Addiction transfer, or cross addiction, after bariatric surgery occurs when individuals trade compulsive eating for other compulsive behaviors. There is also strong evidence of a biological reason for cross addiction.
Studies show various forms of transfer addiction in up to 30 percent of patients who have had bariatric surgery. For these patients, food is no longer being a source of comfort, distraction, reward or escape. Other behaviors or substances now substitute for eating, and can become problematic.
“Process addictions,” such as gambling, shopping and sex addiction can occur, as well as addictions to alcohol and other drug abuse. In some cases, after a period of initial remission, food addiction can reoccur.
Some of the risk factors that show an individual may be affected by transfer addiction include:
- A history of eating disorders, food addiction or compulsive eating
- A family history of substance abuse
- Regular consumption of alcohol before bariatric surgery
- A history of chronic pain/overuse of narcotics for pain management
- A history of trauma, especially childhood sexual abuse
- A history of depression and other mood or anxiety disorders
- A lack of adequate support or feeling isolated
- An avoidance of emotions and experiences
- A history of engaging in self-sabotaging tendencies
If someone is considering having bariatric surgery and has a significant risk of being affected by transfer addiction, it is important for them to take a pause in the pre-operative process to address these issues. For someone who is dealing with an active addiction before surgery, they must seek treatment. It is also recommended they be clean and/or sober from the addiction for a year or more before they consider moving forward with the procedure. There are high rates of relapse in the first year of recovery, and a more solid foundation of sobriety is required before taking on a life-altering process such as bariatric surgery.
Support groups and counseling play an important part in maintaining sobriety. 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous, faith-based groups such as Celebrate Recovery and self-help groups like Rational Recovery are all options. Therapy with an addiction specialist is also important for the healing process and for relapse prevention before surgery.
Many people ask what to look for to determine if they or someone they love is dealing with an addiction. The person dealing with the addiction may deny they have a problem if they consider themselves to be “functional” in their lives. They may also deny it if they have a pre-conceived notion of what an addict looks like.
Addiction does not discriminate and can happen to anyone. The following are some signs and symptoms of addictive behavior:
- A need for more and more of the behavior/substance to achieve the desired effect
- Using the substance or engaging in the behavior for longer than intended, or in higher amounts than desired
- A strong desire to cut back on the behavior/substance, or unsuccessful efforts in doing so
- Any social, professional, personal, financial or legal problems related to the addictive behavior
- Other people have made comments or complained about the behavior, or others have suggested that the person cut back
- The person affected is sneaking around, or lying, to cover up the behavior and the consequences of it
- The person affected is spending more and more time/money to get the substance or engage in the behavior
- There are feelings of guilt or shame about the behavior
- There is defensiveness or denial when others confront the person about their behavior
- The behavior or the substance becomes one of the main things the person looks forward to
If you think you have a problem with transfer addiction, admitting you are struggling with it is an important first step. Talk to someone you trust and break the secrecy surrounding your behavior. You don’t have to be ready to change your behaviors all at once, but isolation and shame can lead you further down the path of continuing addictive behaviors.
Finding support from others who are struggling with similar issues can help you not feel alone or ashamed. Seeking support from professionals is also an important step. If you are using alcohol or drugs, it is important to let your bariatric surgeon and/or primary care physician know what you are dealing with, as substance use following bariatric surgery can significantly impact your physical health. Equally important is becoming connected with a therapist. There are many licensed mental health professionals that treat addiction who can assist you in your journey towards recovery.
About the Author:
Kelly Broadwater, LPA, LPC, CEDS, is the founding co-executive director of The Chrysalis Center for Counseling & Eating Disorder Treatment. As a psychologist and certified eating disorders specialist who is an expert in bariatric psychology, Ms. Broadwater developed the comprehensive aftercare program for bariatric surgery patients offered at her outpatient practice. Her clinical experience includes conducting pre-operative psychological evaluations, providing pre- and post-operative individual counseling and facilitating group therapy for post-surgery patients. Ms. Broadwater frequently speaks on topics related to bariatrics, including co-presenting at the 2015 International Association of Eating Disorder Professionals conference on effective bariatric aftercare. She is an integrated health associate member of the American Society for Metabolic & Bariatric Surgery.
This is no joke..it can happen to any of us… I have a problem with chewing and spitting food all day long. I don’t even realize I’m doing it. I shop shop shop it never ends and it’s putting me and my family in debt.
I am so proud of you for sharing your struggles. Please, please seek help. I am going to pray that you get the right therapist that can assist you in complete recovery. Again, I am immensely proud of you for sharing. You CAN overcome this hurdle.
[…] Transfer Addiction Following Bariatric Surgery […]
Please know there is help out there. I don’t know where you are located, but some good resources to begin looking for a therapist would be the American Society for Metabolic & Bariatric Surgery website or edreferral.com (this is a database of eating disorder professionals in each state).
I am very glad to see more attention being brought to this subject. However, I am concerned that the author continues to perpetuate these unfounded conclusions. Almost immediately when these problems started being noticed, it was attributed to this theory of addiction transfer. Which goes like this….because after obesity surgery you can no longer find enjoyment in food, then you turn to something else. Unfortunately there is no basis for this, and quite a lot of evidence which directly contradicts it. For example, a study out of the Karolinska Institute showed that these new addictions and other mood disorders (including suicide) ONLY increased when the intestines were bypassed. In fact it quadrupled the risk factor. However, there is NO increased cohort in restrictive only procedures such as the lap-band or gastrectomy.
Second, these problems are not showing up right away. They typically show up between 18-24 months post-op. That correlates more to the amount of time stored nutrients would be depleted than some sort of emotional problem because you can no longer eat. Actually the person can eat more than right after surgery. Check out the studies from Dr. Wendy King and Dr. Stephen Benoit and others. Those who are doing research in this area are adamant that these newly acquired addictions and problems ARE NOT because of this emotional loss associated with eating. Nor does any prior history or lack thereof predict whether a person will suffer from this malady. They have yet to figure out where, but there is clearly something happening and its linked to bypassing of the intestines. We need to bring attention to this, but we must stop applying unfounded causes to it so that people can get the appropriate treatment.
Lisa, I appreciate you taking the time to respond. I think there are multi-faceted causes for post-operative addiction- both biological and physical and I hope that my article covered that. I assure you I’ve read all the studies you refer to. But I’m also a therapist working in the trenches with these patients for over 12 years and have seen firsthand their experiences. Many of them dealt with pre-operative eating disorders and those either re-emerge or compulsive behaviors in other areas arise as a means of coping with emotional distress. I’ve seen this with bypass, lap band, and sleeve patients. Our practice is currently doing a large scale study in conjunction with University of North Carolina-Wilmington on the effects of trauma and other psychological issues on long-term outcomes for bariatric patients. “Appropriate treatment” to me is always a holistic approach- I refer them back to their medical practitioner for labs and to the dietitian for nutritional evaluation in addition to seeing them for counseling. I don’t assume that their is one reason only for why people develop addiction after surgery, but I cannot discredit what my patients experience or what I’ve seen in my clinical practice.