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Substance use disorder (SUD) following bariatric surgery is a significant concern. Researchers have hypothesized that patients may supplant binge eating disorder (a common comorbidity with obesity) with more rewarding, addictive behaviors for coping with adversity and stress, a phenomenon known as ‘addiction transfer’. Thus, the objective of this study was to identify new-onset cases of diagnosed SUD among post-bariatric patients and compare these rates to those in the general population as well as those diagnosed with overweight or obesity.


Data for this study were extracted from TriNetX Research Platform and used to build three cohorts of adults (those who had bariatric surgery, the general population, and a population with obesity) from January 1, 2018 to June 30, 2019. Those with a history of SUD were excluded. Included individuals were followed for two years, and incident SUD was tracked.


Overall, incident SUD was calculated at 6.55% (n=1544) of those who had bariatric surgery. When compared to the general population, persons who had any type of bariatric procedure had no increased risk of newly diagnosed SUD with an overall odds ratio (OR) [95% Confidence Limits; CL] of 0.89 [0.86, 0.93]. When compared to persons with obesity, bariatric patients were less likely to develop any form of SUD (OR: 0.65 [0.62, 0.67]).


While bariatric surgery may be protective against SUD for those who have had bariatric surgery, efforts should still be made to address new onset SUD as well as other addictive behaviors in order to support the recovery of post-surgical patients.