Identifying Factors Influencing Alcohol Use after Bariatric Surgery: An Ecological Momentary Assessment

减肥手术是严重肥胖患者最有效的减肥治疗;然而， 5例患者在接受手术后出现酒精使用障碍（AUD）。手术后， 新陈代谢、激素水平和行为改变了酒精的奖励效应，同时也改变了酒精的作用。 它的吸收率，使患者在危险饮酒的风险显着增加。更好地了解 减肥手术后AUDs的发展，我们必须首先确定导致重新开始饮酒的因素 然后升级为酗酒有希望的领域包括情绪和饮食行为。的目的 建议的研究是确定远端和近端的因素，有助于重新启动和偶发性酒精 减肥手术后使用。我们将使用探索性的顺序混合方法方法，首先获得 定性数据为定量阶段提供信息。在定性阶段，我们将对患者进行访谈 减肥手术后6个月至3年的患者（N= 30），以确定他们食用的原因 减肥手术后饮酒我们还将询问频率，金额和前因， 间歇性饮酒的后果（即，情绪、饮食行为）。这些信息将用于通知 定量数据阶段（即，最后确定要评估的结构，如何以及何时测量这些变量，以及 评估的频率）。在定量阶段，还将招募6名患者（N= 100）， 术后3个月和3年。参与者将完成物质使用，情绪和饮食的测量 基线时以及基线后6周和12周的行为，以采集长期数据， 与酒精使用相关的因素。在为期12周的研究期间，参与者还将被随机 在为期3周的时间内，他们将完成生态瞬时评估（EMA）设计。的 EMA设计包括简短的，每天早上和晚上的“实时”情绪评估， 行为（即，物质使用，影响和饮食行为），这将使我们能够确定因素 导致间歇性酒精使用（即，近端因素）。我们还将检查有意和无意 喝酒我们的长期目标是更好地了解从重新开始饮酒到重度饮酒的进展。 使用，以制定AUD，这将有助于有针对性的干预措施，以防止AUD。除了 作为第一项研究，检查手术后酒精使用的远端和近端因素，该项目包括 多个创新组件，包括EMA设计，允许检查非预期的 喝酒此外，鉴于参与者在手术前有不同的饮酒史，我们将探讨 远端和近端预测因子是否对有和没有饮酒的人有不同的预测作用？ 手术前有酗酒史拟议的研究路线是重要的，并与NIH的 使命，因为它将导致量身定制的，有效的干预措施，以减少酒精的使用和预防 在高风险患者中发生酒精使用障碍（即，进行减肥手术的人）。

Bariatric surgery is the most effective weight loss treatment for patients who are severely obese; however, 1 in 5 patients develop an alcohol use disorder (AUD) after undergoing surgery. After surgery, changes in metabolism, hormone levels, and behaviors alter the rewarding effects of alcohol while concurrently changing its absorption rate, putting patients at significantly elevated risk of hazardous drinking. To better understand the development of AUDs after bariatric surgery, we must first identify factors leading to re-initiation of alcohol use and escalation to heavy drinking. Promising areas include mood and eating behaviors. The purpose of the proposed study is to identify the distal and proximal factors that contribute to re-initiation and episodic alcohol use following bariatric surgery. We will use an exploratory sequential mixed methods approach and first obtain qualitative data to inform the quantitative phase. In the qualitative phase, we will conduct interviews of patients who are between 6 months and 3-years post-bariatric surgery (N= 30) to identify the reasons they consumed alcohol after bariatric surgery. We will also inquire about the frequency, amount, and the antecedents and consequences of episodic alcohol use (i.e., mood, eating behaviors). This information will be used to inform the quantitative data phase (i.e., finalize the constructs to assess, how and when to measure these variables, and the frequency of assessment). In the quantitative phase, patients (N= 100) will also be recruited between 6 months and 3-years post-surgery. Participants will complete measures of substance use, mood, and eating behaviors at baseline and at 6- and 12-weeks post-baseline to capture longer-term data to identify distal factors associated with alcohol use. Within the 12-week study period, participants will also be randomly assigned a 3-week period in which they will complete an ecological momentary assessment (EMA) design. The EMA design consists of brief, daily morning and evening assessments in “real-time” regarding emotions and behaviors (i.e., substance use, affect, and eating behaviors), which will allow us to identify the factors contributing to episodic alcohol use (i.e., proximal factors). We will also examine intended and unintended drinking. Our long-term goal is to better understand the progression from re-initiation of alcohol use, to heavy use, to development of an AUD, which will assist in targeting interventions to prevent AUDs. In addition to being the first study to examine distal and proximal factors of post-surgical alcohol use, this project contains multiple innovative components including an EMA design which allows for the examination of unintended drinking. Further, given participants will have varying histories of alcohol use prior to surgery, we will explore whether distal and proximal predictors are differentially predictive of drinking among those with and without a history of heavy drinking prior to surgery. The proposed line of research is significant and relevant to NIH’s mission because it will lead to tailored, effective interventions to reduce alcohol use and prevent the development of an alcohol use disorder among patients at high risk (i.e., those who undergo bariatric surgery).