GLP-1 Drugs Show Promise in Treating Multiple Addictions

About three or four years ago, Ziyad Al-Aly started to notice something curious in his practice as a nephrologist at the VA Saint Louis Health Care System in Missouri. Patients taking a new class of weight-loss drugs, known GLP-1s, reported losing their appetites—and not just for food.

“They told me, Oh you know, I started this GLP-1 medication and all of a sudden, I lost my taste for alcohol,” he says. “I don’t drink anymore. I don’t smoke anymore.”

He might have shrugged it off, but reports accumulated in his clinic and beyond. Oprah Winfrey once downed 17 shots of tequila in a single sitting, she told People magazine. After starting a GLP-1 medication, she stopped drinking alcohol altogether.

Research is quickly catching up. In the last few years, studies have linked GLP-1 drugs like Ozempic and Wegovy with fewer cravings for alcohol, along with lower risks of substance use disorders involving alcohol, cannabis, and nicotine. Even monkeys voluntarily drink less alcohol when given GLP-1 drugs.

But addiction-related benefits may be more far-reaching than previous research suggests, according to a large new study by Al-Aly and colleagues.

People who took GLP-1s for diabetes were less likely to develop addictions in the first place, the researchers found. For those who already had substance use disorders, risk of overdose fell by 39 percent while risk of addiction-related deaths dropped by half. These results applied to a broad list of addictive substances, not just alcohol or smoking. For a few of those substances this is the first time these effects were shown in people.

Current addiction treatments tend to be substance-specific: nicotine patches for cigarettes, methadone for opioid addiction. The new study suggests that GLP-1 drugs might hold clues for the development of a drug for addictions of all kinds, says Al-Aly, a clinical epidemiologist at Washington University in St. Louis.

Because the drugs help across many addictions, they may also provide insight into the biology of addiction in the brain.

“This is not a story about only nicotine or alcohol or heroin or cocaine or opiates,” he says. “It's all of them.”

Glucagon-like peptide-1 receptor agonists, or GLP-1s for short, mimic the GLP-1 hormone that our bodies produce when we eat. This hormone stimulates the production of insulin, which reduces sugar in the blood and appetite in the brain.

Originally approved by the U.S. Food and Drug Administration as a twice-daily injectable treatment for diabetes in 2005, the first GLP-1 drug drew attention for causing people to lose a significant amount of weight too. A newer formulation, called semaglutide, required less frequent shots. And after trials showed dramatic results, FDA approval for weight loss followed in 2021. By the end of 2025, about 12 percent of American adults said they were taking a GLP-1 for weight loss or a condition such as diabetes or heart disease, according to a KFF Health Tracking poll.

As the number of people taking GLP-1s grew, so too did reports about dwindling addictive behaviors. Scientists began tracking the link, but early studies tended to focus on a few main substances, particularly alcohol, tobacco, and cannabis.

To look more broadly at a range of disorders, Al-Aly’s team analyzed health records of more than 606,000 veterans with type 2 diabetes. Over the course of three years, they found, those who took a GLP-1 were 14 percent less likely to develop any substance use disorder compared with those who took a different kind of diabetes drug, called a sodium-glucose cotransporter-2 (SGLT-2) inhibitor.

For every thousand patients, that added up to as many as six people who would have developed a problem with alcohol, cannabis, cocaine, nicotine, or opioids, but didn’t because of the weight-loss drug.

Even more dramatic were benefits for people who already had a substance use disorder. The researchers linked GLP-1 medications to a 39 percent reduction of overdoses, a 31 percent reduction of addiction-related emergency room visits, a 26 percent reduction of addiction-related hospitalization, and a 25 percent reduction of suicidal ideation or attempts. Risk of addiction-related deaths dropped by half. Overall, the drugs led to as many as 20 fewer harmful events per 1,000 people.

“What we're seeing in the data, including in this study, and also anecdotally in clinic is that for some people, [the medications are] very helpful as a kind of a global constraint on appetite, which is really interesting,” says Anna Lembke, a psychiatrist and addiction medicine expert at Stanford University School of Medicine who was not involved in the new study.

Increasingly, research on the link between GLP-1 drugs and addiction offer tantalizing insights into the biology of the addicted brain, experts say, hinting at a future generation of medications designed to tackle addictions at their source.

Studies in animals, including other primates, suggest that GLP-1 receptors are abundant in parts of the brain related to reward-processing, satiety, impulse control, and related processes. These mechanisms have yet to be studied in humans, but people who take the medications often describe a quieting of "food noise,” or incessant ruminations about eating. Al-Aly suspects that they may also lower "drug noise.”

Liberation from the mental load of constant cravings may be why studies are also starting to show relief from depression and improved mood from GLP-1s, Lembke adds. She is working on a study in a non-veteran population that is echoing what Al-Aly’s group found—that the drugs can address many kinds of addictions. Some researchers are investigating their use for behavioral addictions, too, such as gambling and sex.

Not everyone benefits from GLP-1s, Lembke says. In her clinical experience with addiction, the drugs are very effective for some people and not at all helpful for others. Still, she says, the new wave of studies is a welcome development.

Tens of millions of people in the U.S. struggle with addiction, and the number is growing. But treatment options are limited, and the pipeline for new drugs is incredibly slow. Many addiction treatments cause weight gain, which makes people avoid them. GLP-1 drugs are not themselves addictive. And weight loss, for many people, is a bonus.

It is too soon to use GLP-1s as a first-line addiction treatment because there are still too many unknowns, experts say. For example, many people stop taking the medication after they start, and scientists haven’t yet gauged the risk of relapse.

“Do addiction or cravings come back with a vengeance?” Al-Aly says. “That’s a really an important question, because it could undo [the benefits], or lead to even worse outcomes.”

But if someone comes into his clinic with diabetes, Al-Aly plans to take their risk of substance use into account when choosing treatment options.

“Let's say they say, Hey, Doc, I've been trying to quit smoking, and I really haven't been able to for the past 10 years,” Al-Aly says. “I know that if I put them on a GLP-1, I can hit two birds with one stone.”

Lembke urged caution, given the potential for side effects or other adverse outcomes that need to be investigated. But if someone has tried more established interventions without success, she says, it might be worth trying a GLP-1 agonist to address addiction. She currently uses them to treat a variety of addictive disorders primarily related to alcohol and food.

“This is amazing to have a new tool,” she says. “The fact that we haven't had a new tool in our toolbox for a long time makes this a very exciting proposition.”