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Addictive Transfer among Some Bariatric Patients

Posted in Alcohol Abuse

For the morbidly obese person, gastric bypass surgery or restrictive banding can be a lifesaving procedure. The health risks associated with obesity are real. Bariatric surgery can address the physical risk factor of being grossly overweight.

What bariatric surgery cannot address is the behavior which led patients to become obese. For many who receive such surgical procedures, eating was an emotional behavior. The surgery dealt with the effects of eating but not with the compulsion to overeat. And while it is true that in the majority of cases, overweight is the result of insufficient self-control, insufficient exercise and genetics, food addiction is increasingly coming to be viewed as a disorder similar to drug or alcohol addiction. Like those suffering from alcohol or drug dependency, food addicts demonstrate a compulsive reliance upon something to fill an emotional hole or to exert a measure of control. In no way does the bariatric procedure cause the dependency, but it can prove to be the experience which brings the underlying addiction to light.

Initially, bariatric surgery patients experience the emotional high of seeing excess weight fall away. They feel remade. It is surprising for many of them when they plummet back to earth and encounter all the problems and issues that were part of their lives before the surgery. This surprise can easily morph into depression. Not only have their previous problems not melted away with the pounds, in fact, the weight loss can bring its own stresses in its wake. Lifestyle changes after surgery can affect relationships the patient had before the surgery. For example, time that was devoted entirely to relationships or responsibilities for others may now be re-allocated so as to ensure there is a sufficient slice of time for exercise. Such lifestyle and relational changes can be hard for everyone involved. The patient finds he/she is bumping up against the challenges of life and no longer is able to indulge in the eating compulsion as a coping mechanism.

Addictions are efforts to fix how the person feels. The patient imagined that losing weight would eliminate any number of problems in life and therefore would bring emotional satisfaction. After the first rush of enthusiasm however, patients realize that life is the same and they are the same (minus the weight). What sometimes occurs next has been referred to as Addictive Transfer. The patient deprived of one addictive behavior (overeating) substitutes another compulsive behavior in an effort to find relief. In fact, experts warn that with increases in the number of bariatric procedures, there has also been an increase in addictive behaviors among patients, with alcoholism and drug addiction topping the list. One expert said that 5% of bariatric surgery patients experience addiction transfer. Other addictive transfer behaviors have been noted such as compulsive shopping, gambling, and uncharacteristic promiscuity.

Alcoholism is a particular risk to the bariatric patient because the alcohol skips the stomach and is delivered straight into the small intestines resulting in a faster passing of alcohol into the bloodstream. In short, the patient will feel the effects of alcohol sooner and, at least initially, more intensely than others would. One study has followed over 10,000 bariatric patients for 25 years and discovered that these patients are four times more likely to need treatment for alcohol abuse.

There is division among mental health experts as to the true state of affairs. Some say that there is a lack of sufficient psychological data proving addiction transfer. Others point to strong anecdotal evidence gleaned from support groups and follow up care. The National Institutes of Health is in the midst of clinical trials studying addiction. In the meanwhile, there is wisdom in warning patients beforehand about the possibility of transfer addiction. For those already dealing with new addictive behaviors, groups like Overeaters Anonymous, Alcoholic Anonymous, Gambling Anonymous etc can be a way to finally address root causes and find the relief the patient seeks.