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Risk Factors for Alcohol Use Disorder Among Post-Operative Bariatric Surgery Patients

  • Author(s): Krogh, Donna Marie
  • Advisor(s): Macey, Paul
  • Carpenter, Catherine
  • et al.
Abstract

Alcohol use disorder (AUD), is a chronic brain disease that covers two previously independent disorders, alcohol abuse and alcohol dependence (NIH National Institute on Alcohol Abuse and Alcoholism, 2020). Post-bariatric surgical patients represent a vulnerable population that may be at increased risk for AUD as AUD is estimated to occur in 10-15% of post-operative bariatric surgery patients as reported by the Mayo Clinic (Mayo Clinic, 2015), compared to 6.2% of the general adult population (Substance Abuse and Mental Health Services Administration (SAMHSA), 2015). Since the phenomenon of increased risk of alcohol use problem among post-bariatric surgery patients is not fully understood, this study was conducted to evaluate potential predictors of alcohol use problem among 212 post-bariatric surgery patients aged 25.1 to 80.3 years old (mean = 52.4 , SD = 12.0). The study was guided by the Meleis’ Transition Theory framework and the Altered Dopamine Reward Theory, with predictor variables identified in the literature. The sample recruited from UCLA Health and the Kaighan databases were predominantly female, non-Hispanic, White or Caucasian, non-smokers, had a college degree or higher, and underwent sleeve gastrectomy. An online survey was administered in English via Qualtrics which consisted of the following self-report measures: a demographic questionnaire, the Alcohol Use Disorders Identification Test, the Power of Food Scale, the Interpersonal Support Evaluation List-12, the Differentiation of Self Inventory-Revised, the Food Craving Inventory, and Drug Abuse Screening Test-20. Although 6.1% in the study population met the criteria for AUD (ie., were AUD-positive), 21.7% of the population had alcohol use problems (ie., were AUP-positive). Findings from independent samples test analyses supported a significant association between AUD-positive status and three predictor variables - addictive eating behavior, low differentiation of self and low social support, as well as a significant association between AUP-positive status and two predictor variables - drug abuse and addictive eating behavior. Findings from logistic regression analysis supported history of drug abuse, food craving and addictive eating behavior as predictors of AUP-positive status. Together, these findings support previous reports and suggest that individuals with history of drug abuse, addictive eating behavior, low differentiation of self, low social support may be at an increased risk for alcohol use problems, including AUD, following bariatric surgery. This study also highlights that compared to using AUD status as the basis for identifying at-risk individuals, using AUP status proved to be a more comprehensive as it incorporated history of hospitalization and/or counseling due to alcohol use and/or substance use. Now that sleeve gastrectomy has overtaken RYGB to become the leading type of bariatric surgery and given that the association between sleeve gastrectomy and AUD is not as well studied as the association between RYGB and AUD, AUP status may serve as a useful basis for identifying at-risk individuals in further studies.

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