Semaglutide, the popular drug for diabetes and weight loss that has taken America by storm, might be the next big breakthrough in the treatment of addiction.
“Semaglutide, or the GLP-1 inhibitors, are super popular weight-loss drugs,” said Dr. Edward Zawadzki, psychiatrist with the Lighthouse Health Group. “They work because they force your pancreas to secrete insulin which prevents your body from storing sugars as fat.
“The drug also regulates glucagon, another hormone that is released that has to do with sugar storage. And it affects the dopamine reward pathway system. As humans, we get dopaminergic rushes from things that we enjoy like chocolate cake, sexual activity or parachuting.
“We are finding that semaglutide actually suppresses and regulates that dopaminergic rush,” which has implications for the treatment of addiction.
“A lot of the studies having to do with dopamine regulation come from animal studies. In these studies, rodents self-administer things like cocaine, nicotine and amphetamines. When given semaglutide, they would self-administer those substances less.
“What we’ve seen in clinical practice is that a lot of patients with binge eating disorder or alcohol abuse issues are getting Ozempic or Wegovy or some other drug for weight loss and they are telling me that they haven’t touched a drink in a week. They just don’t have the craving for it anymore.”
Semaglutide, developed by Novo Nordisk, is a synthetic GLP-1 receptor agonist designed to mimic the natural GLP-1 peptide hormone produced in the intestines that plays a critical role in glucose metabolism and also has a direct influence on the brain, particularly in regions involved in reward and appetite regulation.
Research shows that the GLP-1 receptor activation may reduce food intake by promoting satiety and triggering the brain’s reward system. Given these effects, the same may be true for modulating brain circuits involved with addiction.
A small clinical trial conducted in 2022 found that semaglutide administration led to reductions in alcohol craving and consumption in individuals with alcohol use disorder. While these findings are promising, more extensive trials are necessary to confirm the drug’s efficacy and safety in the treatment of alcohol abuse disorder.
“You don’t see a lot of doctors prescribing these drugs for addiction yet,” said Dr. Zawadzki. “I personally don’t because that is out of my scope as a psychiatrist [and] … we don’t have any long-term data.
“If one of my patients wants to try a GLP-1, then I suggest they talk to their GP and see if it makes sense for them. There are actually some semaglutide-style drugs in the pipeline now that are exclusively being looked at for addiction and it’s likely that in the next few years we’ll see some new drug with a name that we’re not familiar with that is specifically for this kind of problem.
“Addiction and substance abuse disorders cross all kinds of lines,” Dr. Zawadzki explained. “It’s physical, it’s psychological and even spiritual in many ways. But it’s a behavioral problem by definition. The definition of addiction is negative social consequences because of your use with an inability to control it and continued use despite the consequences.
“So even if you go home and have a bottle of wine every night, it may not be an addiction. You might have dependence, or you might have withdrawal symptoms if you were to stop drinking, but the addictive component from a psychiatrist’s perspective is when you have a negative social outcome.”
While the potential for semaglutide’s use for addiction treatment is promising, long-term side effects need to be studied more closely. Semaglutide appears to reduce cravings and consumption in the short-term, but it remains unclear if it promotes lasting behavioral changes necessary for recovery from addiction. Different abused substances may involve different neurobiological mechanisms, and they may respond differently to a GLP-1 receptor agonist.
“We need to be careful of quick fix schemes,” Dr. Zawadzki added. “Data shows that once you stop the GLP-1 inhibitor you will go back to whatever baseline you had. People will gain the weight back and the same would be true with alcohol addiction. For that reason, you really need to find a more permanent, kind of inclusive solution to the issue, whether it’s therapy, talking to a psychiatrist, taking medication or even an outpatient program.
“You need lifelong skills to help you manage the disorder. If you are going to take medicine for depression, obesity, diabetes or addiction, you have to evaluate the risks and benefits and this is no different. We still don’t know the long-term side effects of semaglutide,” which could include nausea or potential interference with other medications or treatments.
The study of GLP-1 for managing addiction is still in its infancy. Semaglutide may in fact emerge as a valuable tool to be used in conjunction with other addiction treatments like behavioral therapy or traditional pharmacological interventions to provide a more effective approach to managing addictions. Research and clinical trials are ongoing.
Dr. Edward Zawadzki received his Doctor of Osteopathic Medicine from the New York College of Osteopathic Medicine and completed residencies in psychiatry at Mount Sinai School of Medicine at Cabrini Medical Center and Saint Vincent’s Medical Center in New York. He then completed a fellowship in Forensic Psychiatry at Saint Vincent’s Medical Center. He practices at Lighthouse Health Group at 787 37th St. #120, Vero Beach. Call 772-226-5368 to schedule an appointment.
