"I didn't see this coming.": why are postbariatric patients in substance abuse treatment? Patients' perceptions of etiology and future recommendations.

Background: Recent evidence suggests that bariatric patients may be overrepresented in inpatient substance abuse treatment, but the reasons for this are unclear. Patients' perceptions of this problem may be of heuristic value. Using a qualitative approach, the present study evaluated bariatric patients' impressions of how their postsurgical substance use disorders emerged and their future recommendations for those working with bariatric patients.

Methods: Semi-structured interviews were conducted with 24 bariatric patients in an inpatient substance abuse treatment program. Seven prominent themes emerged, four referring to etiology of substance use (unresolved psychological problems, addiction transfer/substitution, faster onset or stronger effects from substances, and increased availability of pain medications) and three pertaining to future recommendations (counseling pre- and/or postsurgery, increased knowledge of the associated risks of substance use postsurgery, and greater "honesty"). Blind coders rated the presence or absence of each theme in each interview.

Results: Of the four etiology themes, 75 % of patients acknowledged unresolved psychological problems, 83.33 % identified addiction transfer/substitution, 58.33 % noticed faster onset or stronger effects from substances, and 45.83 % identified increased availability of pain medications. For future recommendations, 41.67 % suggested counseling pre- and/or postsurgery, 70.83 % suggested increased education about the associated risks of substance use postsurgery, and 41.67 % identified a need for greater "honesty."

Conclusions: Patient perceptions suggest that several common themes may be related to risk for the development of postsurgical substance use disorders.