Alcoholism after gastric bypass: Is it in your mind or gut?

Scientists have competing ideas for why gastric bypass patients show higher rates of alcohol abuse post-surgery

Alcoholism after gastric bypass: Is it in your mind or gut?
As researchers scramble to find explanations for alcoholism after gastric bypass surgery, many doctors still don’t know to warn patients about the risk. [Image credit: Flickr User Faisal Akram]

In 2009, Jackie Kim received a gastric bypass that shrunk her stomach and rerouted part of her small intestine. Within a year, she had lost 180 pounds and felt great.

Then her troubles with alcohol set in. It started with ordering wine in place of dessert at dinner. “At first I thought, ‘This is great, I don’t have to sit at the table twiddling my fork while everyone else is eating their crème brûlée,’” recalled Kim, a 44-year-old medical consultant living in St. Louis, Missouri.

But soon the occasional glass of wine turned into much more.

Kim spent the next two years fighting addiction. “Lots of scary stuff happened during those years,” she said. She regularly drank alone at home, two bottles of wine at a time. Before long, she was hiding bottles from her husband, driving while drunk, blacking out and discovering injuries she didn’t remember getting.

Her story is not uncommon. In 2012, a large study published in the Journal of the American Medical Association reported that the percentage of patients abusing alcohol increased from 7.6 percent before surgery to 9.6 percent two years after surgery — that’s potentially an additional 2,000 alcoholics each year in the United States. Since then, a growing body of evidence has corroborated these findings. The longest-running study suggests the effect persists even a decade after surgery.

Still, many patients today are unaware of the risk of alcoholism when they get a gastric bypass, and scientists themselves are not completely sure why the risk exists. One early theory was addiction transfer, which suggested that people might adopt new addictions after weight-loss surgery because they can no longer fulfill their food addictions. But more recent evidence suggests there may be an anatomical explanation: specific metabolic and hormonal changes triggered by gastric bypass that leave patients especially vulnerable to alcoholism but not other addictions. It’s also possible that both explanations are right — or neither.

“Whether it’s addiction transfer or something else going on, we really don’t know at this point,” said James Mitchell, a doctor and professor of neuroscience at the University of North Dakota. What’s certain, he said, is that the high rates of alcoholism in patients who have had a gastric bypass operation cannot be attributed to chance.

Doctors have long touted gastric bypass surgery as the gold standard for weight-loss operations. Of the 200,000 bariatric procedures performed in the United States each year, roughly 80 percent are gastric bypass surgeries. Research shows the surgery not only causes weight loss — 90 percent of gastric bypass patients keep off 50 percent of their extra weight even a decade after surgery — but also resolves related illnesses such as type 2 diabetes, heart disease and cancer, leading to a 40 percent overall reduction in mortality for gastric bypass patients.

But alcoholism could be a dark consequence of the surgery for some patients — even if no one is sure why.

The explanation of addiction transfer assumes that people who overeat are often predisposed to addiction. Researchers have reported addiction transfer in many forms — a recovering alcoholic might start chain-smoking, for instance. But the general idea is often contested, partly because it can be difficult to pinpoint the roots of addiction: some argue it is physiological, while others insist it is driven by psychology.

One physiological explanation for addiction, first described by a neuroscientist at the University of Florida named Kenneth Blum, is a blunted response to dopamine, a chemical that gets released in our brains when we perform high-reward activities such as eating, having sex, doing drugs and listening to music. Dopamine not only helps us register pleasure from these activities, it also motivates us to repeat them over and over again in search of more pleasure.

In 1990, Blum found a correlation between alcoholism and a genetic deficiency in dopamine-binding receptors in the brain, called D2 receptors. People with compromised D2 receptors seek higher thrills to satisfy their reward cravings than people with normal D2 receptors, Blum believes. He predicts that gastric bypass patients with a D2 deficiency turn to other high-reward activities, such as drinking alcohol, because they can’t binge eat with a constricted stomach.

Still, most scientists attribute addiction to a combination of genetic and environmental factors. Blaming addiction on a single gene is too simplistic, said Lance Dodes, a psychiatrist based in Boston who has written three books on the topic, including one called Breaking Addiction. Dodes believes addiction has a psychological basis. He argues that consuming a substance or behaving compulsively provides an outlet for people who feel otherwise unable to take direct action in their lives. Many of his alcoholic patients, he said, start feeling better the moment they decide to take a drink — not when the alcohol actually enters their bodies.

Addictions can be interchangeable because they are a psychological response to feeling trapped, said Dodes. “We call them separate addictions, but they’re really just one mechanism.”

But one major problem with Blum’s and Dodes’s ideas is that there’s little evidence of higher alcoholism rates after a different common bariatric surgery: gastric banding. Also known as lap banding, this surgery installs an inflatable belt around the stomach to constrict it. Unlike gastric bypass, banding does not permanently alter the stomach’s architecture.

The difference between the two surgeries suggests that alcohol abuse is related to structural changes from gastric bypass, said Alexis Conason, a New York City psychologist and researcher.

In 2012, Conason published a study in JAMA Surgery that found a significant increase in alcohol use for patients after gastric bypass, but not gastric banding. The study also found no significant increase in patients’ use of other drugs, including cigarettes, or compulsive behaviors such as gambling. “If it were addiction transfer, we’d be seeing it across the board,” Conason said.

Researchers have proposed a few physiological explanations for increased alcoholism specifically after gastric bypass. Some believe it’s due to changes in alcohol metabolism, since alcohol enters the bloodstream more quickly in a smaller stomach. A 2011 study from surgeons at Stanford University found that six months after surgery, gastric bypass patients reached higher blood alcohol levels more quickly than they did before surgery. This type of fast and high peak often characterizes addictive drugs, said North Dakota’s Mitchell. Cocaine and heroin, for example, both produce brief, intense rushes that leave users wanting more.

But it’s also possible that increased alcohol dependence has nothing to do with alcohol absorption in the stomach. Recently, a team of researchers led by neuroscientists at the Pennsylvania State University College of Medicine found that rats that had been given gastric bypasses developed a higher dependence on alcohol. Here’s the twist: the effect held even when the rats were given alcohol intravenously instead of orally. The authors concluded that alcohol abuse after gastric bypass could very well occur independently of how quickly alcohol passes from the gut to the bloodstream.

Instead, anatomical changes to the stomach might impact patients’ dopamine response, the Penn State researchers suggested. Some scientists have found that gastric bypass surgery can alter the signaling of D2 receptors. The mechanism for this is unclear, although preliminary research has identified altered patterns of gene expression in areas of the brain that process dopamine. Other researchers suggest that appetite-mediating gut hormones play a role, particularly those that affect dopamine signaling, such as insulin, leptin and grehlin. Scientists have shown that leptin and grehlin levels change after gastric bypass surgery, and both hormones are known to modulate alcohol consumption.

It’s also possible the explanation is not so clear-cut. Conason admits that researchers can’t completely write off addiction transfer, and there might be other reasons why alcoholism is more prevalent than other addictions. For instance, gastric bypass patients may simply be more likely to drink alcohol than take other drugs, which are less socially acceptable.

The risk of alcohol abuse is serious, Mitchell said, but it is one of many considerations for gastric bypass candidates. Particularly for people facing life-threatening conditions such as diabetes or heart disease, the possibility of alcohol abuse might not be strong enough for patients to actually forgo the surgery.

Even so, Mitchell and most of his colleagues agree that doctors need to strongly communicate the risk of alcohol abuse to patients before surgery. In many cases, including Jackie Kim’s, doctors don’t highlight the risk at all.

After years of counseling and seeing her addiction wreak havoc on her relationships and physical health, Kim reached a breaking point. She hasn’t touched a drink in more than two years. “But it wasn’t easy,” Kim said of her hard-fought recovery. She knows that others also might not have been coached on the risks, so she mentors patients who have had the surgery and posts in bariatric support groups online.

Kim believes that being aware of the problem would have made all the difference for her. “I experienced a lot of anger with my surgeons afterwards for not doing a better job educating me,” she said. “If they had told me not to drink, I wouldn’t have started in the first place — and it wouldn’t have spiraled into what it became.”

 

*Correction, Jan. 10, 2015: 

A previous version of this story identified Kenneth Blum by the incorrect profession. He is a neuroscientist.

Posted in: Life Science

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  1. I need help

    Bernie, April 18, 2016 at 4:48 am
  2. Glad I found this! Thank you so much for explaining. It is very informative and well written.

    Hillary, April 18, 2016 at 4:05 pm
  3. Wonderful piece!

    Kathy Abromeit, April 19, 2016 at 10:08 pm
  4. Yes! Finally someone writes about rehabilitation centers.

    rehab programs, April 30, 2016 at 3:21 am
  5. This is ruining my life and my health. And my weight loss! I don’t feel like a regular addiction counselor or group would understand this. Where do we go for help with this? From the article, it seems like they still have no idea what causes it.

    Debbie, May 7, 2016 at 6:38 am
  6. Very informative! Thank you!

    Warren, May 7, 2016 at 3:08 pm
  7. Thank you. I knew something was wrong, but did not make the connection.

    Arlene, May 16, 2016 at 8:42 am
  8. I had gastric bypass that led to alcoholism. I have found that there is a solution in AA, giving me serenity and a new life better than I first found in initial weight loss. I would be happy to share my experience, strength and hope to anyone it might help.

    Christine, May 27, 2016 at 8:54 am
  9. Christine.. would love to hear your story.. have a friend struggling

    Rae, August 2, 2016 at 2:59 pm
  10. That fourth paragraph could have been written about my wife. She just got out of rehab and so far seems to be doing great. I already feel that we have our relationship back.

    Debbie, please don’t let the uniqueness of your situation dissuade you from seeking the help you deserve. In the end, it didn’t matter if people understood the role of the surgery. They did understand how to help my wife get better.

    JJ, August 15, 2016 at 10:03 am
  11. This article was sent to me today.since my gastric bypass
    Approximately 15years ago I have become dependent
    On alcohol and really need to get help for this addiction

    I wish I never decided to have the bypass I would never
    Recommend this to anyone

    Jessica Powers, November 14, 2016 at 2:44 pm
  12. Wow, this is exactly my life in a nutshell. It’s been a horrible journey for the past handful of years. Been in rehab, still struggling but won’t give up. Still researching.

    ErnieB, November 16, 2016 at 11:23 am
  13. I had gastric bypass and am a alcoholic now

    Robin, November 26, 2016 at 11:16 pm
  14. Very happy i found this, i have been thru the exact same thing on and off for years and am now clean and getting healthy again, i gained lbs back and felt like crap and drank to much beer, now alcohol and gluten free im back down 50lbs with 50 to go and feel great thanks for shainc

    Sean, December 2, 2016 at 11:45 pm
  15. Always drank, but not like this. Three years out after surgery. Definitively alcoholic.

    Always gambled, but not like this. Three years out after surgery, have put my family in jeopardy, filing for bankruptcy and that’s after selling my company and coming into more money then I ever had.

    It’s not fair that there wasn’t a substantial warning regarding “transfer addiction”. I bet because it sounds esoteric and no one will believe you and the doctors don’t fear any liability because of that fact.

    Drew, December 4, 2016 at 9:20 am
  16. I have a daughter that had gastric bypass, she is ruining her and her families life with drinking. We have put her in rehabilitation, AA meetings, she still drinks. I don’t know what else to do.

    Elizabeth, December 9, 2016 at 10:05 am
  17. I had a gastric bypass in 2005 and found myself a full-blown alcoholic soon after. I was 65 at the time. I finally got help after a DUI conviction through Celebrate Recovery. CR is a Christ-centered program for anyone struggling with a hurt,habit or hang-up.

    Jan Thomas, December 18, 2016 at 4:28 pm
  18. I had gastric bypass many years ago and new I was having a problem with drinking now. I guit for 5 years and began drinking during a divorce. I ruined my life with alcohol and am committed to not drinking again.

    P, December 20, 2016 at 7:02 pm
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  20. Extremely interesting…so recognisable…but now how to deal with the alcohol addiction ???

    Mg, December 29, 2016 at 8:33 pm
  21. I am 10 years post bypass and I too am struggling with this. I never was a drinker before my surgery. A visit to CA 6 years ago to visit my sister and a trip to a vineyard introduced me to my never ending addiction to wine. Is there a support group out there for this? Thank you. Wonderful article.

    Donna, January 9, 2017 at 10:50 pm
  22. It will be six years next month since my bypass. I was a bit of a drinker prior to the surgery, but since I could no longer eat, drinking became a major problem. I had 2 dui’s in less than a year and my life has turned upside down. I was in an op program, been on house arrest, and I am now on probation. Also attended AA meetings. I want to find a counselor who can specifically deal with this transfer addition issue. Having an extremely difficult time. My family does not understand.

    Tammy, January 9, 2017 at 11:00 pm
  23. My sister is killing herself with alcohol. Fifteen years post bypass and she drinks 5 liters of vodka in a week. I’m scared she will die soon.

    Joyce, January 17, 2017 at 7:39 am
  24. I have had two sisters have this surgery nearly 15 years ago. Since then, both have become full blown alcoholics. My youngest left her husband, lost her job and home, and hit the streets. Going through several rehabs and jail stays did not help her, and she died in 2013, from a heart attack due to too much drinking. She would drink vodka until she would pass out, wanting to “forget” about things, she would say…whatever she was trying to forget, we never knew. My other sister is not as hard core, but she lost three jobs, went to jail once, and was in rehab three times, only to begin drinking after each stay. Her husband is threatening divorce, and her daughter will not let her see her grand daughter while she has this problem…it does not seem to phase her. I also had a sister in law, who went through the same thing as my deceased sister, and also died nearly 6 years ago. There seems to be an obvious problem with the stomach bypass surgery, and wonder if there have been any class action lawsuits pertaining to the results? Either patients are not being told of these findings, or there are not enough testimonies to date to create an investigation?

    Tom, January 19, 2017 at 11:21 am
  25. It has been 17 years since my gastric bypass. I am a functioning alcoholic according to what I hear my mother says. This article explains a lot. It defines me to a tee. I am at the point to where if I don’t quit my long term relationship will come to an end. I have used up two major strikes and if I strike out again I will lose the love of my life. I am trying to be strong and quit on my own but I don’t know if I am strong enough to succeed. I too drink alone, can drink two bottle of wine with no one around, black out, and have injuries that I discover the next day and have no memory of how they happened. This article explains what I did not know. I always felt it was just my lack of will power. I have shown my long term partner this article and hopefully with his love and support and some new found will power I can attempt to quit drinking before I lose everything.

    Vickie Turpin, January 19, 2017 at 12:30 pm
  26. It has been 6 years since my gastric bypass. Since I’ve had the surgery drinking has become a major issue for me, I am in the process of making an appointment with my doctor to get help to quit. Before my surgery I would drink once in awhile I’ve known many people that have had problems with alcohol so I’ve always been very aware. Over the last year my drinking has gotten bad I am hiding it and blacking out, I wake up with bruises wondering what I did. This article made me realize I’m not alone it helps I was starting to feeling really low.

    Tanya, January 26, 2017 at 2:02 pm
  27. I am 4 years post-op gastric bypass and feel great in many ways except my drinking tendency. There are many reasons why someone becomes morbidly obese and unless you address them then you will continue those addictive traits. I am unhappy in my marriage and we both turned to drinking every night, which hasn’t helped anyone! I went to a bariatrics symposium and the surgeon verbalized a disservice to the patients with follow-up care. This may need further addressing and be what he knew many battle with following such a life changing surgery. Good luck and find you fix to this destructive behavior as I hope I will soon because now I am experiencing reactive hypoglycemia! Now that’s an adventure!

    Jennifer, January 28, 2017 at 7:56 pm
  28. I am a great mom, but 5 years post gastric bypass, I definately have a drinking problem. I don’t know where to tun. I am wanting alcohol all the time and am hiding it from my family now which tells me I have a drinking problem . I never had an addiction, even to food, I had other ailments which caused the extreme weight gain. Honestly I really did not overeat..What the heck?

    Dawn, February 2, 2017 at 8:10 pm
  29. I was definitely drinking a lot more about 2 years post op. I’m about 5 now. About a year ago i lost my spouse to an affair she had. I left her and quit drinking. My new found single self decided to out more and dabble in college behaviors. And so now I am starting to swallow cocaine as it is extremely effective. So I should probably stop.

    Scott, February 21, 2017 at 1:02 am
  30. Im 4 years p/o and i have been battling
    This alcoholism issue for a few years as well, just asked my spouse…i wonder why this happened all of a sudden….at this age (37). Wow i wish i would have known.

    Kay, February 27, 2017 at 3:27 pm
  31. I’m almost 8 yrs post op roux en y bariatric surgery . Whilst I always drank moderately and daily my alcoholism really took off almost 5 yrs ago . I thought because of financial ,marital and mental health issues. After severe depression, 3 overdoses , hospitalisation in a safe place for 2 weeks and 2 supervised detoxes , I sometimes question if my surgery could have been contributory? I have been sober for almost 5 years now and attend on a yearly basis the research clinic of the hospital where my bariatric surgery was done . It appears to be well documented on the internet that there are links between the gastric bypass and alcoholism . I would always be happy to chat and share my experiences concerning the above . Best wishes to all going through the same . Peter

    Peter, February 27, 2017 at 4:19 pm
  32. I am 10 years out of a bypass. I drank moderatley prior but did not have a problem. I did not crave it, obsess over it, black out, no DUI’s etc. Within a year of the bypass I had all of the above. Fast forward 10 years and I have 2 DUI’s, countless job losses, too many rehabs and Out Patient programs to count, loss of my family and the list goes on. I am now 48 yrs old, well educated and a raging alcoholic. I am finally at a point where my use is slowing down thanks to Naltrexzone….slowly rebuilding my life thru prayer, AA, meditation, exercise and so on. I have been around AA for the past 5 years and while it educated me, helped me to dig deep and even become a better person I always had it in the back of my mind that my case was different. I wasn’t drinking to block stuff out, I wasn’t drinking to handle depression or anything else….and unlike many on here that drink liters of vodka – I was blacked out after 1.5 bottles of wine…I started to make the connection between my bypass and my alcholism about 5 years ago after meeting a fair amount of people in rehab and recovery going thru the same thing. AA people kept telling me that i wouldn’t get well if i did not dig deep and overcome all my emotions etc…but i kept feeling like that wasn’t why I was an alcoholic…so I started researching and now believe with all my heart that my alcoholism is due to my bypass (physiology) and not (psychology). It has allowed me to stop feeling bad about myself, stop feeling quilty for not being totally abstinent and get on with living. AA does help, my sober friends help, naltrexzone helps…and I am finally feeling better. I do still get urges to drink – but rather than it being every day – I am down to about once a week and working towards stopping completely. Sorry to be so long winded. Truly wish this information had been around 10 years ago….would have saved me a decade of heart ache. If you are struggling – talk with you doctor, go to an AA meeting, maybe even rehab…don’t suffer alone…there are a lot of us out there!

    Laura, February 28, 2017 at 6:45 pm
  33. Ditto on everything. Is there a Facebook group for this

    Cassie jones cullen, March 2, 2017 at 2:10 pm
  34. Does this effect gastric sleeve patients as well?

    Jana, March 14, 2017 at 8:51 am
  35. I’m ten years out from gastric bypass, 46 years old with no prior history of alcohol use, I drank rearely prior to surgery and had no interest in drinking. Due to a new social circle I was introduced to wine frequently and without warning three years later I’m a full blown alcoholic and until now I had no explanation for how this could happen to me & why something that had no control over me now has incredible control. Very sad! Fighting a battle I don’t know how to win!

    Marie, March 14, 2017 at 10:22 pm
  36. I had a gastric sleeve 9 years ago and gradually I began drinking every evening with my meal. Now I know I have a drinking problem and am trying to do something about it.
    I think eventually doctors will find that the alcohol is replacing the lack of hormones produced in the stomach. I remember the strange feeling when eating after the surgery, all the pleasure eating brought had gone. That is what drinking seems to fill in for. Anyway that’s my theory, so good to read this article

    Carol, March 20, 2017 at 2:27 am
  37. I had the roux-en-y surgery, but my surgeon told me before hand, that after the surgery, it was not advised to ever drink alcohol again…. as I was not a drinker before the surgery, I felt it was no big deal….after reading soo many of the comments about developing alcohol addictions, and such, I wonder, if some surgeons are not being clear to their patients before the procedure….

    Dee, April 8, 2017 at 10:52 pm
  38. I just lost my beloved daughter at age 48 from alcoholism. She had the bypass surgery in 1997. She drank occasionally, but was not addicted before that. She said that nothing was said about the danger before or after her op, but who knows? She married a wonderful man, had a son, then chose to leave rather than fight her addiction. She was a very high functioning alcoholic and held a very well-paying job. She was hospitalized and treated/detoxed many times over the last few years, but couldn’t last long. After she fell backwards over a coffee table in November, she had a huge bruise and hematoma on the left side of her back. Since she was on blood thinners for clots that kept forming in her colon, the bleeding probably was pretty deep. I think the job of cleaning up was just too much for her already compromised liver and she was diagnosed with complete liver failure. She was in hospice for about 4 weeks before she passed. It has been devastating for us, her family, and the son she loved so much but couldn’t take care of. I am attending grief support groups and al-anon to help me through this, but it will always be a part of me. Are there any investigative efforts to help those who have become victims of this combination of bariatric by-pass and alcohol? I would gladly offer my input.

    Mary Smith, April 13, 2017 at 12:36 pm
  39. I had the surgery 7 1/2 years ago. I was not an alcoholic before my surgery. 6 months after my surgery I drank wine one night (6 months after that I was drinking 3 bottles of wine a night) I knew then I had become an alcoholic. I went to A.A. that lasted about 7 days then drank again. Over the last 7 years I’ve been in 5 rehabs, 5150 3 times, lost a job I feel completely defeated. My doctor never warned me. Turning to God I recently got together 6 months of sobriety only to blow it just last week. This surgery has taken my dignity, my sanity, my will to live, along with hurting my family and friends. I will keep trying to quit. In hindsight I would not have the surgery. Thanks to all who shared I knew I wasn’t the only one. I believe there numbers are way off. Just look at the posts I’ve heard its like 40% of patients become alcoholic.

    Deanna, April 13, 2017 at 12:39 pm
  40. My husband had a bypass 3 years ago and is now addicted to alcohol. He has his drinking sprees where he is completely non existent to the rest of the world. Last 2 weeks he has been on his sofa drinking one after the other throughout that. Don’t know how to help him.

    Kitts, April 29, 2017 at 12:48 pm
  41. I found out about this link today since when I have been researching. I had my gastric bypass 5 years ago and have definitely noticed desires to drink more alcohol. This is scary but intriguing. I wish someone had warned me.

    Maggi, April 30, 2017 at 3:41 pm
  42. My MD told me in 2004 that I could not drink alcohol post surgery. I said,”Not a problem;I could count on 1 hand the number of drinks I have in a year. I am now 66 and searching for a CD provider who takes medicare.

    Kathleen P. Colley, May 3, 2017 at 12:47 am
  43. My MD told me in 2004 that I could not drink alcohol post surgery. I said,”Not a problem;I could count on 1 hand the number of drinks I have in a year. I am now 66 and searching for a CD provider who takes medicare.

    Kathleen, May 3, 2017 at 12:48 am
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