Severe alcohol use disorder after bariatric surgery

To the Editor,

The prevalence of severe obesity is increasing in Australasia, and bariatric surgery offers the most effective long-term treatment for this condition.

A recent case report in this Journal described the onset of mania following bariatric surgery (Hamdani et al., 2015) highlighting the relevance of this area for psychiatrists. Here, we report the onset of a severe alcohol use disorder (AUD) after bariatric surgery in a woman with no prior history of heavy drinking.

A 55-year-old female health professional was referred for psychiatric assessment before resuming work, having been abstinent from alcohol for 3 months while attending daily Alcoholics Anonymous meetings.

Seven years earlier her body mass index was 40, and she underwent Roux-en-Y gastric bypass surgery (RYGB). The surgery was successful, and the patient’s body mass index fell to 32 within 12 months.

The patient had a lifetime history of consuming less than 20 g alcohol per week before surgery. She had never smoked or used illicit substances, but she described eating compulsively to alleviate stress and boredom. Her mother and a brother were heavy drinkers, and a maternal uncle had fatal complications of chronic alcoholism.

Twelve months after surgery, the patient received a promotion, which she found stressful. She began consuming up to 4 bottles of wine per day. Her relationships and work suffered. Over the next 2 years, she developed a severe relapsing AUD. She lost her professional practising certificate and required 6 months in residential alcohol treatment.

An increased incidence of AUDs following bariatric surgery has recently been reported; risk factors include being male, younger, a tobacco smoker or recreational substance user, having low social support and undergoing RYGB rather than laparoscopic banding (King et al., 2012; Suzuki et al., 2012).

We suggest measuring eating compulsivity and eliciting a family history of addictive behaviours might also help identify patients at risk of AUD following bariatric surgery. Patients should be advised prior to surgery about the risk of AUD. Finally, patients may be more at risk in the second year after surgery (King et al., 2012), highlighting the need for monitoring beyond the initial postoperative period. Mental health clinicians should play a role in this monitoring since much of the morbidity following bariatric surgery is psychiatric rather than surgical.