Semaglutide and liraglutide for alcohol use disorder (AUD)

GLP-1 receptor agonist medications, such as semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda, Victoza) commonly prescribed for type 2 diabetes and obesity, may offer a promising new approach for treating Alcohol Use Disorder (AUD). Recent research from at least two large clinical trials suggests these medications significantly reduce alcohol consumption and related hospitalizations. These clinical trials support prior research that reported that weekly GLP-1 medications reduced alcohol cravings, drinking frequency, and alcohol intake.

For high consumers of alcohol, the reduction in intake with GLP-1 medications was approximately 68%, from 23.2 units to 7.8 units/week. Alcohol use in low consumers reduced from 5.5 to 2.5 units/week. Many people report the effects of GLP-1 drugs at reducing alcohol cravings was “effortless”, saying they were able to cut down their drinking without even really thinking about it.

In the US, over 28 million people aged 12 and older are diagnosed with AUD each year, including 757,000 adolescents aged 12-17 years. New treatments for AUD are needed because current AUD medications such as disulfiram, acamprosate, or naltrexone are difficult to access, underutilized, and sometimes have unpleasant side effects.

How do GLP-1 drugs reduce alcohol use?

Research indicates that GLP-1 receptors are distributed throughout brain regions involved in reward processing and addictive behaviors. When these receptors are activated, studies have observed a corresponding decrease in alcohol consumption patterns and a diminished dopamine response to alcohol.

This occurs because GLP-1 receptor stimulation appears to modify dopamine transmission within the brain's reward pathways. Multiple clinical investigations have demonstrated that individuals receiving GLP-1 medications report diminished urges to drink and consume less alcohol overall.

Scientists theorize that these effects stem from how these medications influence neural circuits controlling reward perception, satisfaction, and the feeling of fullness, potentially addressing both metabolic and addictive processes simultaneously.

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Latest evidence

Significant reductions in alcohol consumption were reported in 262 patients (79% female, mean age 46) treated with the GLP-1 receptor agonists, semaglutide or liraglutide for obesity, in a prospective observational study published in the journal, Diabetes, Obesity, and Metabolism.

• The average alcohol intake decreased by 7.5 units/week from 11.8 to 4.3 units/week (p<0.001).
• People who drank a lot of alcohol (more than or equal to 11 units/week) reduced intake by 68%, from 23.2 to 7.8 units/week, while low consumers reduced from 5.5 to 2.5 units/week.
• No patients reported increased alcohol consumption.
• Participants lost an average of 7.7 kg over approximately 4 months.

These findings suggest GLP-1 receptor agonists may offer dual benefits for patients with comorbid obesity and alcohol use disorder, potentially providing an integrated treatment approach.

Evidence from the Swedish Cohort Study

Semaglutide and liraglutide significantly lowered the risk of alcohol-related hospital admissions in those with AUD in a large Swedish cohort study (227,000 people) published in JAMA Psychiatry. These treatments also help reduce admissions for substance use disorder (SUD).

Patients with comorbid conditions such as type 2 diabetes or obesity, in addition to AUD, benefited the most from these treatments.

Comparative Effectiveness

Semaglutide showed the strongest results:

• 36% lower risk of AUD-related hospitalizations
• 32% lower risk of SUD-related hospitalizations
• 22% lower risk of hospitalizations for other physical conditions.

Liraglutide demonstrated the second-best results:

• 28% lower risk of AUD-related hospitalizations
• 22% lower risk of SUD-related hospitalizations
• 21% lower risk of hospitalizations for other physical conditions.

Would Mounjaro also work for AUD?

Although Mounjaro (tirzepatide) hasn't been as extensively studied as semaglutide and liraglutide for AUD, its dual-receptor mechanism might potentially offer similar or even enhanced effects on reducing alcohol consumption by influencing reward circuitry in the brain.