# Alcohol and Substance Use After Bariatric Surgery: Nutritional Risks and Clinical Implications in Long-Term Postoperative Care

## TL;DR

Bariatric surgery can increase risks for alcohol and substance misuse, leading to health complications that require long-term care and monitoring.

## Contribution

This review highlights the physiological and psychological mechanisms linking bariatric surgery to substance use disorders and proposes a multidisciplinary mitigation framework.

## Key findings

- RYGB surgery alters ethanol metabolism and reward pathways, increasing addiction risks.
- Substance use after MBS correlates with micronutrient deficiencies and liver cirrhosis.
- Screening and nutritional support are critical for preventing long-term complications.

## Abstract

Metabolic and bariatric surgery (MBS) has evolved into a highly effective neurohormonal intervention for severe obesity; however, it introduces unique long-term vulnerabilities, particularly regarding alcohol (AUD) and substance use disorders (SUD). This review synthesizes the epidemiological, pharmacokinetic, and neurobiological drivers of postoperative substance misuse. Procedures like Roux-en-Y gastric bypass (RYGB) radically alter ethanol metabolism, eliminating first-pass metabolism and accelerating gastric emptying, while simultaneously recalibrating reward pathways, creating a “reward gap” that facilitates addiction transfer. These physiological shifts exacerbate critical micronutrient deficiencies (thiamine, B12, iron), increase the risk of post-bariatric hypoglycemia, and correlate with higher rates of liver cirrhosis and suicide. Furthermore, substance use is a primary driver of suboptimal weight loss trajectories and weight regain. Mitigation requires a lifelong, multidisciplinary framework involving preoperative risk stratification, validated screening (e.g., AUDIT-C), and targeted nutritional supplementation to safeguard the long-term metabolic and psychological benefits of MBS.