Ozempic and Wegovy’s usefulness might not stop at weight loss. For more than a decade, research has emerged that similar drugs used to treat diabetes have a surprising side-effect: They make people want to drink less alcohol—way less.
The apparent effectiveness of drugs like semaglutide won’t come as a surprise to doctors who have been prescribing these drugs to patients for years. In 2011, researchers in India found that a drug called liraglutide, a GLP-1 receptor used to treat diabetes, significantly reduced alcohol intake in a small group of patients. In fact, nine of the 63 participants surveyed had stopped drinking altogether.
Hints that these kinds of drugs could be used in the treatment of alcoholism go back even further. The first GLP-1 receptor agonist came on the market back in 2005 in the form of exenatide, and the accompanying waning thirst for alcohol has been reported anecdotally over and over ever since. “Some of [the patients] wanted to have a break going on holidays, because they wanted to be able to enjoy a glass of red wine,” says Mette Kruse Klausen, a postdoctoral researcher at the Psychiatric Centre Copenhagen in Denmark. If it were the case that this already-approved, safe drug could stem alcohol cravings, its potential to treat alcohol use disorder, or AUD—estimated to afflict over 280 million people worldwide—was tantalizing.
Follow-up research was slow. First, researchers had to test the application out on animals, which they did—and it did show promise in using GLP-1 receptor agonists for reducing alcohol intake.
Research in humans followed: A randomized clinical trial in Denmark led by Kruse Klausen started in 2017 looking at treating patients with AUD with exenatide. It worked with 127 patients with AUD; half got exenatide, half a placebo. A setback followed: Researchers found that exenatide did not lead to a reduction in the number of heavy-drinking days between the two groups.
Researchers working on the study theorized that the lack of efficacy could have been due to the cognitive behavioral therapy offered to both groups. Another factor could have been that severity of the patients’ AUD was lower than that of other trials looking at treatments for AUD—and research on interventions for people with AUD is just difficult to do, says Kruse Klausen, due to the high dropout rate. Another analysis of the data found that the drug was effective at significantly reducing alcohol intake–but only in the participants who qualified as obese.
Another reason for the trial’s failure could be that exenatide is much less potent than its newer cousin semaglutide, better known as Ozempic. Now that Ozempic is everywhere, anecdotal evidence is mounting that these drugs reduce cravings not just for food, but for online shopping, smoking, nail-biting, and alcohol.
Now, the first empirical evidence to support the idea that drugs like Ozempic could be an effective treatment for AUD is beginning to appear. This week, a new paper published in the Journal of Clinical Psychiatry strengthened the case. The paper relayed a series of case studies: six patients who had been prescribed semaglutide for weight loss, but who also qualified for having AUD. All six of the participants displayed significantly reduced symptoms of AUD—even those who had achieved minimal weight loss.
This small study is only the beginning. The authors are also running a clinical trial in Tulsa, Oklahoma, looking at semaglutide to treat AUD; a sister study is being conducted in Baltimore, Maryland. It’ll be at least a year and a half before those trials have publishable data, so this case series was done in order to set the table for the clinical trial data, say study authors Kyle Simmons, professor of pharmacology and physiology at Oklahoma State University, and Jesse Richards, assistant professor of medicine at the University of Oklahoma. (Richards receives payment from Novo Nordisk and Eli Lilly, who make GLP-1 receptor agonist drugs, to speak at conferences.)
While scientists aren’t certain how these drugs work to dampen alcohol cravings, it’s suspected to work on the same pathways that produce a shrunken appetite. A thirst for booze is thought to be driven by the rewarding properties that alcohol produces, delivered by a bump of dopamine released in the brain. Over time, that dopamine flurry reinforces a want for alcohol.
GLP-1 receptors are found dotted around the body, including in the brain structures that control our reward pathways. These receptors control the release of the hormone GLP-1, which has a multitude of roles to play in the body, including how we respond to alcohol.
What drugs like semaglutide, which mimic the actions of GLP-1, seem to do is lower the amount of the substance required—like food or alcohol—to feel satiated. Richards says some patients report going to an event where they’d normally expect to drink a lot, like a sports game or a fishing trip, “and instead of drinking their normal amount, they would drink one drink, and then kind of get bored and forget about it,” he says.
To understand what’s happening at a neurological level, new clinical trials will not only track alcohol consumption, but also look at how the participants’ brains respond to alcohol cues in an fMRI scanner.
And alcohol is only one of many addictive substances. Researchers are also considering whether drugs like semaglutide could help smoking cessation or treat other types of drug addiction. Alcohol is a good starting point, says Simmons, because there’s a massive patient cohort who tend to suffer from other conditions, like mental illness.
But this new case series study was tiny, and gold-standard clinical trials take time. On November 24, Simmons and Kruse Klausen, among others leading research on this application, penned an editorial for Nature Medicine warning that while their research was showing tantalizing promise, it was far too early to promote the treatment. First, they say, researchers need to collect good-quality clinical trial data.
In the meantime, they emphasize that there are validated effective treatments available for people struggling with alcohol—approved drugs like naltrexone, disulfiram, and acamprosate. But uptake numbers and success rates for long-term abstaining are paltry—in the US, less than 2 percent of patients use available medications for AUD. “We don’t want patients going to their health care provider and saying, ‘Give me some semaglutide because I want to drink less,’” says Simmons.
In a way, that might already be happening. A huge number of people are using semaglutide for diabetes and obesity. Some of those people might also, almost by accident, find it helps with problematic drinking. If that happens, Simmons argues, Ozempic and similar drugs could quickly become the most widely used addiction treatment ever.
