Finally, it is interesting to note that RYGB and SG are effective partly because they dramatically raise endogenous glucagon-like peptide 1 (GLP-1), improving glycemic control and weight loss (253). Given the current enthusiasm for GLP-1 receptor agonists to treat alcohol misuse (reviewed in (254)), it seems paradoxical that surgeries that elevate GLP-1 also elevate AUD risk. The risk, however, follows a temporal pattern: 40–50% of patients with high-risk alcohol use before surgery reduced drinking within the first postoperative year (233, 255–257), but AUD incidence rises sharply two or more years later (233, 258, 259). This delay points to evolving neuroadaptations that, together with altered alcohol pharmacokinetics and pharmacodynamics, ultimately heightened vulnerability.
