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Drugs originally designed to treat diabetes and obesity are reshaping medicine in unforeseen ways. Their impact on public health is really unprecedented in modern times, perhaps only upstaged by vaccines. Now scientists are exploring whether those same medications might also weaken the grip of addiction.
A massive new analysis of health records from more than 600,000 patients suggests that drugs known as GLP-1 receptor agonists may reduce the risk of developing substance-use disorders and lessen the severity of addiction in people who already have one.
The findings, published in The BMJ, add to growing evidence that medications widely used for weight loss—including semaglutide and the dual GIP/GLP-1 drug tirzepatide—may influence the brain circuits that drive cravings.
“The consistency of effect across multiple substances, which have different mechanisms of action, was quite a revelation,” said Ziyad Al-Aly, a clinical epidemiologist at the VA St Louis Health Care System and a co-author of the study.
Still, researchers stress that the results are observational and cannot prove that the drugs directly prevent addiction. Randomized clinical trials now underway will be needed to determine whether the drugs truly cause the effect.
Inside the Veterans Study
GLP-1 receptor agonists mimic a hormone called glucagon-like peptide-1, which the body releases after eating. The hormone helps regulate blood sugar and signals the brain that the body is full. That combination has made the drugs powerful treatments for both diabetes and obesity.
But over the past decade, doctors began hearing something unexpected from their patients. Some people taking the drugs reported drinking less alcohol or losing interest in smoking.
To investigate those reports, researchers analyzed electronic health records from 606,434 U.S. veterans with type 2 diabetes treated through the Department of Veterans Affairs.
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The team compared two groups: patients who started taking GLP-1 drugs and those who were prescribed another class of diabetes medication called SGLT-2 inhibitors. Because both medications treat diabetes and improve metabolic health, the comparison helped researchers isolate possible effects specific to GLP-1 drugs.
Participants were followed for up to three years.
Among people with no prior history of addiction, those taking GLP-1 drugs were less likely to develop substance-use disorders across every substance studied. The risk of alcohol-related disorders fell by about 18%, cannabis by 14%, and cocaine and nicotine by roughly 20% each. Opioid-use disorders showed the largest decline, dropping by about 25%.
For patients who already had a substance-use disorder, the pattern was similar. GLP-1 users experienced 31% fewer emergency department visits and 26% fewer hospital admissions related to substance use.
Overdoses were about 39% less common, and deaths linked to substance use—including overdoses—dropped by roughly 50%.
In other words, the findings translate to roughly 1 to 10 fewer addiction-related events per 1,000 people over three years.
Where Cravings Begin
Scientists are still working to understand how medications designed to control appetite might also influence addiction.
One possible explanation lies in the brain’s reward system.
GLP-1 receptors are found in both the digestive system and certain brain regions involved in motivation and pleasure. These areas rely heavily on dopamine, a neurotransmitter that reinforces rewarding experiences such as eating, drinking alcohol, or using drugs.
Researchers suspect that activating these receptors may dampen dopamine-driven reward signals, reducing cravings.
Preclinical studies in animals have already shown that GLP-1 drugs can reduce reward-seeking behavior. Early clinical work in humans has begun to hint at similar effects. A randomized trial of semaglutide in people with alcohol-use disorder reported reductions in alcohol craving and some drinking outcomes over a short follow-up period.
The new study adds weight to the idea that these drugs may affect addiction broadly rather than targeting a single substance.
The Caveats
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The emerging patterns were too striking to be ignored. However, experts emphasize that observational studies cannot establish cause and effect.
To make the comparison as fair as possible, the researchers used a method called “target trial emulation.” It analyzes real-world medical records in a way that tries to mimic a randomized clinical trial, the gold standard of medical research. Even with this approach, however, unmeasured differences between patients—such as lifestyle or healthcare access—could still partly explain the results.
Moreover, the study population consisted mostly of older men (around 65 years old) with diabetes, meaning the findings may not apply to younger people, women or individuals without metabolic disease.
Researchers also note that the analysis compared GLP-1 drugs with another diabetes treatment rather than with no medication or with established addiction therapies.
Effective treatments for substance-use disorders already exist. Medications such as methadone and buprenorphine help treat opioid addiction, while drugs like naltrexone and acamprosate can help people with alcohol-use disorder.
Yet these treatments remain widely underused. Addiction experts say stigma, lack of access, and gaps in healthcare systems prevent many patients from receiving evidence-based care.
The editorial accompanying the study argues that GLP-1 drugs should not be viewed as a “magic bullet” for addiction. Instead, they may eventually become one component of integrated care that addresses metabolic disease, mental health, and substance use together.
Future clinical trials will determine whether the medications truly reduce addiction risk—or whether the patterns seen in health records reflect other differences between patients.
For now, researchers say the results offer a promising signal.
Drugs that began as treatments for blood sugar and appetite may be revealing unexpected connections between metabolism and the brain’s reward system. If confirmed, those connections could open a new frontier in the science of addiction.