title: Substance use after bariatric surgery: A review.
abstract: BACKGROUND
  Prevalence of obesity has increased dramatically. Obese individuals may undergo bariatric surgery to lose excessive body fat and mitigate obesity-related comorbidities. However, bariatric patients are particularly vulnerable to substance use problems. We conducted a review to examine the prevalence change and factors associated with substance use and determine the association between substance use and health status after weight loss among bariatric patients.
  
  
  METHODS
  We searched peer-reviewed articles published between January 1990 and January 2015 in several databases (PubMed, PsycINFO, Cochrane Library, Google Scholar) using different keywords combinations. Studies that focused on pre-surgery substance use only or without reported effect measurements were excluded.
  
  
  RESULTS
  Overall, 40 studies were included in the review. Preoperative history of substance use was a reliable correlate of postoperative substance use. The prevalence of postoperative alcohol use was higher among patients with preoperative history of alcohol use than those without. Postoperative prevalence of alcohol use ranged from 7.6% to 11.8%. No significant prevalence change in cigarette smoking from pre-to postoperative period was observed. Time effect was not observed on smoking or drug use prevalence, while an increase in alcohol consumption was inconsistent across studies. The proportion of new-onset substance users among bariatric patients after surgery ranged from 34.3% to 89.5%.
  
  
  CONCLUSIONS
  Substance use is associated with poor health among bariatric patients. Preoperative assessment and postoperative follow-up should include interventions to reduce relapse among users and prevent substance use initiation.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA. Electronic address: lilinlin83@gmail.com.
authors.forename: Linlin
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. Electronic address: litzy.wu@duke.edu.
authors.forename: Li-Tzy
authors.initials: LT
authors.lastname: Wu
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects / Q000523:psychology*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control
keywords: Alcohol use; Bariatric surgery; Drug use; Obesity; Smoking; Substance use