Reported by Lauren Hughes, MD

Weight-loss surgery can help people who are obese ditch their unhealthy relationships with food. But a new study suggests these patients sometimes enter a rebound relationship with something else - alcohol, drugs or cigarettes.

The survey-based study of 155 bariatric surgery patients found a 50 percent rise in the frequency of substance abuse two years after the procedure.

"Many people who undergo bariatric surgery struggle with eating in response to different emotional cues," said Alexis Conason of the New York Obesity Nutrition Research Center, lead author of the study published Monday in the Archives of Surgery. "I [wondered] what happened afterward. If they are no longer able to cope with their emotions through eating … do they turn to something like drugs or alcohol to serve the purpose that food did originally."

Conason tested the theory of symptom substitution - the swapping of one habit for another. Patients who drank and smoked before surgery reported more drinking and smoking two years after. And while one in 25 patients reported using recreational drugs before the procedure, one in eight said they used them two years later. But Conason stressed that much more research is needed.

"The emerging body of literature [on this] is in its infancy," she said, stressing that her study focused on frequency of substance use but not on the quantity of substances consumed or whether doing so caused problems for either the patients or their family members. "We have a small sample size, so it's going to be important to see how this is replicated with larger samples. We need to [better understand] the problematic nature of the substance use … the reasons why."

Some experts think the uptick in substance use might be related to social behaviors.

"What this study may be showing is that morbidly obese people are socially isolated," said Dr. Christine Ren-Fielding, chief of bariatric surgery division in the department of surgery at New York University Langone Medical Center. "After surgery, they not only become physically healthy but mentally healthy and now become more social. They go out on dates and go to parties which may involve a social alcoholic drink."

The frequency of alcohol use among bariatric patients prior to surgery was very low, Ren-Fielding added.

"Perhaps after surgery, the frequency of alcohol use in bariatric patients normalizes to approach the frequency of alcohol consumption in the lean population," she said.

The rise in substance abuse over two years followed an initial decline that Conason attributes to strict instructions for the recovery period after surgery. She said patients should be followed closely to ensure they are maintaining a healthy weight and adjusting well to their new bodies, emotions and relationships.

The length of time needed for follow-up varies by patient and his or her situation, Conason said, adding that she still sees patients who had weight-loss surgery ten years ago.

Patients should also be on the lookout for symptoms of alcohol trouble, such as drinking to the point of excess or escalating use that interferes with work or family responsibilities. If these issues arise, they should talk with their doctors and mental health professionals or seek help through local bariatric support groups, according to Conason.

"The road for bariatric surgery is not an easy one," she said. "Many people say you are taking the easy way out. [Bariatric surgery] requires a lot of work. The surgery date is the beginning of a process of emotional growth and discovery, as well as changes in your weight and other types of behaviors."