Addictive Disorders in Severe Obesity and After Bariatric Surgery
In this chapter, we discuss addictive disorders in severe obesity, a very important clinical consideration in this patient population. The chapter begins with an overview of the prevalence of substance use disorders in severely obese and bariatric surgery
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Carrol Zhou and Sanjeev Sockalingam
11.1 Introduction In this chapter, we discuss addictive disorders in severe obesity, a very important clinical consideration in this patient population. The chapter begins with an overview of the prevalence of substance use disorders in severely obese and bariatric surgery patient populations, followed by a discussion of the neurobiological and physiological correlates of addiction and obesity. We discuss tools for addiction screening and summarize the various forms of psychosocial and pharmacological treatment options for addiction in the context of severe obesity. We finish the chapter with a vignette to help integrate the information learned in this chapter into a clinical scenario.
C. Zhou, M.D. Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, Canada M5T 1R8 e-mail: [email protected] S. Sockalingam (*) Toronto Western Hospital Bariatric Surgery Program, Centre for Mental Health, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Department of Psychiatry, University of Toronto, Toronto, ON, Canada e-mail: [email protected]
11.2 P revalence of Substance Use Disorders 11.2.1 Substance Use Disorders in Bariatric Surgery Candidates Past research has shown that a higher body mass index (BMI) is associated with higher rates of substance use and substance use disorders [1, 2]. The lifetime prevalence of a substance use disorder in bariatric surgery candidates ranges between 24 and 35 % [3–5]. The rate of current substance use disorders at the time of surgery is significantly lower, ranging from 1 to 7.6 % [3, 6]. In a recent meta-analysis of all studies examining psychiatric disorder prevalence rates in bariatric surgery candidates, the current rates for any substance use disorder were 3 % [7]. Although the low rates of current substance use disorders in bariatric surgery candidates could represent true remission, patients may also be underreporting current substance use due to concerns about delays in surgery, a result of an active substance use disorder. Alcohol use disorder (AUD) is the most studied substance use disorder in the bariatric surgery patient population. Data from bariatric surgery candidates suggests that the prevalence of AUDs is similar to that of the general population (7.6 % versus 8.5 %) [4]. Although additional research
© Springer International Publishing AG 2017 S. Sockalingam, R. Hawa (eds.), Psychiatric Care in Severe Obesity, DOI 10.1007/978-3-319-42536-8_11
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suggests that the prevalence of lifetime AUDs is higher among candidates for bariatric surgery compared to the general population in North America, some studies have not replicated this finding [3, 8–10]. Prevalence rates for cigarette smoking in bariatric surgery candidates have been as high as 38 % in the literature, with more than half of these patients reporting heavy smoking [11]. Moreover, several studies suggest that rates of cigarette smoking in bariatric surgery candidates do not signi
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