Bariatric surgery and alcohol and substance use: A case-control survey study

Purpose: Studies suggest alcohol and/or other substance misuse may develop after bariatric surgery (BS), but findings are not consistent or conclusive.

Procedures: This cross-sectional online survey investigated alcohol and other substance use, via a modified version of the Alcohol Use Disorders Identification Test, before and after bariatric surgery, compared to a non-bariatric surgery sample. Data were anonymously collected via Qualtrics from adults who reported alcohol or substance use (BS, n = 328; non-BS, n = 292).

Findings: Problematic alcohol, opioid, amphetamine, and cannabis use were reduced post-surgery compared to pre-surgery. After surgery, participants expressed "guilt" associated with alcohol and other substance use (average 0.24 and 0.31 points higher, respectively) compared to pre-surgery. Compared to controls, the bariatric surgery group reported on average 1.99 points less problematic nicotine use pre-surgery (p = .012) and 2.42 points less post-surgery (p = .004). In contrast, compared to people without any history of bariatric surgery, the bariatric surgery group reported greater problematic use of alcohol, cannabis, hallucinogens, and/or inhalants pre-surgery (all p < .001); same results were found post-surgery for all drugs, (all p < .001) except for hallucinogens which was not significantly different between the two groups.

Relevance: Unlike previous reports, these survey-based results do not show an increase in problematic alcohol and substance use following bariatric surgery. Recall biases and the survey-based methodology are however important limitations of the present study. The observed increase in "guilt" associated with substance use may align with growing evidence suggesting increased subjective response to alcohol and other substances following bariatric surgery.