A groundbreaking review published in the Journal of the Endocrine Society suggests that meds like semaglutide, already revolutionizing diabetes and weight management, may offer hope for people struggling with addiction and drinking problem.
The comprehensive analysis, led by researchers at the National Institutes of Health, examines emerging evidence that GLP-1 receptor agonists could represent a new frontier in treating conditions that have long challenged medicine: substance use disorders affecting millions of Americans.
Approximately 46.3 million adults in the United States live with drinking problems, yet fewer than one quarter receive treatment. Among those who do seek help, less than 2% receive medication-based therapy, highlighting a massive gap in care for conditions with devastating personal and societal consequences.
Current treatment options remain frustratingly limited. While meds exist for specific dependencies, many people face barriers to access, and stigma continues to prevent individuals from seeking the help they need.
The research team, led by Dr. Lorenzo Leggio and colleagues, explored how GLP-1 (designed to control blood sugar and suppress appetite) might also affect the brain’s reward pathways involved in addictive behaviors.
GLP-1 receptors exist not only in the pancreas and digestive system but throughout the brain, including regions crucial for reward processing, craving, and compulsive behaviors. These areas overlap significantly with circuits disrupted in addiction.
Laboratory studies have consistently demonstrated that GLP-1 reduce s*bstance-seeking behaviors across various s*bstances in animal models. Rodents and non-human primates given these meds showed decreased consumption and reduced relapse-like behaviors.
The human evidence, while still emerging, appears promising. Analysis of electronic health records from Denmark revealed that patients prescribed GLP-1 experienced fewer related medical events compared to those on other treatments.
Most compellingly, a recent clinical trial found that semaglutide reduced laboratory measures of s*bstance use and cravings in people with diagnosed disorders. The medication also decreased cigarette consumption among study participants who smoked.
Another controlled trial showed that exenatide, an earlier GLP-1 variation, promoted smoking cessation when combined with nicotine patches, reduced cravings and withdrawal symptoms, and prevented the weight gain that often derails quit attempts.
These appear to work by modulating dopamine (the neurotransmitter central to reward and motivation) in brain regions like the ventral tegmental area and nucleus accumbens. These structures form the mesolimbic pathway, often called the brain’s reward circuit.
GLP-1 receptors in these areas seem to dampen the heightened reward response that drives compulsive use. Meanwhile, connections to the prefrontal cortex may strengthen impulse control and decision-making abilities often compromised in addiction.
Interestingly, the research highlights parallels between addiction and certain forms of obesity, suggesting both may involve similar neurological processes around compulsive behavior and reward dysregulation. This overlap could explain why medications targeting one condition might benefit the other.
Beyond controlled studies, anecdotal reports from social media and patient forums describe people prescribed GLP-1 for diabetes or weight loss who noticed reduced urges to use various substances. While such accounts don’t constitute scientific proof, they’ve prompted researchers to investigate more systematically.
Large-scale analyses of medical records support these observations. Studies examining millions of patient records found that those prescribed semaglutide showed lower rates of opioid overdose, reduced tobacco-related medical encounters, and decreased ca**abis use disorder diagnoses compared to patients on other meds.
The research team emphasizes that this field remains in early stages. Most human studies have been observational rather than randomized controlled trials.
GLP-1 come with side effects, primarily gastrointestinal issues like nausea and vomiting. For people with disorders who often face nutritional challenges and other health complications, these effects require careful consideration.
The high cost of newer GLP-1 meds poses another significant barrier. Many people struggling lack resources for expensive treatments, potentially limiting access precisely when these might help most.
Questions also remain about long-term use. Some patients discontinue GLP-1 therapy within a year due to side effects, costs, or reaching treatment plateaus.
More than a dozen clinical trials are now underway or starting soon to rigorously test GLP-1 medications in people with various disorders. These will examine different s*bstances, dosing strategies, and combinations with existing treatments.
Researchers are also investigating newer multi-targeted meds that activate GLP-1 receptors alongside other systems. These next-generation therapies might prove even more effective while minimizing side effects.