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 House
I am acutely aware of those moments of “unfairness” during recovery. And I know that feeling frustrated and blindsided can derail the best laid sobriety plan.
So, when I visited Sanford House Nurse Practitioner, Brenda Kargel, and she furrowed her brow and said, “I’m seeing a trend in the treatment centers – bariatric surgery and alcohol use disorder,” I perked up and listened. Now, Brenda seems like the kind of no-nonsense person who might tell me, “Life isn’t fair, Marilyn,” if I had said what I wanted to say. But I’ve been thinking about the pitfalls of bariatric surgery ever since…
First, what is Bariatric Surgery?
Bariatrics is the branch of medicine that deals with the study and treatment of obesity. Bariatric surgical procedures are designed to 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 obesity.
The Connection Between Bariatric Surgery and AUDs…
I know from experience, there is a connection between disordered eating 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, the likelihood she/he will also struggle with drugs or alcohol is greatly increased. 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’. Unfortunately, the disordered eating is often overlooked or undiagnosed. 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, Director – Comprehensive Treatment for Eating Disorders, LLC
The NIH Weighs In…
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. And to minimize the risk of negative outcomes, there are psychological assessments conducted before surgery. These assessments are not dissimilar to an addiction treatment assessment. Assessments help to identify strengths, such as family support and motivation to exercise 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
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
The commonality between post-operative bariatric surgery and addiction treatment is predictability and control. Individuals are not best served by concentrating on the avoidance of unwanted behaviors (I’m not going to binge, I’m not going to drink). Instead, they may focus their attention on changing what they are going to do. And adding a positive focus on healthy eating habits and new interests. A person can deal with an urge if they know it’s coming and are able to control their response.
Omar Flores, LMSW, CAADC Sanford House Clinical Director
If you have already undergone bariatric surgery, or if you are considering it now, here are some things to think about:
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; your own drug or alcohol use; the underlying reason for the surgery; and the emotional triggers that may lead or are leading to unhealthy choices or cross addictions.
2. If you use food or alcohol to “self-medicate” or alter your mood, be prepared for the potential problems ahead…
Speak to a professional and learn to control the response. Replace the dopamine rush of a doughnut or 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. 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 at approximately two-years after bariatric surgery. Get regular checkups and seek treatment if drinking becomes unmanageable.
Forewarned is Forearmed…
The road to wellness and recovery is not paved in Carrara marble… In fact, self-improvement is rough. Some might even say the trials and tribulations are “unfair”. But at Sanford Addiction Treatment Centers, we believe education and preparedness is key. (Believe me, if I had known then what I know now, I would not have “treated” my newly sober self with high sugar content foods…).
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 the chance of success. Forewarned is forearmed…