Bariatric surgery is the most effective weight loss treatment for patients who are severely obese; however, 1 in
5 patients develop an alcohol use disorder (AUD) after undergoing surgery. After surgery, changes in
metabolism, hormone levels, and behaviors alter the rewarding effects of alcohol while concurrently changing
its absorption rate, putting patients at significantly elevated risk of hazardous drinking. To better understand the
development of AUDs after bariatric surgery, we must first identify factors leading to re-initiation of alcohol use
and escalation to heavy drinking. Promising areas include mood and eating behaviors. The purpose of the
proposed study is to identify the distal and proximal factors that contribute to re-initiation and episodic alcohol
use following bariatric surgery. We will use an exploratory sequential mixed methods approach and first obtain
qualitative data to inform the quantitative phase. In the qualitative phase, we will conduct interviews of patients
who are between 6 months and 3-years post-bariatric surgery (N= 30) to identify the reasons they consumed
alcohol after bariatric surgery. We will also inquire about the frequency, amount, and the antecedents and
consequences of episodic alcohol use (i.e., mood, eating behaviors). This information will be used to inform the
quantitative data phase (i.e., finalize the constructs to assess, how and when to measure these variables, and
the frequency of assessment). In the quantitative phase, patients (N= 100) will also be recruited between 6
months and 3-years post-surgery. Participants will complete measures of substance use, mood, and eating
behaviors at baseline and at 6- and 12-weeks post-baseline to capture longer-term data to identify distal
factors associated with alcohol use. Within the 12-week study period, participants will also be randomly
assigned a 3-week period in which they will complete an ecological momentary assessment (EMA) design. The
EMA design consists of brief, daily morning and evening assessments in “real-time” regarding emotions and
behaviors (i.e., substance use, affect, and eating behaviors), which will allow us to identify the factors
contributing to episodic alcohol use (i.e., proximal factors). We will also examine intended and unintended
drinking. Our long-term goal is to better understand the progression from re-initiation of alcohol use, to heavy
use, to development of an AUD, which will assist in targeting interventions to prevent AUDs. In addition to
being the first study to examine distal and proximal factors of post-surgical alcohol use, this project contains
multiple innovative components including an EMA design which allows for the examination of unintended
drinking. Further, given participants will have varying histories of alcohol use prior to surgery, we will explore
whether distal and proximal predictors are differentially predictive of drinking among those with and without a
history of heavy drinking prior to surgery. The proposed line of research is significant and relevant to NIH’s
mission because it will lead to tailored, effective interventions to reduce alcohol use and prevent the
development of an alcohol use disorder among patients at high risk (i.e., those who undergo bariatric surgery).
