New weight loss drugs may reduce cravings for alcohol.
Drugs like Mounjaro (tirzepatide), Wegovy (semaglutide), Ozempic (semaglutide), and Trulicity (dulaglutide) belong to a class of drugs called glucagon-like peptide-1 (GLP-1) agonists. They started off as diabetes drugs, but as the drugs became popular and effective for lowering blood sugar, it became apparent they lead to weight loss by increasing satiety and decreasing food cravings.
Cravings are also common for alcohol, especially for people with alcohol use disorder (AUD), which used to be called alcoholism. Animal and human studies suggest that GLP-1s can also help people drink less.
A new study from Virginia Tech’s Addiction Recovery Center, published in the journal Scientific Reports, found that many people using GLP-1s for diabetes or weight loss report reduced use and craving for alcohol, too.
People with AUD have trouble controlling or are unable to stop drinking alcohol despite adverse effects, even if they know that alcohol is interfering with their work, school, relationships, or health. AUD is a major problem for many Americans. A recent National Survey on Drug Use and Health found that almost 30 million Americans ages 18 and older suffer from AUD.
This new study used social media to gather data. The research team searched the social media site www.Reddit.com for any posts using terms that included GLP-1 brand names and alcohol. Using an artificial intelligence app designed to tease out these comments, the team searched more than 68,000 posts and selected about 1,000 that were relevant. More than 70 percent of those posts were from people who reported a definite reduction in alcohol use, reduced cravings for alcohol, less pleasurable effects from alcohol, or less binge drinking.
These findings seemed to support the premise that GLP-1 drugs could benefit people struggling with alcohol use.
The researchers added a second part of the study to confirm their findings. They recruited 153 people who were both overweight and regular drinkers of alcohol. All the people in the study had a body mass index over 30. Two-thirds of them were taking a GLP-1 drug for at least 30 days for weight loss or diabetes, and one-third were not taking a GLP-1. The drug users reported fewer drinks per day, less intoxication, and less binge drinking.
Cravings are a hallmark for addictive disorders, both for drugs and alcohol. In fact, cravings are a major reason for overuse, misuse, and return to use after a period of abstinence. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), the gold standard for diagnosing mental health conditions, includes cravings as one of the key diagnostic criteria for addictive disorders.
The DSM-5 includes AUD as an addictive disorder along with cannabis, tobacco, opioids, hallucinogens, sedatives, stimulants, caffeine, and gambling disorder. Cravings are a big part of all these mental health conditions. Cravings are caused by changes in brain chemistry, and they are one of the reasons mental health providers think of addiction as a treatable disease, just like obesity or diabetes.
The FDA has approved three drugs for AUD treatment, including naltrexone, acamprosate, and disulfiram. These drugs can be effective, but their use is limited by side effects. Naltrexone is also approved for treatment of opioid use disorder (OUD), and several other medications are available for OUD as well, but there are no drugs for other addictions, including behavioral addictions like gambling. Having a new medication with few side effects that could be used in all types of addictions, including behavioral addictions, could be a game changer.
Another possible use for GLP-1s could be controlled drinking. AUD treatment in the past has been targeted at complete abstinence, no alcohol at all. However, complete abstinence is a goal too far for many people, and controlled drinking may be a better option for some people. Addiction treatment has been moving away from the all-or-nothing abstinence model for AUD. Naltrexone, for example, was approved on the secondary endpoint of reduction in heavy drinking days. However, older AUD drugs are based on abstinence; for example, if you drink any alcohol while taking disulfiram, you will get violently ill.
For now, GLP-1s for AUD are still in the experimental stage. There will need to be new and larger studies to prove these types of medications are an effective and safe option. Further studies will also help develop an understanding of what each drug is best used for, how much, and for how long. The researchers conclude that their study provides good evidence in the real-world setting of social media that GLP-1 drugs reduce alcohol use and cravings. That is not the same as a placebo-controlled clinical study, but these studies are underway. For now, you may get the benefit of reduced cravings if you qualify for a GLP-1 drug for obesity or diabetes.
An important key takeaway from the new study is that it demonstrates how AUD is a chronic, relapsing brain disease, which could help reduce some of the stigma around it. AUD changes your brain in a way that has nothing to do with willpower. GLP-1 drugs may help reverse those changes, and that could be a major benefit for millions of people.
