Ozempic curbs more than just appetite

By Jennifer Leavitt, MS | Fact-checked by Barbara Bekiesz
Published May 29, 2024

Key Takeaways

  • Experiences shared by patients on social media have helped identify new potential uses for GLP-1RAs (such as Ozempic), including treating alcohol use disorder (AUD).

  • GLP-1RAs influence the brain's reward system, potentially reducing cravings for addictive substances. In ongoing trials, these trending weight loss drugs were found to reduce alcohol intake in both animals and humans.

  • Social media has become a valuable tool for monitoring drug safety and effectiveness, and may help guide future clinical research.

Initially recognized for managing type 2 diabetes (and, more recently, obesity), GLP-1 receptor agonists (GLP-1RAs) are now being explored for their potential to treat alcohol use disorder (AUD).[]

Patients taking GLP-1RAs for diabetes or weight loss have shared experiences on social media platforms, noting their waning interest in alcohol as an unexpected side effect.[] Over time, this data helped researchers identify patterns and come up with new lines of inquiry—it’s an excellent example of how patient reports can guide clinical research. 

As research progresses, integrating patient experiences and social media data with rigorous clinical studies could provide a much deeper understanding of what role GLP-1RAs might play in the treatment of alcohol and other addictions, and how these drugs might differ from one another.

GLP-1RAs and alcohol cravings

GLP-1RA affects the food reward system, primarily via effects on the ventral tegmental area (VTA) and nucleus accumbens (NAc), both of which are mesolimbic brain regions.[] GLP-1 receptors are expressed in these brain regions, and researchers believe that GLP-1RAs might influence the brain's reward system, making alcohol less appealing.[] 

In vitro studies indicate that exendin-4 upregulates dopamine transporter function.[] A study published in EBioMedicine found that GLP-1 receptor stimulation reduced alcohol intake in rodents, especially those with a history of high alcohol consumption.[] 

One might assume that some of the known side effects of GLP-1RAs—the gastroparesis, aversion to certain foods and beverages, rapid satiety, and digestive discomfort—are responsible for alcohol aversion. However, these factors alone do not explain why GLP-1RAs also reduce cravings for nicotine,[] cocaine,[] and opioids[] in animal studies.

Observational studies of humans mirror the animal studies and anecdotal evidence from social media, with individuals taking GLP-1RAs for weight loss reporting a decreased desire for alcohol.[]

In other research, a 2023 case series published in The Journal of Clinical Psychiatry involved six patients who were positively screened for AUD and treated with semaglutide for weight loss.[] All patients showed significant improvement in AUD symptoms, achieving Alcohol Use Disorders Identification Test (AUDIT) scores indicating “low-risk” drinking during follow-up. The mean decrease in AUDIT scores was 9.5 points (P < .001).

Social media and pharmacovigilance

Social media has become a powerful tool for pharmacovigilance across many drug categories, providing real-time, unfiltered insights into patient experiences, including adverse drug events and off-label uses of medications. Platforms like Twitter, Reddit, and patient forums are capturing these experiences. 

Given the volume, velocity, and variety of social media data, these platforms can serve as a valuable supplementary data source, providing insights from patients not typically reached through traditional pharmacovigilance channels.[]

Combining social media data with other sources can make the synthesis of adverse drug event reports more representative and comprehensive, particularly by including reports from medically under-resourced communities often overlooked in regulatory reporting programs. 

This concept is not new. Researchers have been investigating the potential of using social media for drug safety data since 2010.[] Even FDA guidelines recognize social media as a significant source for collecting patient experience data, incorporating both qualitative and quantitative patient voices into the drug development process.[]

Two studies on alcohol cravings 

Two key studies, one social media-based, were conducted by a group of researchers to analyze the effects of GLP-1 and GLP-1/GIP agonists on alcohol consumption.[] The first study analyzed approximately 68,250 posts on Reddit using machine-learning-based attribution mapping. The posts were categorized into eight major themes, including effects of medications (30%), diabetes (21%), and weight loss and obesity (19%). 

Among the 1,580 alcohol-related posts, 71% mentioned craving reduction, decreased desire to drink, and other effects.

The second study involved 153 participants (current alcohol drinkers with a BMI ≥30) who self-reported taking either semaglutide or tirzepatide for ≥30 days, or no medication as a control group. Results showed a significantly lower self-reported intake of alcohol, drinks per drinking episode, odds of binge drinking, and scores on the AUDIT, along with stimulating and sedative effects in the semaglutide or tirzepatide groups compared to before starting medication (within-subjects) and the control group (between-subjects). This suggests potential efficacy for treating AUD in people with obesity.

Beyond AUD

Clearly there is evidence that GLP-1RAs reduce preference, intake, and seeking behaviors for alcohol and other addictive substances. Studies indicate that finding the optimal dose is crucial for favorable outcomes, and that both acute and chronic GLP-1RA treatments can mediate addiction behaviors.

Importantly, GLP-1RAs were found to reduce cue-, drug-, and stress-induced seeking behaviors, which are major pathways to relapse.[]

Experts suggest that semaglutide’s effects on dopamine may also contribute to the observed reductions in alcohol use. Researchers are cautiously optimistic, noting that randomized placebo-controlled clinical trials are needed to confirm semaglutide's efficacy in treating AUD. However, the case study authors pointed to the strong potential for semaglutide to become an effective tool in managing AUD, especially for patients who already have other indications for its use.[]

There are several randomized controlled trials exploring the effects of GLP-1RAs on addiction currently underway, including trials on alcohol use.[][]

What this means for you

Keep an ear open for rapidly evolving clinical updates on GLP-1RAs. Encourage patients to share their experiences and document any notable observations about GLP-1RAs and any other medications they take. Consider social media as a supplementary source of information to get a sense of what your patients are experiencing and what they might be reading online.

Read Next: The neurobiology of tolerance: Predicting alcohol use disorder
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