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. 2025 Apr;35(4):1242-1250.
doi: 10.1007/s11695-025-07774-z. Epub 2025 Mar 12.

Alcohol and Other Substance Screening in Bariatric Surgery Candidates: Utility of Self-Report and Toxicology Tests, Including Ethyl-Glucoronide

Silvia Cañizares  1   2 , Laura Nuño  3 , Pablo Barrio  3 , Mireia Forner-Puntonet  4 , Carolina Gavotti  3 , Miquel Monràs  3 , Patricia Gavín  5 , Ricard Navinés  6   7 , Lilliam Flores  7   8 , Maite Barrios  9 , Alba Andreu  7 , Judit Molero  7 , Amanda Jimenez  7   8 , Josep Vidal  7   8 , Anna Lligoña  3
Affiliations

Alcohol and Other Substance Screening in Bariatric Surgery Candidates: Utility of Self-Report and Toxicology Tests, Including Ethyl-Glucoronide

Silvia Cañizares et al. Obes Surg. 2025 Apr.

Abstract

Following bariatric surgery (BS) patients have an increased risk of alcohol misuse.

Purpose: This 1-year cross-sectional study in potential BS candidates had several objectives: (a) assess the prevalence of risky drinking, alcohol use disorder (AUD), and other substance use/disorder; (b) compare the prevalence of these behaviors to that of the general Spanish population; (c) determine the proportion of patients with positive results in toxicology tests; and (d) study the predictive factors of risky drinking.

Setting: tertiary university hospital.

Materials and methods: Alcohol and other substance use were evaluated with the AUDIT-C and ASSIST questionnaires. Urine tests analyzed several markers (ethyl-glucoronide [EtG] ≥ 500 ng/ml, amphetamine, benzodiazepine, cannabinoid, cocaine, and opioid). The Mini-International-Neuropsychiatric-Interview (5.0.0) was employed to assess psychiatric diagnoses.

Results: Among 308 candidates for BS, 196 were accepted to participate (69% women; mean age 46.7 ± 10.9 years; mean body mass index 45.6 ± 5.9). AUDIT-C and ASSIST identified 7% and 5% of risky drinkers, respectively. Men were more frequently risky drinkers compared to women (18% vs. 2%) and compared to the general population (18% vs. 8%). Six percent of individuals had AUD, being men the most affected, and 2% met criteria for other substance disorder. Fifteen percent of the sample presented risky tobacco use. Cannabis was self-reported only by males (3%). EtG ≥ 500 ng/ml was present in 15% of the sample, being a risk factor for risky drinking together with the male sex.

Conclusion: Identification of candidates at risk for risky drinking can help to prevent any alcohol misuse after BS. The combination of subjective and objective measures improves the validity of the assessment of substance use.

Keywords: ASSIST; AUDIT-C; Alcohol; Bariatric surgery; Drugs; Ethyl-glucuronide; Obesity; Risky drinking; Toxicology.

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Conflict of interest statement

Declarations. Ethics Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethical Review Board of our institution (HCB/2016/0666). Consent to Participate: Informed consent was obtained from all individual participants included in the study. Conflict of Interest: The authors declare no competing interests.

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