Understanding Post-Bariatric Surgery Substance Abuse 

Bariatric surgery can be a life-changing experience for some patients. It has genuine potential to help people shed pounds, improve their physical health, limit the progression of comorbidities, and significantly enhance their quality of life. Yet, there is an uncommon but possible undercurrent that often goes unaddressed: the increased risk of substance abuse after surgery.

Our goal isn’t to discourage weight loss surgery – far from it. Nor are we suggesting that everyone who struggles with obesity will also struggle with addiction. What we DO want is for people to approach surgery with a complete understanding of the situation, raising awareness about a serious issue that often doesn’t receive the attention it deserves.

Sometimes, the same behaviors that contributed to weight gain, such as compulsive eating, can shift toward other addictions like alcohol misuse, especially if underlying mental health concerns aren’t addressed alongside the physical changes. Our aim here is to promote early recognition and intervention before the problem escalates.

Understanding Root Causes

To be clear, bariatric surgery doesn’t cause addiction. What it can do, however, is reveal or accelerate patterns that were already present but perhaps less obvious before surgery. Researchers are still trying to figure out patterns and influential factors that cause the high incidence of alcohol use disorder (AUD) in post-bariatric surgery patients. Some risk factors that have emerged include previous mental health issues and complications from the surgery itself, but current models point to unresolved psychological patterns and coping mechanisms.

What Is Addiction Transfer?

Moving from one unhealthy coping mechanism to another is a phenomenon sometimes referred to as “addiction transfer.” In the context of post-bariatric surgery patients, it often takes the form of increased alcohol use.  Many people have complex relationships with food that can be tied to emotional regulation or past trauma. When the primary coping mechanism – compulsive eating – is no longer available after surgery, some people can subconsciously seek out a substitute. Studies also suggest that this doesn’t develop right away, sometimes taking several years to become fully apparent. 

Another hypothesis as to why AUD affects a significant number of post-surgery patients is based on how alcohol can “alter pharmacokinetics” – how the body interacts with alcohol. Because the surgery predisposes patients to reach intoxication levels quicker than they did before surgery, researchers also wonder if that increased sensitivity could be the culprit.

Combine emotional factors with the way bariatric procedures can alter alcohol metabolism – faster absorption, higher blood alcohol levels, and more pronounced effects – and the risk of misuse increases even more.

Surgery may change the body, but it doesn’t automatically heal deeper issues. There’s a clear psychological component at play, and the issue can become two-pronged when physiological changes are layered on top.

Transparency with Your Care Team

Communication and honesty – it’s that simple. If your care team doesn’t know something because you aren’t telling them, how can they help? From the initial consultation through long-term follow-up, transparency is essential to protect your health and well-being. Start with telling the truth, even when it’s uncomfortable.

The physicians, surgeons, and support staff all participating in your care are trying to help you succeed. But they can only work with the information they’re given. If you’re struggling with alcohol, returning to disordered eating, or feeling overwhelmed mentally, letting them know ASAP gives them a chance to step in with the right resources. Whether it’s adjusting a treatment plan, referring you to a therapist, or simply listening without judgment, care teams are better equipped to help when they have a complete understanding of what you’re facing.

We also understand that there is a real fear of being judged or misunderstood. Unfortunately, some people have been dismissed or stigmatized in medical settings before. If that has been your experience, it makes sense to hesitate. But the right provider will treat you with dignity and compassion. 

Prevention and Resources

Prevention is one of the best cures, so be prepared to hit mental health head-on, before and after the procedure. Look past pre-op checklists and BMI targets. Ask the hard questions, explore your relationship with food, and try to identify any emotional patterns that may need extra support.

Counseling can be a game-changer here. Working with a therapist who understands addiction, trauma, or disordered eating creates a safe space to unpack unhealthy patterns and build better coping mechanisms. In-person and online support groups can also offer solid social connections, and that shared experience can make a huge difference. 

Surgeons, primary care doctors, nutritionists, and mental health professionals each bring a different perspective, but they aren’t there to micromanage your recovery – they’re on standby so that you don’t have to white-knuckle it alone.

Start with a Conversation

If you or someone you care about has had bariatric surgery, be aware of the signs that substance misuse might be taking hold. Look for changes like increased alcohol use, mood swings, social withdrawal, or secrecy. 

Remember, this isn’t about blame – approaching these concerns with empathy and without judgment is the best way to get on track with healing. Gently encourage professional help and ongoing care to create a lifeline, not a barrier. Struggling with substance abuse is not a moral failing or a personal weakness; it’s complex and rooted in emotional and physiological factors that aren’t easily tackled, or well understood, for that matter. Know that you and your loved ones are not alone.

There are wonderful people in healthcare who are more than willing to help and accommodate your needs as best they can. Sometimes, it takes multiple attempts to find the right support or the right moment to ask for help. Feeling discouraged is natural, but never let it stop you from meeting your needs. Your well-being is in your best interest, and it’s worth preserving. You are worth it to keep trying.

If you have concerns about substance use after bariatric surgery or simply want to make sure you’re set up for long-term success, Dr. Higa’s team is ready to support you. We offer a compassionate, judgment-free space where your whole health matters – physical, emotional, and beyond.