The consistency that I'm hearing from all across patient groups is gain of control, whereas previously, there was a loss of control… All of a sudden they're able to step back and say, 'oh, well I had this shopping phenomenon that was going on, gambling, addiction, or alcoholism, and all of a sudden, it just stopped,'
- Dr. Gitanjali Srivastava, Vanderbilt Medical Center
Evidence that GLP-1 treatments like Ozempic and Mounjaro have strong anti-addictive effects across substances and behaviors has been mounting every month. This article reviews the published studies in the field as well as the strategic opportunity they present to reduce addiction at a society-wide level. The strength of the anti-addictive effect of GLP-1s appears so clear that some physicians are already using these treatments off-label for patients with substance use disorders (SUD), despite ongoing shortages (particularly for Mounjaro / Zepbound) and complications with insurance coverage. (...)
Medications to address addiction only work if people take them. Existing addiction treatments face a number of obstacles to adoption that have severely limited their use, including patient resistance, stigma, side effects, low long-term adherence rates, and, for treatments like methadone, massive cultural resistance that has persisted for over 50 years, despite a mountain of evidence showing the public health benefits of expanded access. As we have seen so clearly in recent debates on vaccines and reproductive rights, it can be far easier to make sustainable progress in science and medicine than in culture and politics. Because GLP-1 drugs are not opioid-based treatments and are not primarily SUD treatments, they are positioned to completely bypass the culture wars surrounding substance use treatment, which will enable them to have a dramatic impact on the global prevalence of addiction, at a scale that existing treatments cannot reach.
We believe that if addiction is truly understood as a disease and a public health emergency, we have both a moral obligation and a strong self-interest as a society to move as quickly as possible to bring effective treatments to patients, at scale. If we can reduce opioid, stimulant, alcohol, and nicotine addiction by just 20%, we would avoid ~150,000 deaths per year and incalculable suffering for families and communities. But we believe even more is achievable. A 40% reduction in harmful addiction over 8 years can be accomplished with a coordinated strategic plan. We will be publishing specific strategy proposals over the coming months. (...)
Surveys and Reports from Providers and Patients
Several human studies of GLP-1s for addiction, detailed below, have been initiated following widespread reports from patients and providers of unexpected anti-addictive effects from semaglutide and tirzepatide. At a high level, what appears to be most tangible about the experience of patients on GLP-1s is an abrupt reduction in cravings and compulsive behaviors and a sense of increased agency: the ability to make conscious decisions about what to consume, whether it is food or other substances, rather than feeling pulled by a strong internal urge. If anecdotal evidence feels like a distraction to you, feel free to skip this section and jump to the research studies. That being said, we do believe that patient narratives provide important clues about the rapid onset of effect and magnitude of effect size across behaviors.
While not a scientific publication, Morgan Stanley recently surveyed 300 GLP-1 users and found that alcohol consumption and cigarette smoking had dropped substantially. As reported by CNBC,
Here’s one patient’s narrative:
Beginning with Ozempic, and now reported even more strongly from patients taking Mounjaro and Zepbound, the sudden reduction of cravings that occurs at initiation or dose increase is perhaps best compared to the accidental discovery of Viagra. First developed for hypertension, patients in clinical trials for Viagra kept reporting that something… ‘interesting’ was happening when they took the drug. This was a specific and unexpected side effect, reported by a large percentage of patients, and, again, less likely to be a placebo effect. What we’re hearing from GLP-1 patients today is similarly specific, widespread, and unexpected. You can read our compilation of patient reports here and these are a few more representative examples:
We believe that if addiction is truly understood as a disease and a public health emergency, we have both a moral obligation and a strong self-interest as a society to move as quickly as possible to bring effective treatments to patients, at scale. If we can reduce opioid, stimulant, alcohol, and nicotine addiction by just 20%, we would avoid ~150,000 deaths per year and incalculable suffering for families and communities. But we believe even more is achievable. A 40% reduction in harmful addiction over 8 years can be accomplished with a coordinated strategic plan. We will be publishing specific strategy proposals over the coming months. (...)
Surveys and Reports from Providers and Patients
Several human studies of GLP-1s for addiction, detailed below, have been initiated following widespread reports from patients and providers of unexpected anti-addictive effects from semaglutide and tirzepatide. At a high level, what appears to be most tangible about the experience of patients on GLP-1s is an abrupt reduction in cravings and compulsive behaviors and a sense of increased agency: the ability to make conscious decisions about what to consume, whether it is food or other substances, rather than feeling pulled by a strong internal urge. If anecdotal evidence feels like a distraction to you, feel free to skip this section and jump to the research studies. That being said, we do believe that patient narratives provide important clues about the rapid onset of effect and magnitude of effect size across behaviors.
While not a scientific publication, Morgan Stanley recently surveyed 300 GLP-1 users and found that alcohol consumption and cigarette smoking had dropped substantially. As reported by CNBC,
“Notably, the survey also found that 40% of participants reported smoking traditional cigarettes at least weekly before starting a GLP-1, but that number declined to 24% after treatment. Weekly e-cigarette use similarly fell from 30% to 16% of respondents.”That’s a 40% decrease in cigarette smoking rates as an incidental side effect of a GLP-1. The same survey reported that about 60% of GLP-1 users reported drinking less alcohol since beginning treatment, with 14-18% quitting drinking completely. Morgan Stanley is warning investors that the alcohol companies Molson Coors, Boston Beer Company, Constellation Brands, and Diageo are most at risk of a significant sales decline due to the projected ongoing increase in GLP-1 users.
Here’s one patient’s narrative:
“I (37F) have been a pretty severe alcoholic for a decade or more. The longest I went without drinking in 10 years was 2 weeks. I would drink to blackout maybe 3 nights a week, sometimes more.. 7 to 10 shots of 90 proof vodka. Or more. My tolerance was pretty high. I titrated up to .5 semaglutide this past Friday and haven't had a drink or even a desire to drink since. I caught sight of the vodka bottle under my bed and started gagging… And I have tried medically assisted ways to quit alcohol which never worked. Yes there is such thing as booze chatter for me, and I no longer have it.” - Semaglutide patientIt is important to distinguish these reports from a typical placebo effect. When patients report a dramatic reduction in opioid cravings from a drug that was prescribed for a different condition (diabetes or obesity), it is unlikely to be a placebo effect because the reduction in cravings was not the goal or an expected impact of the treatment. In addition, patients frequently report that the reductions in substance use cravings occur immediately when they increase their dose and sometimes report that cravings return weekly as they reach day 5 or 6 before taking their next injection on day 7. Furthermore, patients report that substance cravings fully return with cessation of treatment and disappear again when treatment is resumed.
Beginning with Ozempic, and now reported even more strongly from patients taking Mounjaro and Zepbound, the sudden reduction of cravings that occurs at initiation or dose increase is perhaps best compared to the accidental discovery of Viagra. First developed for hypertension, patients in clinical trials for Viagra kept reporting that something… ‘interesting’ was happening when they took the drug. This was a specific and unexpected side effect, reported by a large percentage of patients, and, again, less likely to be a placebo effect. What we’re hearing from GLP-1 patients today is similarly specific, widespread, and unexpected. You can read our compilation of patient reports here and these are a few more representative examples:
“My pretty problematic drinking has reduced to very little comparatively. If my husband didn’t drink I probably wouldn’t at all… I’ll drink half a glass and then literally Saran Wrap it and put in the fridge. Compare this to being a nightly bottle of wine-plus drinker before… And this effect happened IMMEDIATELY.” - Semaglutide patientPatient reports like these don’t just come from people with problematic substance use. Many people simply lose all desire for the occasional cigarette or beer with friends.
“I love drinking. I absolutely do. There's nothing better to me than a summer night outside listening to some live music with your friends enjoying a few beverages. But I just can't anymore. It doesn't make me physically ill at all, my brain just says, "Nope, you're done." I can't even explain it because I want to drink but I'm just completely done after one or two. It's kind of annoying if I'm being honest but I definitely wouldn't go backwards” - Mounjaro patient
“Loving this! My mom started when I did and used to have a drink every night. When I told her about the studies being done into alcohol she realized she hadn’t had a drink in over a week and had no desire for one. She’s not an alcoholic but she just liked having her nightly drink.” - Semaglutide patientThe reduction in desire and compulsion often goes beyond substances to include behaviors.
“I had a REALLY BAD impulse shopping problem. It went away totally when I started Wegovy. It was nuts I could not believe it.” - Wegovy patientThis CNN article has a story that really articulates the immediacy and unexpected nature of the positive impact for many:
A smoker for most of her life, Ferguson started Ozempic 11 weeks ago to try to lose about 50 pounds she’d gained during the Covid-19 pandemic, which had made her prediabetic.
She’d switched from cigarettes to vaping last summer in hopes of quitting but found vapes to be even more addictive. That changed, she said, once she started Ozempic.
“It’s like someone’s just come along and switched the light on, and you can see the room for what it is,” Ferguson said. “And all of these vapes and cigarettes that you’ve had over the years, they don’t look attractive anymore. It’s very, very strange. Very strange.”
by Nicholas Reville and Zarinah Agnew, Recursive Adaptation | Read more:
Image: Wang et al., 2024 Nature Molecular Psychiatry
