Alcohol and Drug Use Among Post-Operative Bariatric Patients: A Systematic Review of the Emerging Research and Its Implications

• Alcohol affects the body very differently after bariatric surgery: faster absorption, higher blood alcohol from smaller amounts, and longer intoxication than before surgery.
• Some patients, particularly gastric bypass patients, may be at increased risk for alcohol use problems after surgery.
• The review explains 'addiction transfer,' where compulsive behaviors redirect toward substances like alcohol or marijuana after surgery removes the ability to overeat.
• The review also examined prescription pain medications, marijuana, and illicit substance use after surgery.
• Published in a leading addiction medicine journal, demonstrating recognition across medical specialties.
• Best bariatric programs screen for substance use risk factors, educate patients about altered alcohol/drug response, and provide ongoing monitoring.

Why This Review Was Needed

Reports of patients developing drinking problems after bariatric surgery were growing, but the research was scattered and hard to interpret. This review, published in the official journal of the Research Society on Alcoholism, brought together everything known about alcohol and drug use after weight-loss surgery.

How the Review Was Done

The team searched the literature in January 2015 for every study reporting alcohol use, alcohol use disorders or illicit drug use after bariatric surgery. Twenty-three studies met the criteria.

What the Review Found

• Of six studies that followed patients over time, three found alcohol use increased after surgery.
• Larger long-term studies, such as the LABS-2 study (JAMA, 2012), showed gastric bypass patients are at higher risk of alcohol problems.
• Bariatric patients may be overrepresented in substance abuse treatment programs.
• Risk factors included drinking before surgery, male sex, younger age, tobacco use and ADHD symptoms.
• Illicit drug use after surgery was reported as low.
• Most studies involved White women in their 40s, and only 11 of 23 used validated tools.

What This Means for Patients

Most patients do not develop alcohol problems after surgery, but some are at clear risk. If you drank heavily before surgery, smoke, or are younger, plan for extra support. Read Two Drinks Become Four and our guide Mental Health, Body Image, and Alcohol After Bariatric Surgery.

Clinical Pearls

• Gastric bypass is associated with higher risk of postoperative alcohol problems.
• Pre-surgery drinking is the strongest risk factor.
• More diverse and longer-term studies are needed.

Strengths and Limitations

This was a comprehensive review at a time when the topic was emerging. Study quality varied, few used validated tools, and samples lacked diversity, which motivated our team’s later research in young, ethnically diverse patients.

Expert Commentary

This review shaped how I counsel patients about alcohol. The risk is real but predictable, so we can identify who needs extra support before surgery rather than after a problem develops. It also showed how little research included patients like mine, which is why we went on to study young Hispanic and Black patients directly.

— Dr. Nestor de la Cruz-Muñoz

Related Research

• Alcohol Use Patterns and Alcohol Use Disorders Among Young Adult, Ethnically Diverse Bariatric Surgery Patients
• A Qualitative Examination of Increased Alcohol Use after Bariatric Surgery among Racially/Ethnically Diverse Young Adults
• Postoperative Marijuana Use and Disordered Eating Among Bariatric Surgery Patients