title: Alcohol and Drug Use Among Postoperative Bariatric Patients: A Systematic Review of the Emerging Research and Its Implications.
abstract: BACKGROUND
  Emerging research suggests that some bariatric surgery patients are at a heightened risk for developing substance use problems, especially alcohol use problems.
  
  
  METHODS
  An exhaustive literature review was conducted in January 2015 to investigate all articles published that included data on postoperative alcohol use, alcohol use disorders, and illicit drug use among bariatric surgery patients.
  
  
  RESULTS
  Twenty-three studies reported on alcohol and/or substance use among bariatric patients. Six studies longitudinally assessed alcohol use behaviors; 3 of these studies found an increase in alcohol use following surgery. Six studies were cross-sectional, and 2 studies assessed medical records. Five studies investigated the prevalence of admissions to substance abuse treatment, and 3 studies combined alcohol and drug use data in a single index. Six studies reported on illicit drug use and reported low-postoperative use. The studies' samples were primarily non-Hispanic white females in their upper 40s, and only 11 of the 23 studies utilized validated assessment instruments.
  
  
  CONCLUSIONS
  Studies employing longitudinal designs and large sample sizes indicate that bariatric patients who had the gastric bypass procedure are at an elevated risk for alcohol use problems postoperatively. Research also indicates that bariatric surgery patients might be overrepresented in substance abuse treatment facilities. Risk factors for problematic postoperative alcohol use include regular or problematic alcohol use presurgery, male gender, younger age, tobacco use, and symptoms of attention deficient and hyperactivity disorder. As a whole, however, studies indicate bariatric surgery patients demonstrate a low prevalence of problematic alcohol use, and studies about gastric bypass patients are not entirely conclusive. Prospective, longitudinal studies are needed, utilizing standardized and validated alcohol assessment instruments that follow postoperative bariatric patients well beyond 2 years, and account for types of bariatric procedure. Finally, study samples with greater racial/ethnic diversity and wider age ranges are needed.
authors.affiliation: Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Spadola
authors.affiliation: Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Eric F
authors.initials: EF
authors.lastname: Wagner
authors.affiliation: Department of Educational and Counseling Psychology, University at Albany, State University of New York, Albany, New York.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Dillon
authors.affiliation: Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Trepka
authors.affiliation: Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Nestor
authors.initials: N
authors.lastname: De La Cruz-Munoz
authors.affiliation: Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Messiah
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000523:psychology / Q000639:trends; D035843:Biomedical Research / Q000379:methods* / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D011182:Postoperative Care / Q000379:methods / Q000523:psychology / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology
keywords: Addiction; Alcohol; Bariatric Surgery; Drug Use; Substance Use