Increased Risk of Alcohol Use Disorder Following Bariatric Surgery

Obesity affects over 40% of adults in the U.S., and bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is among the most effective treatments for sustained weight loss and comorbidity reduction. However, emerging evidence has linked bariatric surgery to an increased risk of alcohol use disorder (AUD), particularly in the years following surgery.

To review the evidence surrounding the incidence, timing, mechanisms, and risk factors associated with AUD following bariatric surgery, with an emphasis on RYGB.

A comprehensive review of the literature examining postoperative rates of AUD among bariatric surgery patients was conducted, highlighting trends, mechanisms, and subpopulations at risk.

RYGB is associated with a significantly increased risk of developing AUD, with incidence rising notably 2-8 years postoperatively. Risk factors include younger age, male gender, preoperative substance use, poor mental health, low social support, and undergoing RYGB rather than other surgical procedures. The delayed increase in AUD appears to result from both physiological changes such as faster alcohol absorption and higher peak blood alcohol levels and psychological factors like addiction transfer. Additionally, bariatric surgery increases risks for alcohol-related liver disease and psychiatric hospitalization related to alcohol misuse.

AUD is a significant long-term risk following RYGB, warranting routine preoperative screening, patient education, and long-term postoperative monitoring. Use of validated screening tools and provision of behavioral health support are critical to mitigate this risk and ensure optimal long-term outcomes for bariatric surgery patients.