GLP1s vs. Addiction, a quick review
We trace research on GLP1s and addiction through the years and try to find studies that match the anecdotes.
GLP1 Receptor Agonists aren't miracle drugs – they are a class of well-studied (but not completely understood) FDA-approved treatments for Type 2 diabetes and weight management.
Check out our quick explainer
GLP1s have proven at this point to be low risk (maybe they could be dangerous after 5-10-15-20 years of continued use, but we can't know that yet) – but what's more impressive is that we keep finding new positive side-effects.
We've covered the links between GLP1s and addiction management in the past with relation to other topics:
GLP1.Guide Staff
Covering negative side effects is arguably even more important:
GLP1.Guide Staff
GLP1.Guide Staff
In this article, we'll try to combine most of the relevant studied and pointers in the right direction.
2021: Exenatide + Nicotine Patch reduces smoking
A study conducted way back in 2021 on one of the earliest GLP1 Receptor Agonists, Exenatide, showed that adding Exenatide to a smoking cessation regimen (what people do to stop smoking) improved the ability of people to stop smoking:
The study is quite small – only 84 people, but the methods are clear:
Eighty-four prediabetic and/or overweight smokers were randomized (1 : 1) to once-weekly placebo or exenatide, 2 mg, subcutaneously. All participants received NRT (21 mg) and brief smoking cessation counseling. Seven-day point prevalence abstinence (expired CO level ≤5 ppm), craving, withdrawal, and post-cessation body weight were assessed following 6 weeks of treatment.
So in brief, 84 people were given NRT (the nicotine patch), and they were randomly given Exenatide along with some counseling – then they were measured for 6 weeks.
The results were quite an astounding success:
Exenatide increased the risk for smoking abstinence compared to placebo (46.3% and 26.8%, respectively), (risk ratio [RR] = 1.70; 95% credible interval = [0.96, 3.27]; PP = 96.5%). Exenatide reduced end-of-treatment craving in the overall sample and withdrawal among abstainers. Post-cessation body weight was 5.6 pounds lower in the exenatide group compared to placebo (PP = 97.4%). Adverse events were reported in 9.5% and 2.3% of participants in the exenatide and placebo groups, respectively.
Adding Exenatide created a significant difference – people who were on it were almost twice as likely to not smoke.
This wasn't free, of course – since adverse events (i.e. negative side effects of the given medication manifesting) were up over 4x. More concretely, 4 people out of the 84 tested had a negative reaction to the medication.
Digging into what the adverse effects actually were:
In the exenatide group, the AEs reported were injection site nodules. The nodules were <5 mm in diameter; there was no accompanying skin discoloration or any signs and/or symptoms of infection. The nodules resolved within 1–2 weeks. In the placebo group, one participant experienced localized pruritus (without rash) at the site of the nicotine patch application.
So for people treated with Exenatide, the adverse effects were not of the serious kind that we know GLP1 Receptor Agonists are capable of.
Even with such a small study, a nearly 2x improvement in smoking craving reduction with no serious/significant adverse effects is quite a result.
2022: Scientists try to figure out why GLP1 may be effective
The process of science reveals truths about the known world – and scientists seek to figure out the "why". In 2022, a paper on the possible why behind GLP1s and it's effect on addictive disorders was published:
The highlights are easy to understand:
GLP‐1 receptors are expressed in regions previously identified as important players in the neurobiology of addiction, and importantly, GLP‐1 receptor agonists seem to cross the blood–brain barrier.
Overall, preclinical research has identified potent reductions in substance use and attenuation of drug‐seeking behaviour with several different GLP‐1 receptor agonists, especially regarding alcohol (alcohol, see Figure 1; nicotine, stimulants, opioids and cocaine, see Figure 2).
A human genetic association study has reported on a GLP‐1 receptor variant associated with increased alcohol self‐administration and changes in brain response in reward‐related areas, as revealed by fMRI brain imaging.
It is also suggested that individuals suffering from obesity and individuals suffering from addiction have overlapping brain dysregulations, and the anti‐obesity effects of GLP‐1 receptor agonists support the potential usefulness of GLP‐1 receptor agonists for the treatment of SUD and AUD.
The study acknowledges that scientists don't know why GLP1 has the effect it does on addition:
The precise mechanisms of GLP‐1 receptor agonists' actions on addiction‐related endpoints have yet to be established, but the effects seem to be mediated centrally, at least in part through modification of dopamine signalling. No clear and well‐defined circuit‐level mechanism has been identified yet, instead GLP‐1 seems to modulate brain circuits at multiple levels, and the relevant mechanisms of action may well be species dependent.
And that the only reasonable hard data present is the Exenatide study (linked above).
2022: GLP1 reduces Opioid usage in rats
Liraglutide was found to reduce the propensity of rats to try to take fentanyl (one of the most popular classes of opioids) when treated with GLP1s (in particular, Liragutide):
Luke A Urbanik
Advances in rat models may make for good indications of what might work in humans but they are not definitive – many approaches that work in rat models do not work for humans.
That said, this progress is substantial in pointing towards outcomes that might hold for humans (we'll come back to this later).
2023: Analysis of social media anecdata shows Semaglutide & Tirzepatide reduce alcohol consumption for obese people
A study published in 2023 details the improvement that Semaglutide (Wegovy, Ozempic, Rybelsus) and Tirzepatide (Mounjaro, Zepbound) produced in helping people with Alcohol Use Disorder (AUD) drink less:
✉Corresponding author.
This research was not the outcome of a trial but rather scraping and analyzing social media (in particular, Reddit).
We think this study is worth mentioning because while clinical environments are the best place to get ground truths about GLP1s (or any other medications/treatments), once a drug is widely used, anecdotal evidence is incredibly useful to find unexpected side effects, whether positive or negative.
In this case, a significant amount of reports indicated that GLP1s were helping people reduce alcohol consumption, and reducing cravings.
2024: Analysis finds Semaglutide to increase cognitive function, and reduce nicotine use
A meta analysis published in 2024 revealed that Semaglutide significantly helped improve cognitive function:
Riccardo De Giorgi
While in this case Semaglutide was analyzed against other drugs (sitagliptin, glipizide, empagliflozin), the cohorts in the study are much larger, with around ~20,000 people each.
This study was not a trial, but instead represented over 100 million patient health records from TriNetX US Collaborative Network. This isn't as good as a peer-reviewed double-blind clinical trial, but good analysis on completed experiments can also reveal truths.
The study found that Semaglutide was not associated with a higher risk of "adverse neuropsychiatric outcomes", but actually potentially beneficial in two areas: cognitive deficits and nicotine misuse.
2024: An excellent long-ranging review on GLP1s and addiction
As anecdata and other indications grow, scientists often find it reasonable to perform and aggregate relevant research and perform reviews of the hard and soft data.
In 2024, an excellent review was published which explored this in depth:
Nicolaus Bruns Vi
As the review is quite approachable and well sectioned, it's a great read, separating both pre-clinical and clinical trial supported evidence/information.
2024: Small study finds opiate reduction in humans
A dataset presented at the annual meeting of the American Association for the Advancement of Science (AAAS, which publishes Science) in Denver showed that a particular study suggested that GLP1s could cut opiate cravings in humans:
This data is execellently covered by STAT
Simar Bajaj
To summarize, the study left a LOT to be desired – it's small (only 20 people), and occurred only a very limited period of time.
More good news, but not enough to be a significant source of hard data.
2025: Analysis suggests that Semaglutide may
An analysis conducted of patients who were hospitalized with Alcohol Use Disorder (AUD) or Substance Use Disorder (SUD)found that the ones who were also taking Semaglutide and Liraglutide (GLP1s) were at lower risk for being hospitalized again for AUD/SUD:
Markku Lähteenvuo
The findings of the analysis were clear, though – Semaglutide and Liraglutide were associated with reduced risk of hospitalization with AUD/SUD:
Among patients with AUD and comorbid obesity/type 2 diabetes, the use of semaglutide and liraglutide were associated with a substantially decreased risk of hospitalization due to AUD. This risk was lower than that of officially approved AUD medications. Semaglutide and liraglutide may be effective in the treatment of AUD, and clinical trials are urgently needed to confirm these findings.
2025: Finally, a randomized clinical trial into Semaglutide for Alcohol Use Disorder
One of the most promising studies we've seen so far in 2025 is the randomized trial into semaglutide for Alcohol Use Disorder (AUD):
Christian S Hendershot
Unfortunately this study is still quite small – only 48 patients were randomized and included in the study. The results are quite promising:
Low-dose semaglutide reduced the amount of alcohol consumed during a posttreatment laboratory self-administration task, with evidence of medium to large effect sizes for grams of alcohol consumed (β, -0.48; 95% CI, -0.85 to -0.11; P = .01) and peak breath alcohol concentration (β, -0.46; 95% CI, -0.87 to -0.06; P = .03). Semaglutide treatment did not affect average drinks per calendar day or number of drinking days, but significantly reduced drinks per drinking day (β, -0.41; 95% CI, -0.73 to -0.09; P = .04) and weekly alcohol craving (β, -0.39; 95% CI, -0.73 to -0.06; P = .01), also predicting greater reductions in heavy drinking over time relative to placebo (β, 0.84; 95% CI, 0.71 to 0.99; P = .04). A significant treatment-by-time interaction indicated that semaglutide treatment predicted greater relative reductions in cigarettes per day in a subsample of individuals with current cigarette use (β, -0.10; 95% CI, -0.16 to -0.03; P = .005).
Roughly summarized, the study found that people did not necessarily change when they drink, but reduced how much they drank during a given sitting.
