Neuro-Genetics of Reward Deficiency Syndrome (Rds) as the Root Cause of “Addiction Transfer”: A New Phenomena Common after Bariatric Surgery

Abstract

Now after many years of successful bariatric (weight-loss) surgeries directed at the obesity epidemic clinicians are reporting that some patients are replacing compulsive overeating with newly acquired compulsive disorders such as alcoholism, gambling, drugs, and other addictions like compulsive shopping and exercise. This review article explores evidence from psychiatric genetic animal and human studies that link compulsive overeating and other compulsive disorders to explain the phenomenon of addiction transfer. Possibly due to neurochemical similarities, overeating and obesity may act as protective factors reducing drug reward and addictive behaviors. In animal models of addiction withdrawal from sugar induces imbalances in the neurotransmitters, acetylcholine and dopamine, similar to opiate withdrawal. Many human neuroimaging studies have supported the concept of linking food craving to drug craving behavior. Previously our laboratory coined the term Reward Deficiency Syndrome (RDS) for common genetic determinants in predicting addictive disorders and reported that the predictive value for future RDS behaviors in subjects carrying the DRD2 Taq A1 allele was 74%. While poly genes play a role in RDS, we have also inferred that disruptions in dopamine function may predispose certain individuals to addictive behaviors and obesity. It is now known that family history of alcoholism is a significant obesity risk factor. Therefore, we hypothesize here that RDS is the root cause of substituting food addiction for other dependencies and potentially explains this recently described Phenomenon (addiction transfer) common after bariatric surgery.

Cambio en el patrón de consumo de sustancias posterior a cirugía bariátrica: presentación de un caso clínico

“…Basados en modelos animales y la evidencia existente de estudios en humanos, se han evaluado similitudes neuroquímicas que relacionan formas compulsivas de alimentación con otras conductas compulsivas, sugiriendo que la primera en pacientes obesos, actúa como factor protector de otras conductas como recompensa de drogas y otras conductas adictivas. De esta forma se ha sugerido que la privación de azúcar provoca desbalances en neurotransmisores similares a estados de privación de opioides 18 . Así, se ha acuñado el término de "síndrome de deficiencia de la recompensa" (SDR) referido a la insuficiencia de sentimientos habituales de satisfacción y que serían resultado de una disfunción de ciertas cascadas cerebrales relacionadas a la recompensa que involucran interacción entre diferentes neurotransmisores, principalmente dopamina y opioides 19 .…”

“…Así, se ha acuñado el término de "síndrome de deficiencia de la recompensa" (SDR) referido a la insuficiencia de sentimientos habituales de satisfacción y que serían resultado de una disfunción de ciertas cascadas cerebrales relacionadas a la recompensa que involucran interacción entre diferentes neurotransmisores, principalmente dopamina y opioides 19 . Dichos elementos estarían a la base del cambio de la "adicción a la comida" por otras "adicciones" (fenómeno conocido como "transferencia de la adicción") que permiten explicar, desde otra perspectiva, el aumento del consumo de sustancias de pacientes obesos sometidos a cirugía bariátrica 18 y que en el caso clínico expuesto corresponderían a alcohol y cocaína.…”

Should We Embrace Vaccines for Treating Substance- Related Disorder, A Subset of Reward Deficiency Syndrome (RDS)?

“…We are, however, concerned that simply blocking the effects of the drug of choice, would fail to treat poly-drug abuse. It would also leave the hypodopaminergic trait (genetic) or state (epigenetic) untreated resulting in addiction transfer or other RDS behaviors such as food and process addictions as suggested by Blum et al [19].…”

Bariatric Surgery and Substance Use Disorders, Eating Disorders, and Other Impulse Control Disorders

“…Excessive exercising (see Chaps. 7 and 28) that is often linked to eating disorder pathology and extreme fear of regaining weight may also result (Blum et al, 2011;Larsen et al, 2006). Post-bariatric surgery patients frequently suffer from redundant skin.…”