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Alcoholism
Can GLP-1 Agonists Treat Alcoholism?
The current state of research on GLP-1 agonists for treating addiction.
Posted December 9, 2024 Reviewed by Gary Drevitch
Key points
- Approximately 30 million Americans are believed to have alcohol use disorder (AUD).
- Despite being widespread, AUD, like all substance use disorders, is very difficult to treat.
- Anecdotal and preclinical evidence has indicated that GLP-1 agonists can help people reduce alcohol intake.
- Preliminary evidence indicates some people with AUD may respond to treatment with GLP-1 agonists.
Glucagon-like peptide-1 (GLP-1) receptor agonists have quickly become some of the most ubiquitous drugs in the United States. Though they were originally indicated to treat diabetes, and to assist nondiabetic patients with weight loss, the drugs are now believed to have a wider range of applications, particularly in psychiatry.
Recent research has explored the potential role of GLP-1 agonists in the treatment of substance use disorders, particularly alcohol use disorder (AUD). Substance use disorders (SUD) are quite common, with an estimated 46.3 million Americans over age 12 meeting DSM-5 criteria for an SUD, with 29.5 million of that group meeting the criteria for AUD. Both disorders are notoriously difficult to treat, as they represent far more than just a problematic relationship with a substance or a fear of withdrawal symptoms. Individuals with substance use disorders regularly place the substance at the center of their daily lives and routines, and abstinence does not just mean quitting the substance; it requires one to abandon their routines and potentially disrupt relationships with coworkers, friends, and even family.
Because of alcohol’s legality, routines that are based on alcohol can be socially acceptable and may even be benign within the proper context. For example, meeting up with friends for happy hour is a completely normal activity, especially if it only happens a few times per month. However, the routine becomes problematic if one is frequently going to happy hour multiple nights per week, having more than just one or two drinks, and then continuing to drink once happy hour is over.
Even though people who engage in this kind of behavior may not experience intense cravings for alcohol or ruminate about it when they are not drinking, they struggle to curtail their drinking once they begin. When asked why they seem to lose control, most patients struggle with an explanation. Many feel as though “it just kind of happens.”
Who Is at Risk?
It is unclear why some people struggle to remain in control when they drink alcohol. The same is true for any addictive behavior, even if it does not involve a substance. Behavioral compulsions (such as compuslive gambling or excessive gaming) and substance use disorders are not one-dimensional issues. Individuals may be predisposed to these conditions due to a variety of psychosocial, cultural, neurobiological, or genetic factors. As a result, no single root cause underlies all addictions or compulsions.
An individual with no family history of addiction who comes from an extremely supportive environment may still develop a severe substance use disorder. Conversely, an individual with a family history of substance use disorders and a deeply troubled childhood may never experience a problematic relationship with a substance or a compulsive behavior.
Can GLP-1 Agonists Treat Substance Use Disorders?
The short answer is that we do not know yet. However, individuals who have taken GLP-1 agonists have long reported that they found themselves drinking far less without intentionally attempting to do so. As one person told NPR, “I ordered a beer, took a sip, and I couldn’t finish it.” Rather than having several drinks during dinner, he casually sipped on just one.
It’s not just anecdotal evidence. Recently, two large studies—one involving a survey of more than 14,000 individuals in WeightWatchers’ telehealth weight management program, another being a retrospective observational study involving over 680,000 patients from two distinct study populations—found an association between the prescription of GLP-1 agonist semaglutide (Wegovy) and a reduced risk for incident and AUD relapse among patients with either obesity or type-2 diabetes. Five additional studies that examine the association in greater detail and among a more diverse population (including those who have neither diabetes nor obesity) are currently underway.
There also seems to be a mechanistic explanation for the observed effect, which centers on dopamine signaling in the brain. Dopamine is the brain’s “feel-good” hormone. As such, it serves as the proverbial carrot that motivates certain behaviors, including eating, having sex, and participating in positive social interactions. When a person engages in these activities, dopamine is released in the pleasure centers of the brain. Unfortunately, this same mechanism is activated when one has a cocktail or wins a hand of poker, which creates the urge to have another drink or continue gambling. For some people, this urge becomes overwhelming and can lead to social, financial, and occupational problems.
GLP-1 agonists appear to attenuate the release of dopamine in the brain’s reward center, particularly the ventral tegmental areas and nucleus accumbens. Consequently, the urge to drink becomes less incessant and easier to ignore.
Limitations of GLP-1 Agonists
As noted above, AUD is very difficult to treat and beginning on the road to recovery is very difficult. Anything that can help those with AUD to cut down or stop drinking has the potential to improve countless lives. However, it’s important to remember that GLP-1 agonists may help some people curb behavioral addictions and problematic substance use, but they do not work for everyone. As mentioned above, addiction does not have one root cause, so there will never be one treatment modality that is effective for every person struggling with addiction.
In fact, the only randomized controlled study to focus on the use of GLP-1 agonists for AUD produced some surprising results. As expected, participants with obesity (defined as a BMI over 30) reported a decrease in alcohol consumption. However, non-obese participants did not experience the same level of decline. Alcohol use dropped precipitously when measured four weeks after the study began, but then inched back up at subsequent follow-ups and nearly returned to baseline at the study’s end.
Does this mean that GLP-1 agonists only help individuals with obesity? Not necessarily. This was only one study, and it only involved 127 participants, so it should not be taken as the final word on the matter. However, it should encourage us to temper our excitement about this class of drugs and to recognize that addiction is not solely a neurobiological phenomenon.
