Many of us are familiar with the real danger of alcohol addiction following surgery. Why this is the case is matter of debate. Reasons suggested are:

• Transference of food for self soothing, to alcohol
• Change in stomach structure which seems to change absorption depending on the form of WLS

In another discussion board someone suggested the Sinclair Method as an alternative to AA. This had me really intrigued. My sister and several friends are in recovery and help other alcoholics. Dr. Sinclair did his work in Finland where he showed that 70%+ of problem drinkers were able to stop or greatly reduce their alcohol consumption by taking Naltrexone one hour before drinking. This drug was initially used to treat addiction to heroin. It blocks the release of endorphin's taking away the high, which lead to people being able to quit. (See this summary from a neutral source: http://www.centersite.net/poc/view_doc.php?type=doc&id=11132&cn=14).

What has me intrigued is the language we naturally use in our discussion of addictions be it food or alcohol..."Relationship." Many of us used to think of food as "our friend." And I know people who use the same word to describe their past relationship with drugs and alcohol. But we use the the term "friendship" in the past tense because when you are in the grip of addiction you don't realize the relationship. You just know panic if you thought it was going away. I think this is a point of reference most of us can understand when we look back, but we couldn't see it before surgery.

Now I'm going to go from what I know, to speculation, and I'm hoping someone may be able to point me in the right direction.

I think the transference starts because some WLS people who start drinking start feeling the same soothing they used to get from food from alcohol. The gaba receptors receive endorphin's which gives a warm feeling akin to sex or a close relationship. It's artificial, but to the brain it feels the same. The problem is with alcohol it takes more and more to get that feeling we all naturally want.

For those of you who are familiar with Bill W and the AA model, this is what they refer to the disease of alcoholism. At the time of AA's founding there were no MRI or PET scans to show how the brain reacts to certain chemicals, but now we can see exactly what parts of the brain react. And from what I've seen as a lay person is the you can give someone a drink or an orgasm and the same gaba receptor parts are going to light up. (This is not to say these are equivalent, just in that section of the brain).

The nation of India's Health Department recently suggested that Neltrexone be given to people before they have an alcohol problem which is interesting. Alcoholism is so bad there that they think this inexpensive drug might prevent people from becoming alcoholics.

This is where I think there is an intriguing question, "Can we prevent WLS patients from developing a problem with alcohol by giving them Neltrexone if they decide they want to drink after the requisite few months post surgery? Now I'm sure there are those who will say "well you shouldn't drink anyway." Yes and teens shouldn't have sex before marriage, bla bla bla. I don't care. People will drink and are free to do so if they are over 21 in the US. What I'm thinking about is harm reduction and alcoholism prevention. Alcoholism is a real and expensive problem, and if it can be prevented, it is worth it.

So if anyone knows about this or any research in this area please post.

If anyone has fears that they have or are becoming alcohol dependent, but are scared to think about stopping drinking, Google The Sinclair Method. This isn't new. Neltrexone has been approved by the FDA for alcohol treatment since 1994. The science backing it up is solid. You just have not heard of it because most of the people who do treatment are abstinence only and they have a strong bias in that direction. Neltrexone is not a licence to drink, but may be one of the best tools to stop someone from hitting rock bottom helping them get control and I think a possible preventive medication but the idea of it as preventative is speculation on my part.

I know this is kind of deep, but we have people here with a great deal of education and experience and I'm curious.

WOW, very interesting. I have never heard of Neltrexone. If they advertise Chantix for smokers (and they do quite heavily!), why do we not hear about Neltrexone or see ads for it? As much grief drinking has caused me (usually from running my fat mouth..), I know I would buy it!

@@Malin - Because unlike Chantix, it's cheap. I hate to sound conspiratorial, but if there isn't any money in it, no one is going to pay to advertise it. And it is just so counter to what we think we should do..."oh you have an alcohol problem, take this and in an hour pour yourself a drink." But it only works if you drink. But from what I have read, God help you if you use it for a while and then quit. You will relapse much harder and faster than when you began because the brain increases the number of receptors to make up for the blocking mechanism of Nalterxone. That's the trade off.

Gotcha. And you're absolutely right, if there's no big profit in it there's no advertising. There were a few raging alcoholics in my family (notice the past tense usage...), and something like Neltrexone could have saved their lives.

I like this but I think the alcoholism transference is more complicated than soothing with alcohol instead of food.

We are skipping the mental component that a lot of people didn't really live life before WLS and are now enjoying life, sometimes in a way they never did before, and they are just going off the rails on partying. Some of us did that in College when everyone else was doing it, no need to repeat. There are other people that never had that chance and didn't learn the lessons of partying early on (all parties are the same, seriously, facts, thus one doesn't matter more than the next).

Which is why more comprehensive post-op therapy is necessary for a lot of people.

I don't want to derail this convo, I like where this is going but I still feel like everyone really ignores the mental and emotional aspects of massive weight loss for some people.

@@OutsideMatchInside - Damn good point. I just didn't think about that because I have stayed in touch with my therapist who I was seeing about other issues way before WLS. He liked my results so much, he decided to have it himself. (Kind of weird to warn your shrink about hormone dumps, but at least his wife enjoyed it).

I was on a diet pill last year that had naltrexone and bupropion in it (Contrave). A one month prescription was over a hundred dollars.

Sent from my iPhone using the BariatricPal App

Very thought provoking and well presented. I am with you 100% regarding the chemical effects of food on the brain and how it is similar across addictions. Your argument for transference makes a lot of sense. But personally, I would not want to take a drug prophylactically solely based on an increased statistical risk within the full population of WLS patients.

@@bananashake - I found it online for about $11 a month. Before you say "that's dangerous," the Indian pharmaceutical companies produce most generics in the US. I was surprised when I did a stint at the Justice Department that Big Pharma did not want us to investigate the quality of what was being sent to the US. I found out later that it was because the quality was so good. An online Viagra is the same as you would get at CVS. I was actually shocked there was more of a counterfeiting problem in US drug stores than online from over seas. The reason why is actually interesting...online overseas pharmacies don't want to lose their credit card processing services. When people get bad product, they return it, and too many charge-backs result in being disconnected.

I had an online chat with Roy Eskapa, PhD who was Dr. Sinclair's associate about this...

Now here is my question, has anyone looked into using Nax before they develop an alcohol problem? For instance, if someone has had WLS, hit's their goal weight and then wants to drink, can they take it as they start to keep the gaba receptors from beginning the cycle of dependence? The Indian Department of Health seems to be close recommending as a prophylactic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899995/. I don't know if anyone has studied this, or if you have.

HAS NO EFFECT WE KNOW OF ON GABA BUT BLOCKS THE OPIOID SYSTEM. (WE RAN A SMALL TRIAL IN INDIA -- AMONG RURAL POOR -- WHEN THE MEDICATION RAN OUT OF FUNDS THOSE WHO SAMPLED ALCOHOL SOON RETURNED THE HEAVY DANGEROUS DRINKING

SINCLAIR PROVED IN THE LAB ANIMALS THAT EVEN IF THEY CARRIED THE GENETIC PREDISPOSITION FOR ALCOHOL IF THEY WERE GIVEN NALOXONE OR NALMEFENE OR NALTREXONE THEY COULD NOT LEARN THE DRINKING RESPONSE ...

SO HIS (Dr. Sinclair's) BIG THING BEFORE HE PASSED AWAY WE DISCUSSED IN HIS CABIN IN MARCH 2015 THAT EVENTUALLY FOLKS WOULD BE ABLE TO TEST IF THE GENES FOR MUTATION ON MU OPIOID RECEPTORS COULD BE RELIABLY TESTED THEN PARENTS COULD WARN CHILDREN ABOUT DRINKING AND YES IF THEY DID DRINK THEY SHOULD TAKE THE MEDICATION 1 HOUR BEFORE. IF THERE IS NO TEST YET CONFIRMED AS VALID AND RELIABLE THEN IF THERE IS A BLOOD RELATIVE WITH AN ADDICTION MEDIATED THROUGH THE OPIOID SYSTEM THEN IT IS WISE TO USE THE MEDICATION AS OUTLINED IN THE BOOK THE CURE FOR ALCOHOLISM

Here are a couple of items of note:

1. In 1990, Blum found a correlation between alcoholism and a genetic deficiency in dopamine-binding receptors in the brain, called D2 receptors. People with compromised D2 receptors seek higher thrills to satisfy their reward cravings than people with normal D2 receptors, Blum believes. He predicts that gastric bypass patients with a D2 deficiency turn to other high-reward activities, such as drinking alcohol, because they can’t binge eat with a constricted stomach.

2. There’s little evidence of higher alcoholism rates after a different common bariatric surgery: gastric banding. Also known as lap banding, this surgery installs an inflatable belt around the stomach to constrict it. Unlike gastric bypass, banding does not permanently alter the stomach’s architecture.

The difference between the two surgeries suggests that alcohol abuse is related to structural changes from gastric bypass, said Alexis Conason, a New York City psychologist and researcher.

In 2012, Conason published a study in JAMA Surgery that found a significant increase in alcohol use for patients after gastric bypass, but not gastric banding. The study also found no significant increase in patients’ use of other drugs, including cigarettes, or compulsive behaviors such as gambling. “If it were addiction transfer, we’d be seeing it across the board,” Conason said.

Researchers have proposed a few physiological explanations for increased alcoholism specifically after gastric bypass. Some believe it’s due to changes in alcohol metabolism, since alcohol enters the bloodstream more quickly in a smaller stomach. A 2011 study from surgeons at Stanford University found that six months after surgery, gastric bypass patients reached higher blood alcohol levels more quickly than they did before surgery. This type of fast and high peak often characterizes addictive drugs, said North Dakota’s Mitchell. Cocaine and heroin, for example, both produce brief, intense rushes that leave users wanting more.

But it’s also possible that increased alcohol dependence has nothing to do with alcohol absorption in the stomach. Recently, a team of researchers led by neuroscientists at the Pennsylvania State University College of Medicine found that rats that had been given gastric bypasses developed a higher dependence on alcohol. Here’s the twist: the effect held even when the rats were given alcohol intravenously instead of orally. The authors concluded that alcohol abuse after gastric bypass could very well occur independently of how quickly alcohol passes from the gut to the bloodstream.

Instead, anatomical changes to the stomach might impact patients’ dopamine response, the Penn State researchers suggested. Some scientists have found that gastric bypass surgery can alter the signaling of D2 receptors. The mechanism for this is unclear, although preliminary research has identified altered patterns of gene expression in areas of the brain that process dopamine. Other researchers suggest that appetite-mediating gut hormones play a role, particularly those that affect dopamine signaling, such as insulin, leptin and grehlin. Scientists have shown that leptin and grehlin levels change after gastric bypass surgery, and both hormones are known to modulate alcohol consumption.

http://scienceline.org/2015/01/alcoholism-after-gastric-bypass-is-it-in-your-mind-or-gut/

Alcohol absorbtion changes post surgery in bi-pass and sleeve, but not so with the band...

The authors concluded that alcohol absorption was considerably modified after sleeve gastrectomy with higher and longer blood alcohol values for equivalent amounts of alcohol.

Hagedorn et al. compared 17 controls and 19 postgastric bypass patients after consuming 5 oz of red wine to assess the change in alcohol metabolism [15]. Alcohol breath analysis was performed every 5 minutes. They found peak alcohol breath level of .08% in the bypass patients and .05% in the control group (P = .004). The gastric bypass group needed 108 minutes to reach alcohol breath level of 0 versus 72 minutes in the control group (P = .001). However, the gastric bypass patients didn’t experience more symptoms than the control group.

A prospective crossover study of 19 gastric bypass patients found that postbypass patients have significantly higher peak breath alcohol content after ingesting alcohol (5 oz. red wine) at both 3 months (.059%; P = .0003) and 6 months (.088%; P = .0008) postoperatively than matched preoperative controls (.024%) [16]. Patients also took considerably more time to return to sober at 3 months (61 minutes) and 6 months (88 minutes; P = .01) than preoperatively (49 minutes).

https://asmbs.org/resources/alcohol-use-before-and-after-bariatric-surgery

If you read this study you will see there is a very real need to be vary wary of alcohol use post surgery, and it might be even more dangerous if people in your family have alcohol problems.

But I'm more and more convinced that IF you are going to drink, look up the Sinclair Method http://www.cthreefoundation.org/, , http://www.the-sinclair-method.com/the-sinclair-method-guide/step-5-the-golden-step-staying-cured/.