An alarming number of people who have elected to have gastric bi-pass are finding that they are experiencing problems with other addictions, alcoholism being one of the primary manifestations. Some studies have indicated that as many as thirty percent of these people are experiencing what is termed “addiction transfer”. The term addiction transfer simply means that they have traded their compulsive addiction to food for another unhealthy addiction such as alcohol, drugs or gambling.

This concept is not new in studies of addicts. This type of behavior is explained as the individual seeking a new substance to fill an inner void. The fact is that a large number of these people haven’t had any therapeutic help in addressing the issues that were perpetuating their eating disorder. Many sought comfort in food and when the stomach is dramatically reduced in size that is no longer an option. In order to fill this void many turn to alcohol, which brings with it a whole new set of problems.

There are many physiological explanations for this phenomenon. It is thought that the brain’s pleasure center for these people was stimulated by food. When they consumed something that they enjoyed they stimulated their dopamine system. Dopamine is a neurotransmitter that produces pleasurable feelings when rewards are presented. It is believed to provide a teaching signal to the sections of the brain that are responsible for acquiring new behavior. Thus, the person would seek a pleasurable sensation by eating. This behavior is now being transferred to another behavior that produces the same dopamine release and emotional sensation.

One of the primary problems with alcoholism for the bariatric patient is one of a physical nature. After the surgery, the stomach is very small and the way that alcohol is metabolized is severely impacted. Alcohol is normally contained in the stomach when it is consumed where it is partially metabolized with the aid of the enzyme alcohol dehydrogenase. It is release slowly into the intestines. The length of time that the alcohol stays in the stomach is impacted by the much smaller stomach and more of the alcohol enters the intestines where it is absorbed rapidly due to the large surface area of the intestines. This causes intoxication at an accelerated pace, some studies have indicated almost twice as fast. Alcohol triggers the same dopamine release that the patient formerly received by eating. The alcohol induced dopamine release becomes the new addiction and alcohol dependence rapidly develops.

When the decision is made to have bariatric surgery the patient should consult with a psychotherapist and get the help necessary to modify compulsive behavior and treat any underlying issues that may be present. If therapy is not part of the treatment, the resulting and desired weight loss will occur but the danger of addiction transfer is substantial.

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