will treat the symptom – obesity, but not the issues that caused you to overeat initially.

To improve your odds of success, you need to be honest with your surgeon about your eating habits and other lifestyle issues before and after surgery, and you need to participate in the behavioral programs prescribed. With openness and hard work, you can set yourself free from your old habits and body weight.

Side Bar

“Addiction transfer” is a term coined by psychologists involved in substance abuse treatment. It refers to the tendency for people who relapse after being treated for one form of substance abuse to develop a compulsion for another substance or harmful behavior. For example, a person with a history of alcoholism may give up drinking, but may start using prescription painkillers or gambling excessively.

Posted by admin on Wednesday, September 16, 2009 at 12:07 pm

www.obesityaid.org/surgical-weight-loss/limit-addiction-transfer-after-bariatric-surgery

Life Skills Training Promoting Health and Personal Development

Life Skills Training is a comprehensive, research and outcome based prevention program that emphasizes proven skills training methods. It addresses all of the most important factors leading adolescents to use one or more drugs by teaching a combination of health information, general Life Skills, and drug resistance skills over a three year time period.

Media Literacy Training

"Media Literacy is the ability to "read" television and mass media. Media literacy education teaches people to ACCESS, ANALYZE, EVALUATE, and PRODUCE media. Many studies suggest that such education can produce less vulnerable children and adolescents. National PTA's, Teachers' professional organizations, substance abuse prevention programs and the President have all endorsed media literacy. Children who understand the motivations and production techniques of media are less likely to adopt the destructive attitudes and behaviors that are depicted in the media. Media education represents a new and exciting approach to protecting children and adolescents from the unhealthy effects of the media."

Rite Aid Drug Quiz Show

The Drug Quiz Show strives to heighten school/community substance abuse awareness by providing middle school students with the opportunity to have fun while gaining the knowledge, skills, and self-confidence needed to make safe, healthy, real-life choices, including those regarding the use of tobacco, alcohol, and other drugs. Each school participating in the program is provided with education material and face-to-face meetings with LEAF staff as requested. The “Show” is an exciting competition for teams from each school. The theme is “everyone is a winner.” The community is invited to attend.

CROP After School Program

CROP: Creating Rural Opportunities Partnership, funded by a BOCES grant, is an after-school program in which LEAF is an active partner and participant. It is designed to enhance the lives of youth living in Otsego and Delaware Counties.

Education and Training Events

LEAF’s professional staff presents informative programs and workshops to service clubs, churches, businesses, and school and parent groups.

All LEAF presentations provide accurate, current, culturally relevant and age-appropriate information.

Choices & Consequences

LEAF’s Choices and Consequences Program, or C&C, is an innovative, alcohol awareness program designed for youth ages 12 to 20. The program addresses the dangers of underage drinking for those youth who have violated the underage drinking laws, such as the Alcohol Beverage Control Law, Section 65(c). C&C is court mandated by the Otsego County judges who feel offenders will benefit from alcohol and other drug information, and the class will give them the opportunity to explore and address the consequences of ATOD use and abuse.

Otsego County Drinking Driver Program

The Drinking Driver Program (DDP) is part of New York State's effort to reduce the personal and property losses caused by drivers under the influence of alcohol and/or drugs.