Evaluating Alcohol and Substance Use in Bariatric Surgery Candidates

Overview

This study assessed the prevalence of risky alcohol and substance use in bariatric surgery candidates using self-reports and toxicology tests, including ethyl glucuronide (EtG). Findings revealed notable rates of risky drinking and substance use, with EtG providing objective confirmation of recent alcohol intake.

Background

Obesity is a major health concern, and bariatric surgery (BS) is the most effective treatment for sustained weight loss. Alcohol use is clinically relevant in BS candidates due to its impact on weight loss, nutritional status, and the risk of developing alcohol use disorder (AUD) post-surgery. Preoperative psychological evaluation should include assessment of alcohol and other substance use. Biomarkers like EtG can objectively detect recent alcohol consumption, complementing self-reported data.

Data Highlights

Key Findings

• 4% of bariatric surgery candidates met criteria for alcohol abuse and 2% for alcohol dependence, with men more likely to have AUD.
• 33% had a current Axis I psychiatric disorder, with major depressive disorder being the most common (14%).
• Self-reported questionnaires (AUDIT-C and ASSIST) were used alongside urine toxicology to assess alcohol and substance use.
• Urine EtG testing detected recent alcohol consumption with a cutoff of ≥500 ng/ml, providing objective evidence of drinking within 72 hours.
• Psychopharmacological treatment was common: 32% on antidepressants, 28% on benzodiazepines, and 17% on opioids.

Clinical Implications

Preoperative evaluation of bariatric surgery candidates should incorporate both self-reported assessments and objective biomarkers like EtG to accurately identify risky alcohol use. Recognizing psychiatric comorbidities and psychopharmacological treatments is essential for comprehensive care. Early identification of risky drinking can guide interventions to improve surgical outcomes and reduce postoperative complications related to alcohol.

Conclusion

The combined use of self-report tools and toxicology assessments, including EtG, enhances detection of risky alcohol and substance use in bariatric surgery candidates. This approach supports better preoperative risk stratification and tailored patient management.

References

1. American Psychiatric Association 2013 -- DSM-V Diagnostic Criteria
2. Thermo Fisher Scientific Diagnostics -- DRI-EtG EIA Method