Recent studies suggest that glucagon-like peptide-1 (GLP-1) agonists, such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro), may offer a novel approach to treating substance use disorders. Originally developed for type 2 diabetes and weight loss, these medications are now being investigated for their potential to curb cravings and reduce the risk of overdose.
The Neuroscience of Addiction and GLP-1 Agonists
Addiction is characterized by a hijacking of the brain's reward pathways, where addictive drugs produce intense pleasure by activating reward circuits more powerfully than typical rewards. This leads to a learned connection between pleasure and drug use, making it difficult to prioritize basic needs. GLP-1 agonists mimic naturally occurring hormones and may help restore balance by reducing dopamine levels, which lowers brain activity in response to the anticipation of a reward. This mechanism could potentially interrupt the urge to misuse drugs.
Nora D. Volkow, MD, director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health, notes, "These weight-loss medicines are also the most promising option I’ve seen for a drug that could treat addiction, whether to alcohol, opioids, or nicotine."
Clinical Evidence and Ongoing Research
While anecdotal evidence and preclinical studies have been promising, clinical trial results have been mixed. One study showed no significant difference in quit rates between smokers receiving a GLP-1 agonist (dulaglutide) and those receiving a placebo. However, a 2022 paper following patients with alcohol use disorder found that a subgroup with obesity who received the GLP-1 agonist exenatide drank less, and all groups receiving exenatide showed reduced reactivity in the brain region driving reward.
More clinical trials are underway, examining various substance use disorders using newer GLP-1 agonists like semaglutide. Researchers are also analyzing electronic health records to compare substance use disorder rates among people prescribed GLP-1 agonists versus the general population.
Integrating GLP-1 Agonists into Addiction Treatment
Experts emphasize that GLP-1 medications should be part of a comprehensive treatment plan. Dr. Michael Baca-Atlas, president of the North Carolina Society for Addiction Medicine and associate professor at UNC Family Medicine and Psychiatry, underscores the importance of community support networks and therapy, stating, "This would sort of be one additional thing that could really help but cannot overstate the importance of our therapists in the community or mutual support groups, things like AA."
If studies continue to show positive results, GLP-1 agonist drugs could be used to treat addiction to drugs of all types, potentially jumpstarting substance use disorder recovery alongside social and psychological support. They may also be used in conjunction with existing medications like methadone and buprenorphine to help people stay in treatment longer.
