Alcohol-use disorders after bariatric surgery: The case for targeted group therapy

Process and observations. Participants described high levels of excitement and hopefulness about being in a group with other WLS patients who had developed SUDs. They had a particular interest in reviewing medical/anatomical information about WLS and understanding more about the potential reasons for the elevated risk for developing SUD following WLS. Discussions regarding weight stigma proved to be quite emotional; most participants reported that this material readily related to their own experiences with weight stigma, but they had never discussed these ideas before.

Participants explored the role that grief, loss, guilt, and shame had in the decision to have WLS, the development of SUDs, weight regain or medical complications from the surgery or from substance abuse, career and relationship changes, and worsened body image. Another theme that emerged was the various reasons that prompted the members have WLS that they may not have been conscious of, or willing to discuss with others, such as pressure from a spouse, fears of remaining single due to their size, and a desire to finally “fit in.”

Repeatedly, group members expressed how satisfied and emotionally validated they felt being with people with similar experiences. Most of them had felt alone. They reported a belief that “everyone else” who had WLS was doing well, and that they were the exceptions. Such beliefs and emotions increased the risk of relapse and decreased participants’ ability to develop more positive coping strategies and self-care skills.

Participants reported that feeling less alone, understanding how stigma impacts health and well-being, and focusing on the general benefits of good self-care rather than the pursuit of weight loss were particularly helpful. The HAES and fat acceptance approaches have given group members new ways to think about their bodies and decreased shame. Several group members reported that if they had learned about the HAES approach prior to having a WLS, they might have made a different decision about having surgery, or at least might have been better prepared to handle the emotional and psychological challenges after WLS.

Although evidence for post-WLS addictions is fairly robust, causal mechanisms are not well understood, and research identifying specific risk factors is lacking. Because post-WLS patients with addictions seem to represent a specific phenotype, specialized treatment might be indicated. Future research will be needed to determine optimal treatment approaches for post-WLS addictions. However, a number of aspects are likely to be important. For example, it is likely that unaddressed experiences of weight stigma contribute to challenges, including substance abuse, after WLS; therefore, clinicians involved in the care of individuals presenting with post-WLS SUD should be knowledgeable about weight stigma and how to address it. Because of the specific nature of post-WLS addictions, patients often feel alone and isolated, and seem to benefit from the specialized group setting. We note that the PWAG group leader is herself a large person who models fat acceptance and follows the HAES approach, and therefore led the group using this experience and her specialized clinical training. As with other addiction recovery treatment modalities, clinicians who have lived the experience can add a valuable component to the program design and patient experience.