Woman stressed while drinking (© fizkes – stock.adobe.com)

For years, people taking GLP-1 type drugs (e.g., Ozempic, Wegovy) have noticed that the medicines didn’t just help them to eat less — many also drank less alcohol. A recently published study, the first of its kind, validated that experience.

The current issue of JAMA Psychiatry reports a study in which 48 people with moderate alcohol use disorder (AUD), taking low doses of semaglutide for nine weeks, had significantly greater reductions in how much alcohol they drank, compared with people using a placebo. They also experienced fewer cravings for alcohol.

Researchers hoped to see a reduction in drinking and craving among participants, but they didn’t expect the magnitude of the effects seen in this trial. It was greater than the effects of other AUD medications.

Larger trials, with a greater number of participants who have more severe disease, are necessary to determine if GLP-1 type drugs are effective treatments for AUD. Scientists hope that the research will also reveal how the drugs work to curb imbibing.

What To Know About Alcohol Use Disorder

Alcohol use disorder affects almost 29 million people in the United States, according to the 2023 National Survey on Drug Use and Health. People with the condition struggle to control or stop alcohol consumption despite its negative consequences.

Current recommendations advise drinking less or abstaining from alcohol consumption to improve health. Recently, the former US Surgeon General Dr. Vivek Murthy issued an advisory that alcohol raises the risk of at least seven types of cancer. He said that alcoholic beverages should have updated warning labels.

Currently, there are three drugs approved by the U.S. Food and Drug Administration (FDA) for the management of alcohol use disorder. Fewer than 2% of people with AUD use them. Study authors speculate that the reasons may be not knowing there is medication for AUD available and that fear of stigma may interfere with consent for treatment.

Naltrexone, one of the three drugs, has a small effect on AUD. Researchers describe the GLP-1 effect as medium to large.

How The Study Worked

The study enrolled people with AUD who were not pursuing treatment. The female participants reported drinking more than seven drinks in a week. The men reported drinking at least 14 drinks in a week. They had two or more heavy drinking episodes within the last month, defined as at least four drinks for women and five for men.

Half of the participants were given low-dose injections of semaglutide weekly. The other half received a placebo injection.

Participants then spent two hours in a lab set up as a living room, complete with television and a bar stocked with their preferred alcoholic drink. They could drink as much as they wanted, up to a limit for safety. Someone from the study administered a questionnaire and took breath alcohol measurements hourly.

Nine weeks later they repeated the procedure and compared results. Those taking semaglutide drank 40% less alcohol than those who had received a placebo.

What Are The Side Effects Of Semaglutide?

The side effects of GLP-1 drugs include nausea, constipation, and other gastrointestinal symptoms. Participants in the trial who received semaglutide experienced mild symptoms of that nature.

It raised the issue that side effects of the drug, not the drug itself, may have been the reason those individuals drank less alcohol. When people are nauseous, they may not want to drink.

Hendershot explained that they did not have enough participants to study drug side effects as the reason for drinking less, but said the scientists didn’t feel like side effects were solely responsible for the decrease in drinking. The matter requires more study.

How GLP-1 drugs didn’t work

Semaglutide was not associated with drinking fewer days of the week – just that when participants did drink, they drank less. Dr. Raymond Anton, an addiction psychiatrist at the Medical University of South Carolina, said that drinking less may be a reasonable goal for some patients because most people seeking treatment do not want abstinence for the rest of their lives.

Anton also said he’d like to see data on whether side effects of the drugs influenced drinking, and if there is a correlation between weight loss and drinking reduction. In the study, the participants on semaglutide lost about 5% of their body weight over nine weeks.

There are already more trials underway to investigate the relationship between GLP-1-type drugs and AUD.

My perspective

The effects seen in this study could potentially lead to more harm than benefit. By definition, individuals with AUD have already encountered significant adverse consequences due to their drinking. Their physiological response to alcohol is different from people who do not continue to drink after adverse consequences. There has been no convincing evidence supporting the possibility of safe, moderate alcohol consumption after an AUD diagnosis. Newly diagnosed individuals want to believe that they can continue drinking with impunity, which is a manifestation of denial, not a viable goal. At this stage, judgment is impaired, and the individual requires support and encouragement to pursue abstinence.

Enabling individuals with AUD to continue drinking could be seen as a violation of the medical community’s commitment to do no harm, potentially depriving patients of the benefits of abstinence – recovery of physical, mental, emotional, and spiritual well-being. Would using semaglutide and similar drugs to decrease, not cease, alcohol consumption merely help them stay sick?

The duty of healthcare providers is to act in their patients’ best interests, not necessarily to give them what they want, especially when what they want has already proved to cause them substantial harm. If additional research demonstrates that GLP-1 drugs can safely enable abstinence, I could support their use for that purpose.