Andrew Kahn thought that after he got his weight under control, his problems would be over. Instead, he, like many gastric bypass surgery patients, traded his food addiction for an alcohol habit.
"Drinking for me became like eating used to be — instant satisfaction," said the 60-year-old South Florida man. "But I eventually realized food and alcohol were cover for me not taking responsibility for my problems."
Swapping one addiction for another is common among gastric bypass patients, who struggle more than the general population with issues of addiction.
Marty Lerner, a psychologist and clinical director of Milestones in Recovery, a residential eating-disorders program in Fort Lauderdale, sees many patients who have transferred their food addictions.
"Alcohol and drug dependencies are the most common," he said, "followed by compulsive shopping and sex addiction." In every case, people are substituting one form of self-medication for another.
"All addictions are about fixing how one feels," Lerner said. "Changing the nature of the addiction does not change the nature of the person."
So far, the most-studied of these transferred addictions is alcoholism.
Patients who undergo gastric bypass surgery are four times more likely to require inpatient care for alcohol abuse than the general population, according to a study presented last month at a conference in Chicago.
The study, which followed 12,277 bariatric surgery patients over 25 years, also found that gastric bypass patients were more at risk for abusing alcohol than those who had restrictive procedures, such as banding.
The reasons for the addiction transference are both psychological and physical, experts say.
Because gastric bypass surgery causes food and drink to move past the stomach and directly into the small intestine, alcohol hits patients faster, said Magdalena Plecka Ostlund, lead researcher on a study conducted at the Karolinska Institute in Sweden.
"The alcohol enters the small intestine rapidly, which results in a high and quick peak of alcohol in the blood," she said.
"Some don't like that effect, but some like it a lot," said Dr. James Mitchell, chairman of neuropsychiatry at the University of North Dakota School of Medicine and a researcher involved in a bariatric study funded by the National Institutes of Health.
"Bariatric surgery patients have a two to three times greater chance of moving onto another substance addiction," Mitchell estimated.
The other driver is mental.
"When you take away someone's primary addiction, in this case food, they often need to build their world around something else," Mitchell said.
For Kahn, postsurgical depression also played a role in his turning to alcohol. Within a year of his 2003 surgery, he went from 367 pounds to 180 on his 5-foot-7 frame. He joined a gym and in 2005 ran a marathon. But like many patients who lose a lot of weight, Kahn's skin didn't shrink with the rest of him.
"It just hangs there. I hate looking at it," he said.
Though his insurance covered his weight-loss surgery, in 2008 the company declined to pay for the skin-reduction surgery, which is considered cosmetic. And Kahn couldn't afford the $10,000.
That's when he started drinking.
"My finances were bad. I couldn't do anything about the extra skin, which depressed me, and vodka would tell me everything was okay."
Last August, he checked himself into a detox clinic.
Still, experts agree, the benefits of the gastric procedure — eliminating diabetes, reducing high blood pressure and heart disease and curing sleep apnea — greatly outweigh the risks.
"The increased risk for alcoholism after gastric bypass should be balanced against the many positive health effects of the surgery and weight loss," Ostlund said. "Surgeons have to advise patients to consume alcohol with care."
Before he operates, Dr. Raul Rosenthal, a bariatric surgeon in Fort Lauderdale, says he puts patients through a psychological exam to be sure they can handle the adjustment.
"We look at their alcohol and tobacco use and other addictive behaviors," he said. "It's important for patients considering the procedure to be told that the risk exists and that if they had a tendency to drink before, they will need to be very careful."