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Alcohol abuse

High-risk alcohol users report improvement after surgery

At 12 months 13% reported high-risk drinking compared to 17% at baseline

A study from Beth Israel Deaconess Medical Center suggests that upwards of half of high-risk drinkers are actually less likely to report high-risk drinking behaviour after bariatric surgery. The paper, which is published in the journal, Surgery for Obesity and Related Diseases, is thought to be the first to report an improvement in drinking habits post-surgery, with some previous studies have shown a lower alcohol tolerance and a longer time to return to a sober state after surgery.

"This is the first study to show that high-risk drinking may actually improve post weight loss surgery," said lead author and principal investigator, Dr Christina Wee, Director of Obesity Research in the Division of General Medicine and Primary Care at Beth Israel. "It's possible that previous studies may have missed this positive effect because post-surgery alcohol use wasn't compared against baseline consumption.” 

Wee and colleagues interviewed patients who participated in the Assessment of Bariatric Surgery (ABS) Study, which aims to understand patient preferences and decision making processes about weight loss and bariatric surgery. They followed 541 clinically obese patients who underwent weight loss surgery, interviewing them at baseline and then twice again at the end of one and two years.

"Given the greater clinical attention being paid to caloric intake and substance abuse issues after weight loss surgery, we hypothesised that a subset of high-risk drinkers who undergo weight loss surgery may actually experience amelioration of their high-risk drinking," write the authors.

Study participants were asked questions assessing frequency of drinking over the past year, quantity of alcohol consumed on an average daily, and binge drinking over the past month. Results were used to determine which individuals were high-risk drinkers.

Outcomes

From the 541 patients who had surgery, 375 (69% retention) completed the one-year interview and 328 (63% retention) completed the two-year interview.

At 12 months, 13% reported high-risk drinking compared to 17% at baseline, (p=0.10) and at 24 months 13% reported high-risk drinking compared to 15% at baseline (p=0.39). Seven and six percent of patients reported new high-risk drinking at 12 and 24 months follow-up, respectively. Interestingly, at 12 and 24 months follow-up more than half of those who reported high-risk drinking at baseline no longer did so.

A larger proportion of gastric bypass patients (71%) reported amelioration in high-risk drinking than gastric banding (48%) at 12 months follow-up, but this difference did not reach statistical significance (p=0.07); the difference largely dissipated at 24 months follow-up (50% versus 57%) .

"So much of the existing literature focuses on increased risk", said senior author, Dr George Blackburn, Director of the Center for Nutrition Medicine. "Even though we expected to see something different with this data, we were still surprised by the findings."

Wee thinks understanding the complete picture can better prepare clinicians to counsel their patients who are considering weight loss surgery and follow up with them after surgery.

"Often, high-risk drinkers are steered away from weight loss surgery,” said Wee. “Knowing that a significant percentage of these patients may actually cease high-risk drinking after weight loss surgery may help us recommend more patients for surgery.”

"We routinely screen for alcohol misuse as part of routine pre- and post-operative care, with a heavy emphasis on patients who are known to be at risk," said co-author, Dr Dan Jones, Director of BIDMC's Bariatric Surgery Center. "This study tells us that we can do a better job of screening for and supporting patients who are newly at risk as opposed to only focusing on those who may have had a problem before surgery."

Wee says more research is necessary to understand why weight loss surgery seems to help some patients improve alcohol misuse, while it increases misuse in others. "We also need to better understand which patients are at highest risk for developing alcohol misuse so that we might better counsel and monitor them."

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