From Food to Booze

Each year, more than 100,000 people undergo weight-loss surgery in the United States, and for many it's a life-saving procedure. But there's a widely reported side effect that seems to be causing concern—even Oprah is worried. It's called addiction transfer, and if some mental health professionals are right, after bariatric surgery you have a 30 percent chance of replacing food with booze. This drug of choice may just lead you to become an alcoholic.

Some researchers, however, say that that number needs to lose some weight of its own. "The problem does happen," says Stephanie Sogg, a psychologist at the Massachusetts General Hospital Weight Center. "But there is no evidence that it happens as frequently as the media suggests."

Sogg says that there are no airtight studies on the prevalence of addiction transfer, but the best of the bunch was published in the journal Surgery for Obesity and Related Diseases by a team from North Dakota. Of the 70 people who completed questionnaires, fewer than 6 percent increased alcohol use after surgery, and four times that many actually decreased their alcohol consumption.

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According to James Mitchell, president and scientific director of the Neuropsychiatric Research Institute in Fargo, North Dakota, and an author of the paper, "A small number of people will develop problems with alcohol postoperatively, but the problem may be a little overblown."

Addiction transfer has also been said to spawn addictions to sex, gambling, shopping, and Internet use. "I have only seen one or two [cases] with shopping" Sogg says, but that may result from the need to continually restock one's wardrobe as the pounds come off. Out of the 500 postoperative patients she's seen in the last five years, none had Internet, gambling, or sex issues. Though, according to Sogg, it doesn't mean it's not out there.

Why all the hype?

"People latch onto catchphrases," Sogg says. "And the popular media have been selling it. They love it because it sounds sexy." People also love the idea of addictive personalities, but neither Sogg nor Mitchell believe there's enough empirical evidence for their existence. For those who do turn to booze after bariatric surgery, she says, these people may suffer poor coping skills. Some patients have trouble dealing with depression, stress, and anxiety, so they use food for comfort. After surgery they can't use food so they look for something else that will help.

The coping skills model is different from the addiction model because "it doesn't assume a fundamental, innate, and enduring personality flaw," Sogg says. "Which means it's not stigmatizing." It also offers a clear guideline in fixing the problem. You teach appropriate coping skills through cognitive behavioral therapy, for example. People learn to identify triggers that may lead to relapse, and they practice avoiding those triggers or reacting to them appropriately.

Finally, if a person believes that she has an addictive personality, this will limit her self-efficacy, or belief that she can take action and make changes in her behavior. Numerous studies show that self-efficacy is the most important factor in successfully changing a bad habit.

Still, Sogg says, patients should be aware of the chance of alcoholism. If you had trouble coping with your emotions before surgery, you may have trouble afterward too. And if find yourself engaging in any risky behavior, you should contact your surgical clinic or a mental health professional in your area immediately.

Sogg, however, scolds those who propagate the high rate of addiction transfer. "This surgery is medically necessary for many people. And panicking them—with limited data—is irresponsible and potentially harmful."

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