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

对于严重肥胖的患者来说，减肥手术是最有效的减肥治疗方法；然而，1/2 5例患者手术后出现酒精使用障碍(AUD)。手术后，情况发生变化 新陈代谢、荷尔蒙水平和行为会改变酒精的奖赏效应，同时也会改变 它的吸收率，使患者危险饮酒的风险显著增加。为了更好地理解 减肥手术后AUDS的发展，我们必须首先确定导致再次开始饮酒的因素 并升级为酗酒。前景看好的领域包括情绪和饮食行为。该计划的目的是 建议的研究是确定导致酒精重新启动和发作的远端和近端因素。 在减肥手术后使用。我们将使用探索性的顺序混合方法，并首先获得 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(N=30)，以确定他们消费的原因 减肥手术后的酒精。我们还将询问频率、数量和前身和 间歇性饮酒的后果(即情绪、饮食行为)。此信息将用于通知 量化数据阶段(即最终确定要评估的结构、如何以及何时测量这些变量，以及 评估的频率)。在定量阶段，患者(N=100)也将在6岁之间招募 术后3个月和3年。参与者将完成对物质使用、情绪和饮食的测量 基线时以及基线后6周和12周的行为，以捕获长期数据以识别远端 与饮酒有关的因素。在为期12周的研究期间，参与者也将随机 分配了3周的时间，在此期间他们将完成生态瞬时评估(EMA)设计。这个 EMA设计包括关于情绪和情绪的简短的每日早晚评估 行为(即，物质使用、情感和饮食行为)，这将使我们能够识别因素 导致间歇性饮酒的因素(即近端因素)。我们还将检查有意和无意的 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过程 使用，以开发AUD，这将有助于有针对性的干预措施，以预防AUD。除了……之外 作为第一项检查手术后饮酒远端和近端因素的研究，该项目包括 多个创新组件，包括EMA设计，允许检查意外情况 喝酒。此外，考虑到参与者在手术前有不同的饮酒史，我们将探索 远端和近端预测因子对饮酒的预测在有无A的人群中是否存在差异 手术前有大量饮酒史。建议的研究路线对美国国立卫生研究院的 因为它将导致量身定做的、有效的干预措施，以减少酒精使用并防止 在高危患者(即那些接受减肥手术的患者)中出现酒精使用障碍。

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).