A Technology-based Intervention to Reduce Alcohol Use after Bariatric Surgery - Despite bariatric surgery being the most effective weight loss intervention for patients who are severely obese,
as many as 1 in 5 patients will develop an alcohol use disorder after their surgery. Changes in metabolism,
hormone levels, and behavior as a result of bariatric surgery alter the rewarding effects of alcohol while
concurrently changing its absorption rate, putting patients at significantly elevated risk of hazardous drinking.
Simply providing education to this vulnerable patient population about post-surgical risks has not been
sufficient to reduce alcohol use, yet comprehensive in-person interventions are met with significant challenges,
including hours-long distances between patients and their bariatric surgery programs. Thus, our long-term goal
is to increase access to an empirically-supported intervention for reducing alcohol use among patients who
undergo bariatric surgery by leveraging technology. Our intervention, rooted in motivational interviewing and
the transtheoretical model, is a two-session computerized brief intervention (CBI), supplemented by six months
of tailored text messaging based on participants’ CBI results and subsequent fluctuations in their readiness to
change. The purpose of the proposed study is to optimize this technology-based intervention for patients who
undergo bariatric surgery and to examine feasibility and acceptability of the intervention. In the first phase,
patient interviews (n= 20) will be utilized to identify preferences for intervention content and treatment delivery.
Ten patients will then participate in an open trial of the intervention, which will be subsequently revised based
on feedback from these patients. In Phase 2, patients (N = 60) will be recruited between 3 and 6 months
following bariatric surgery and randomized to the intervention or treatment as usual control group. All patients
will complete baseline questionnaires and at 1, 3, 6, and 9 month post-assessments. We expect that this
intervention will be both feasible and acceptable to patients. Results will be used as preliminary data to inform
a large, fully-powered clinical trial to test the larger efficacy of this intervention. Although primary outcomes
focus on feasibility and acceptability, we also expect that patients assigned to the intervention will have a
longer time to their first post-surgical drink, report more days of abstinence, fewer drinks per drinking day, and
a lower prevalence of alcohol use disorder after bariatric surgery compared to controls. This project is
innovative because it expands upon existing interventions for bariatric surgery patients by implementing
evidence-based strategies for alcohol use. By utilizing a technology-based approach, we can also reach a
larger number of patients to prevent initiation of drinking, reduce current alcohol use, and facilitate better
engagement in care, should individuals opt into traditional treatment approaches. The proposed line of
research is significant and relevant to NIH’s mission because the intervention is expected to reduce the
likelihood that patients will develop an alcohol use disorder following bariatric surgery. Given the potential of
wide dissemination at low cost, the proposed study has high potential public health and clinical significance.
