NEW YORK NURSE: December 2009
by Nancy Webber and Becky Eisenhut, RN, Regional Coordinator, Statewide Peer Assistance for Nurses Program
In the Statewide Peer Assistance for Nurses (SPAN) Program, we admit nurses with alcohol and other drug dependencies on a regular basis. About a year and half ago, we started noticing an increase in nurses who had bariatric surgery and later developed an addiction to alcohol or opiates. The increase is so significant that we have started to track this phenomenon.
Research reveals that food and alcohol (as well as other drugs) stimulate the same reward center in the brain. These substances increase the levels of dopamine in the brain, which enhances our sense of well-being. So, someone with an eating disorder has many of the same characteristics as someone with a drug or alcohol addiction because of their similar effects on the brain.
Although food is not an addictive substance, compulsive overeating has many similarities to alcohol/drug addiction: loss of control, continued behavior despite negative consequences, and withdrawal symptoms.
After weight-loss surgery, people may continue to crave the neurological stimulus they used to get from eating food. An unknown number of them (between 5% and 30%) try to satisfy those cravings by drinking alcohol or by ingesting a drug such as hydrocodone, demerol, Percocet, or oxycodone.
There is growing evidence that gastric bypass patients metabolize alcohol differently than people who have not had the surgery. One study1 found that, after drinking five ounces of red wine, post-operative gastric bypass patients had a breath-alcohol level of .08% while a control group’s level was .05%. It took an average of 108 minutes for the bypass patients’ breath-alcohol levels to return to zero, compared to 72 minutes for the control subjects.
Researchers proposed that there might be physiological reasons for this difference. Rapid emptying of the gastric pouch facilitates rapid absorption of alcohol by the small intestine. With no stomach to speak of, enzymes that normally break down some of the alcohol before it can be absorbed are no longer present.
More study is needed to determine whether bariatric surgery patients should abstain from alcohol or the appropriate alcohol intake for this population.
A nurse in her 30s had bariatric surgery following years of obesity. She was convinced that she would be healthier and happier if she lost weight. She was prescribed hydrocodone for post-op surgical pain. Even after the pain subsided, she continued to use the drug because it made her feel calm and happy. Eventually, she started to experience withdrawal symptoms if she didn’t take the drug. A downward spiral began, with the nurse eventually turning to diverting drugs in her workplace. Then she was caught stealing drugs, and her career and her license were in jeopardy.
A nurse in her late 20s had endured years of ridicule and low self-esteem because of her weight. After gastric bypass surgery, she lost more than 100 pounds and finally began to feel attractive and desirable. But she found that when she was out drinking with friends, the effects of alcohol were greater and lasted longer. She didn’t feel significantly impaired, however, so she continued the same drinking habits as before her surgery. Within two years, she was admitted to an inpatient facility for the treatment of alcohol dependence after two arrests for DWI.
Post-operative gastric bypass patients appear to be more likely to develop addictions if they have family histories of addiction or alcoholism. Nurses in SPAN support groups often report addictive disease in their families, indicating a genetic predisposition to alcoholism or drug abuse. Individuals with eating disorders, especially binge eating, have more difficulty adjusting after weight loss and are more likely to develop alcohol dependence.2
Should bariatric surgery be denied patients who are likely to develop addictions? This risk may be offset by the significant benefits of weight loss in preventing diabetes, heart disease, and cancer.
Further preventive measures may be necessary to reduce the likelihood that bariatric surgery patients will develop addictive behavior. For example, pre-surgery screening could be conducted by substance abuse professionals. Post-operative counseling should include more education about the risk for addiction, with references to therapeutic services for individuals who have underlying issues that will not be resolved by their losing weight.
1 Hagedorn, J.C., Encarnacion, B., Gabriel, A.B., Morton, J. (2007). “Does gastric bypass alter alcohol metabolism?” Surgery for Obesity and Related Diseases, 3(3), 543-548.
2 Guisado Macias, J.A., Vaz Leal, F.J. (2003). “Psychopathological differences between morbidly obese binge eaters and non-binge eaters after bariatric surgery,” Eating and Weight Disorders, 8(4), 315-318.