In 2022, when the surge in popularity of the GLP-1 class of weight loss and diabetes drugs really began, stories of surprise benefits besides shedding pounds soon surfaced. One of those – that the medication changed drinking and smoking habits overnight – understandably piqued the interest of researchers. Now, the results of a human trial provide the evidence that backs the anecdotes.
"There's really been a large number of clinical and anecdotal reports coming in suggesting that people's drinking behaviors are changing and in some instances pretty substantially while taking [Ozempic or Wegovy]," psychologist and addiction researcher Christian Hendershot told NPR in 2023. "It does seem like there's a pretty strong signal here."
This new study is the results of one of six clinical trials spearheaded by Hendershot from the University of Southern California. In a double-blind randomized nine-week trial, 48 US adults (71% female) with a mean age of 39.9 years were assigned either semaglutide (0.25 mg/week for four weeks, 0.5 mg/week for four weeks and 1.0 mg for one week) or a placebo at weekly clinic visits.
What the researchers found was that while there was a reduction in some – but not all – clinical measures of alcohol use, the drug significantly impacted participants' desire to reach for a drink. For anyone wanting, but struggling, to cut back, not necessarily quit altogether, blocking alcohol cravings could be a game-changer in developing healthier habits.
While semaglutide did not significantly impact average drinks per calendar day or number of drinking days, it did have a huge effect on how much booze was consumed on those drinking days.
"For weekly drinking outcomes, medication effects on number of drinks per calendar day were nonsignificant; however, semaglutide significantly reduced alcohol craving and drinks per drinking day, also interacting with treatment week to predict reductions in heavy drinking days," the researchers noted. "Consequently, the proportion of participants with zero heavy drinking days increased significantly in the semaglutide group across the two-dose phases."
The smokers in the trial receiving semaglutide also saw a change in habits. Overall, the smokers on semaglutide went from an average of 14 cigarettes per day to eight per day.
Also of interest is that the 48 participants in the study were non-treatment-seeking drinkers, meaning they were people who had some unhealthy alcohol behaviors but were not at the extreme end of alcohol use disorder (AUD). Eligibility for the trial included men having consumed more than 14 standard drinks in a week (seven for women) in the last month, as well as both sexes having experienced two or more "heavy drinking episodes" in the time frame. This was categorized as four or more drinks in one session for women, and five or more for men.
Earlier animal trials had shown how the glucagon-like peptide 1 receptor agonist (GLP-1RA) semaglutide (Wegovy, Ozempic) drastically changed the way rats and mice sought out alcohol 'rewards' after they'd been conditioned to crave it. If you want to read more on that, University of Gothenburg pharmacologist Elisabet Jerlhag and colleagues have published an impressive amount of research covering this work.
And in 2023, a small but significant human study also found that semaglutide could benefit those with AUD and potentially other addictions.
What's more, as the researchers point out, there have been only three medications targeting alcohol use approved in the US since 1951, showing the need to provide people with more options for treatment.
"Since the FDA approval of the first AUD medication (disulfiram) in 1951, only two medications (naltrexone and acamprosate) have received subsequent FDA approval for AUD," they wrote. "The rate of one new approval every 20 to 25 years is inadequate and is in stark contrast with the pace of FDA approvals for diabetes medications, which now outnumber AUD medication approvals 20-fold."
Clinically, AUD is diagnosed based on measures that gauge drinking habits; the more boxes that are ticked, the more serious an individual's relationship to booze is. But alcohol use is a spectrum, not one that jumps from zero to addiction with no points in between.
According to the 2023 National Survey on Drug Use and Health (NSDUH), 218.7 million US adults (84.9%) had consumed alcohol at some point in their lifetime, with 172.9 million drinking within the past year, and 132.9 million having imbibed during the previous month. And 16.3 million of these adults had also reported to what equates to binge-drinking in the past month (6.3%).
Many of these millions may not have a serious problem with booze that consistently impacts their daily lives, but data suggests that there are a significant number of Americans who'd like to cut down, be it for financial, health or other issues. A 2024 survey of more than 1,000 adults aged 21 and over found that 49% were aiming to drink less in 2025 – a massive 44% increase since the 2023 research.
One of the impediments to cutting down is what drinking does provide. Social behaviors aside, biologically, the brain's alcohol reward pathway – as detailed in this landmark 1994 paper – is a complex web of neurotransmitter interactions. And a key one is the ability of ethanol to boost dopamine production. (And we now know that brains that are dopamine-poor or have poorly regulated dopamine – seen in people with ADHD – are more susceptible to 'seek out' triggers to boost its production, such as drinking alcohol.)
Overall, this interaction with feel-good brain chemicals means that for many, alcohol cravings can form the biggest challenge for those hoping to cut back or better moderate their drinking behaviors. And it's not the only way semaglutide could help – given its current popularity, it has the potential to normalize treatment for alcohol use, which remains a barrier for people who'd like more than willpower to change habits but are unlikely to seek out the existing medications.
"Should additional Phase 2 and Phase 3 clinical trials support repurposing one or more GLP-1RAs for AUD, these treatments could have broad clinical infiltration, with potential to bypass many traditional impediments to the uptake of AUD medications, including low public and provider awareness and stigma toward AUD treatments," the researchers noted.
It's also worth mentioning that the participants received significantly lower doses of semaglutide than those using the medication for weight loss and diabetes management.
"This study used the two lowest clinical doses of semaglutide, whereas doses for weight reduction reach 2.4 mg/week," the researchers noted, adding that while higher doses might yield greater results, it would also most likely come with increased weight loss – something that's has potentially negative outcomes.
"The extent of weight loss in the semaglutide group (−5% on average), though similar to that observed at these doses in populations with overweight or obesity, has additional safety risks for people with normal or low weight, necessitating evaluation of which doses (and which GLP-1receptor agonists) optimally balance safety and efficacy," they added.
The study was published in the journal JAMA Psychiatry.
Source: University of Southern California via Scimex