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
Steph Yin • January 9, 2015
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.
I am a LCDC in Texas and at one point I did Utilization Review for two years and started to notice a trend. Many people were seeking treatment that had gastric bypass surgery or bariatric surgery. They and there families were adamant about them having no problems with alcohol prior to the surgery.
My personal view relates the problem to the stomach and metabolism. I do not believe it is addiction transfer or it would happen with other drugs as well. But just like the article stated, it is really happening consistently with alcohol, not other drugs. The testimonies after the article say it all, this is a huge problem. I once heard a doctor give a lecture on how alcohol breaks down in the stomach and the theory that in natural born alcoholics they are missing some of the chemical processes that occur in the stomach consistent with what Dr. Silkworth called the “Craving”. People who drink their way into alcoholism damage their stomachs so that it does not process alcohol like a normal person and now we have a bypass issues that would mean the stomach is not going to be able to process alcohol like a normal stomach.
It is just my theory. Not really grounded in research…. yet. But I recently went back to school and looking for my dissertation topic in case I really do make it all the way and this one keeps coming up for me.
I am in recovery myself and it’s like I told a Pt. of mine once. It does not really matter how you arrived at this point, there are many paths to alcoholism as it is already a complicated disease, but you’re here and you can’t drink and expect to live at this rate. There is a solution if you want to stop drinking, and support, it’s in the 12-steps. The steps are not a program, they are a way of life, and you can’t go to a way of life, you have to live it. People seem to get that confused as well.
I hope one day I can help on this topic with more than speculation. But I do wish everyone struggling with this new found problem since the surgery, that they find a safe harbor in the rooms of AA.
I had gastric bypass December 2014. By April 2015 (a little over 4 months post op) I started drinking red wine. I liked the feeling but wine would no longer satisfy my cravings by the summer of 2015. During the summer I started out drinking Cosmopolitans, a lady’s drink and just about pure alcohol. By the end of summer I was consuming 1-2 pints of Jack Daniels per day. I have blacked out, been arrested, been committed in the psych ward by my children, said some of the most hurtful things to the people who loved me the most that I’m surprised they’ll still even talk to me. I got help several times but it’s always short-lived. The longest I’ve made it this past year without a drink is 30 days. As soon as I got my 30 day AA coin I had to celebrate with shots of Fireball which turned back into Bourbon bingeing. In the past 2 days I drank a gallon of Jack Daniels. I feel like crap, have constant pain in my stomach, both lower and upper, and my doctor said I am in early Stage 2 liver disease. How in the heck did it happen that fast? She said right now my liver can still heal so why do I feel compelled to push it to the very brink so that I can keep drinking. I feel sick without any alcohol in my system. It’s funny, I had this surgery to be healthy & look good and I’m probably the most unhealthy I’ve ever been. But, hey, at least I look good, right?!?!
My daughter is experiencing a way of life much like yours Tammy. Faith has been keeping our heads above water; it’s a non ending. I can’t just ignore and let her die. Please, there has to be a way to turn this monster around. Advise of any solution that we might try. Time is getting short for many of families.
Sharon Jan 23rd, 2018
Wow, I feel a little relieved to know that I am not the only one. I’ve been struggling with this for several years. I drank before the surgery but it was pretty moderate, post surgery it has been just like what the article says. I also feel more depressed which indicates to me that I am low in Dopamine, strangely enough as well I got diagnosed with ADHD post surgery. I think the surgery changes our chemistry more than we will ever know. I wish this research had been available around the time I had surgery, I think I would have felt more prepared. I have a friend who had the same exact experience and I am starting to hear more and more that others are struggling with alcohol. I feel like this information may help me to go through recovery.
My son underwent gastric bypass surgery 4 years ago since then his alcohol abuse has become worse each year..Well today we couldn’t find him and found out he was in jail overnight for public drunkness…This young man is a very book smart person who holds a master, a doctorate and now is doing his phd…Yet does not want to face that he is an alcoholic…Any advice to try and help before he not only ruins his career but his life..
2.5 years out of surgery, alcohol dependent 1.5 years, AA 24 days, alcohol free 24 days. did not drink 25 years prior to surgery. Only ever told not to drink as it took up space in an already smaller stomach with no nutritional value. Never warned or advised of Alcohol dependency. Would have it changed my mind ? Probably not. But if I were better educated about the risks of dependency I might have not taken the first drink.
Please take this very seriously. My 43 year old daughter had bariatric surgery in 2013. She did not have a drinking problem before that. She started drinking wine and could not stop. She was in and out of rehab, emergency rooms, hospice and Mayo Clinic. They turned her down for a liver transplant. I lost my beautiful daughter February 25th, 2019. She was 46 when she passed. The pain is unbearable.
My sister had bariatric surgery to lose weight and feel better. She was about #350 and short. She is also a physician. She liked to drink socially before the surgery. After the surgery, she drank constantly. She also has a problem of not remembering what she says or does while drunk. As a physician, she knew the risk of drinking after Bypass. Now ten years down the road, she is down to 90# and unable to eat anything because of the pain in her stomach. She drinks to forget, pain reliever, and is dying a very slow and painful death. She was fired from her job 2 years ago and has nothing to do all day but drink. She is single and has no children and family are many thousands of miles away. She was a very wealthy woman a few years back, no broke and broken.
Has anyone heard of The Sinclair Method (TSM)and the use of Naltrexone? Its very worth reading up on and has brought many people the support they need. Ive started in April of this year and consumption is half, which for me, is a great improvement.
I feel like this is my story exactly. Before surgery, I occasionally drank but never thought about it. Within 2 years I was an alcoholic ruining my life and relationships even lost my job. After 4 years of drinking thankfully I got myself to AA meetings and have been in recovery for almost 5 years. I feel very lucky to be alive.. addiction to alcohol was way worse than my addiction to food and would have surely killed me much faster if I had not stopped.
I had a gastric bypass in 2003 and I didn’t drink alcohol but after the surgery I’d say 6 months in I had a craving for it. I started drinking Bloody Mary’s a couple days a week, then everyday. Within 2 years I would buy a half a gallon of Vodka and sneak and drink it day and night. Then I was drinking 2 of them a week. Well I started drinking any kind of alcohol I could find. I lost my job. A very good one at that. I lost a couple more jobs too. I stayed drunk all the time. I would hide it in places I knew no one would look. And when we went somewhere I would put it in Mt.Dew bottles. So I would always have it on me. I had many trips to the hospital from alcohol poisoning. I almost died a couple of times. I struggle everyday. I fight the wanting a drink everyday. If I do have 1 drink I don’t stop till I fall out. Then I can go for months with out it but let me get 1 drink and I have to fight to leave it alone. To this day I still fight it.
I had a bypass 4th July 218 first year I was fine, last year and a half my drinking has been out of control. I am just starting to get to grips with it now. It is not easy
Are there any books out there to help with this topic. Reading helps me with my recovery and I can not seem to find any books.
As a post bypass alcoholic I understand it. I have heard of people taking alcohol via enema for instant results. After bypass alcohol kinda does a similar thing just by drinking and it bypassing the stomach. No disgraceful alcohol enema but similar results. Would love help if anyone wants to reach out.
I had gastric bypass surgery in 1993 and never touched alcohol before the surgery. I didn’t like the taste or the feeling. By 1995 I became a full fledged alcoholic. I’ve had DUI’s and been to rehab 4 times. I have managed to be ok for the past 12 years, keeping my job but when I drink I hurt myself, I’ve had multiple injuries, I black out, I soil myself. I don’t enjoy drinking socially, I drink alone. I ‘ve ruined relationships, I lost my daughter to suicide because I became such an awful mom, my other daughter is disgusted with me, even though I only binge about every other month, it’s always severe, where I fall and hurt myself. I no longer drink and drive, haven’t in over 10 years. I try my haradest to practice harm reduction.
Can I get my gastric bypass reversed to stop this insantity?
My husband is struggling with alcoholism after having this bariactic surgery. As all of you are. I am trying to be supportive to him but im struggling myself trying to deal with all his lies and hiding his drinking. Ive been watching him struggle with this for 8 years now and we dont know what to do. I am scared for him and ive been trying to research solutions to help him. He went to aa meetings, 12 steps, counseling, and it is driving me crazy. Does anyone have suggestions that might help him???
Glad to have found the comments and info, I know the gastric bypass caused my severe alcoholism , I had the surgery in 2017 and by 2018 I became a terrible alcoholic , blackouts, lost everything I’m 52, lost my 20 year marriage, 2 of my kids, my little dog and my house my husband took those, my family and friends, my social standing, I have no self worth, in 2019 I got two DUIs, my husband had me arrested at our home twice, I’m still on probation, my husband said I repulsed him because of my weight that’s why I had the surgery if I had not done it yes I would have been very fat but I would not be in this Hell, I’ve tried everything to quit, I think I would like to try one more time with a new psychiatrist about an anxiety medication , but they all had affected me badly I heard a couple people in AA had good luck with Wellbutrin , I thought about that but hesitate to try since I had bad effects from other meds in that class, I’m just always white knuckling it to force myself not to drink then the stress of everything I just break down and drink it’s been hard because no one I knew Used a loving approach to me or to help they just all said terrible hurtful things wrote me off my sister said I can just live on the streets I still get cut down and that approach only makes someone go drink
After reading these comments in June of 2020, I had stopped drinking. The pain I read of gb people and their families, I couldn’t bare to drink anymore. I have to thank God that I’m still alive. I had my gb 19 years ago and have drank almost daily since. I have been sober over 100 days now and am committed to staying that way. I read the Big Book weekly, am a regular on Taking Sober, have the wonderful support of friends and family, and have replaced my drinking behaviors with other wonderful life-filled happy moments like baking, watching movies, Zooming in meetings, etc. Being a non-drinker before gbs, I didn’t think I was an alcoholic. And then when it hit me in the face, I got even angrier because IT WASN’T MY FAULT. But it doesn’t matter now. I wrote a bio on TS and read it often. I read the pain in the posts in here often. I am determined to make a difference in anyway that I can. If you’re suffering from over consumption of alcohol and are post gbs, you can stop. It takes inner power and support. Accountability and knowledge are imperative. Stop being in denial because I know that it’s not your fault. But take the power back and make it about being the best person you can be, sober. ❤️ Hugs to all that are struggling.
I had open RNY 20 yrs ago and I now only have 2 feet of small intestine. Part of my Jejunum in my stomach was removed and after about 5 years and giving birth to my youngest child, I had MAJOR sleep deprivation. I went to my Dr and they prescribed me meds to take for sleep and since I only have 2 ft of small intestine the meds did not dissolve in my system so sleep meds did not work for me. I turned to alcohol and later just started drinking beer and slept well. The jejunum part of the stomach is what breaks down vitamins in the food you eat, vitamin D, B, E, etc. I have stated this numerous times in the past about my findings, and the reason for my specific reason for drinking was for sleep alone! No partying, etc. This is not something that was told to me in all my nutritional classes I had to take, not told to me by the psychologist I met with before my surgery and DEF not by my DR that did my surgery. Honestly I do not think any of them knew the consequences of this surgery when removing part of the Jejunum to decrease the stomach and still it is not being brought up in todays forums. WHY arent any of these drs looking into the removal of the Jejunum part of the stomach when having gastric bypass? Look it up people!
It’s not addiction transfer and I’m the proof. In 2007 I got the lap band and in 2017 I got the gasket bypass. So I quit eating a lot in 2007 but I didn’t start drinking alcohol until 2018. Six months after gastric bypass an 11 years after the lap band.
I had gastric bypass in 2006 and within a few months I was drinking and blacking out. I attended some group meetings with a psychologist and she finely told me that I should start going to AA meetings. I did and stayed sober for a little over 2 years and then went back to drinking, off and on. Before the bypass I didn’t drink, didn’t like how it made me feel. Now, if I decide to go to the store to get some vodka, I start getting a tingling in my body. I want to stop for good which is why I started looking for a site like this one. I believe that doctors who perform this surgery should STRESS the possible problems that can occur with alcohol, even just ONE drink after surgery.
I lost a very good friend two years ago to liver failure/kidney failure/cardiac arrest–her whole body just shut down. She was only 41 yrs. old. She had had gastric bypass in 2010. She drank before the surgery but it very much increased after. She withdrew from her family and friends and just drank herself to death. I wish the doctors had kept better track of her or intervened or she had reached out for help. She was a beautiful person before the surgery and I wish she had never had it. I feel she would still be here with us.
There is a group of us Alcoholics After Gastric Bypass, AAGB, on FB that share and meet online. Please find us if you are needing help or know someone who does. This is a growing group as others are starting to find us.
I too became a raging alcoholic after bariatric surgery. I spent so much money for treatment.
Does anyone want to do a class action?
My sister had roux-en-y bariatric surgery in August of 2020, and died of liver failure related to alcohol abuse in July 2021, at 41 years old. She was working towards her doctorate in education, which she was posthumously awarded. She touched so many people’s lives. She was an amazing, kind, dedicated woman. And she bled to death at home, slowly and painfully. She didn’t deserve that end. Please, please, do not get this surgery if you are considering it. If you are struggling with alcohol use, please tell your doctor and seek treatment as soon as possible! It cost my sister everything. I just want her back. I’d give anything to have her back.
I was sleeved 07/06/2020 loved how I felt after. Starting dinking about 6 months ago and cannot stop! I black out to the point I remember NOTHING! My husband says I turn into a total jerk to him and that hurts so bad. I HAVE TO STOP!! I reached out to my Dr and told her and she really didnt seemed to be alarmed!
So relieved to have found a site to share and the FB group. I had gastric bypass in 2005 and slowly began realizing I usually don’t stop once I start drinking. I can drink and stop but once I get relaxed and around friends, it begins tasting like water. It’s created a lot of problems with family and like another writer above, I’m not met with support or compassion but with ugliness which makes me want to drink more. I don’t usually drink along but have been known to. Yes black outs and falling and hurting my head, etc which is very scary.
Will be joining the fb site, trying naltrexone and personal counseling. It’s not worth losing my family but I also don’t want to get bullied and give up drinking. Yup, sounds like the typical statement. We’ll see what the future holds.
I’m 16 years out. I’ve been drinking on a daily basis! Nobody understands! I’ve gained 80lbs of my 130lbs weight loss. I hate myself and get depressed and don’t want to interact with friends or the public because I feel self conscious about my weight and appearance. I know if I use my tool it will work bit something always draws me to the alcohol!
Thank you for sharing. I am a sister of a girl alcoholic and its breaking my heart, and my family’s. I appreciate the brave news of your sharing your stories and resources, treatments that help. I am hoping she will soon accept the help she needs.
I had an RNY in 2002. I was not a drinker prior to the surgery. Around 2010 I started drinking a glass of wine in the evening. I HATE the taste of alcohol. All of it! By 2014 I was an alcoholic. In 2018 I finally went to AA. After a couple of setbacks I now have 20 months sober. Until looking up some info on gastric bypass for a friend, I had no idea my alcoholism was related to the surgery. Now I am a bit mad. I have felt so much shame for so long over this. This will take some processing….
I need help. My wife had a gastric bypass a year ago. She has always drunk but this time she is having memory problems, parasomnias, and balance problems. We’ve been freaking out. She’s only 47. I try to get her to cut down but she thinks she’s drinking very little That is even after I tell her that, every shot for her is like 2 for anyone else and that it lingers longer. I don’t know where to go. Alcohol programs for the whole god thing down the throat and we’re atheists. She has an appointment with a neurologist, a sleep doctor – but we’re freaking out. Especially her.I need someone to talk to her that can explain it with some credibility.