Innovative Medications: Exploring Ozempic and Wegovy’s Impact on Alcohol Dependency Treatment
During the COVID-19 pandemic, J. Paul Grayson was hit with an avalanche of health problems — high blood pressure, prediabetes and a heart arrhythmia.
He also gained 40 pounds to his 6-foot 3-inch frame.
“I felt like my weight was getting out of control,” “I had to start taking all these medications that I never had to take before. I actually felt pretty depressed about my health.”
—J. Paul Grayson, 73-year-old retiree
About six months ago, Grayson began taking the popular weight-loss drug Ozempic.
He knew the side effects could be rough, including nausea, constipation and diarrhea. But he thought it would be worth it if he could stave off further heart problems by losing the extra weight.
“Right away, I started eating less and losing weight,” he says. That was expected. But what Grayson hadn’t expected was that the drug also immediately altered one of his other habits.
I remember going to dinner for the first time [while taking Ozempic],” I ordered a beer, took a sip, and I couldn’t finish it,” You know how sometimes you taste a beer, and it’s like, ‘Oh my God, this tastes so good that I want to guzzle it.’ Well, I didn’t feel like guzzling. I just really felt like sipping it.”
J. Paul Grayson
And instead of having several beers with dinner, Grayson stopped at just one drink.
J. Paul Grayson experienced an interesting side effect when he started taking Ozempic: He lost his taste for alcohol.
In the past year, prescriptions for both the diabetes drug Ozempic and its weight-loss counterpart Wegovy have skyrocketed, despite the fact that each costs about $1,000 a month and some health insurers recently stopped covering them.
Both drugs contain the same active ingredient, semaglutide, which belongs to a class of drugs known as GLP-1 (aka “glucagon-like peptide 1”). These drugs regulate your blood sugar and make you feel satisfied after eating. Ozempic is approved for treating diabetes and, in some cases, excess weight.
With the drug’s surge in popularity, doctors and patients have begun to notice a striking side effect of these drugs: They appear to reduce people’s cravings for alcohol, nicotine and opioids. They may also reduce some types of compulsive behaviors, such as gambling and online shopping.
“There’s really been a large number of clinical and anecdotal reports coming in suggesting that people’s drinking behaviors are changing and in some instances pretty substantially while taking [Ozempic or Wegovy],” says Christian Hendershot, a psychologist and addiction researcher at the University of North Carolina.
He’s leading one of six clinical trials now underway aimed at understanding how semaglutide may alter people’s drinking and smoking habits.
“All these reports, for the most part, are anecdotal,” Hendershot adds. “At the same time, it does seem like there’s a pretty strong signal here.”
Scientists are hopeful that a new class of treatments for alcohol use disorder or smoking may be on the horizon. Some doctors have even started prescribing these drugs for this specific purpose, even though evidence from large, randomized controlled trials are still years away.
Stopping at just one cookie or beer
To many doctors and patients, like J. Paul Grayson, Ozempic’s effect on alcohol came as a big surprise.
“Before Ozempic, I could consume a whole bottle of wine in an evening without trying real hard, along with a bag of chocolates,” he says, laughing. “But with Ozempic, even one beer didn’t feel good to me somehow.”
“I had no idea this would happen,” he adds. “Nobody told me anything about the drug affecting alcohol, too.”
But for scientists who study GLP-1 drugs, this striking side effect was exactly what they expected. “It’s really not surprising,” says pharmacologist Elisabet Jerlhag.
For more than a decade now, Jerlhag and her colleagues at the University of Gothenburg in Sweden have been figuring out in great detail how GLP-1 drugs, such as Ozempic, reduce alcohol consumption in rats.
She and other scientists have published nearly a dozen studies showing how these drugs stop binge drinking in rats or mice, prevent relapse in “addicted” animals, and overall decrease their consumption of alcohol. “So we see a reduction by over 50%, which is quite dramatic,” Jerlhag says.
Other studies in animals have also found that GLP-1 drugs reduce the consumption of nicotine, opioids, as well as psychostimulants, such as cocaine and methamphetamine.
So why would a weight-loss drug do this? Turns out, these drugs (as well as the GLP-1 hormone) don’t just work on blood sugar. “They also work in your brain,” says Dr. Lorenzo Leggio, who’s the clinical director of the National Institute of Drug Abuse.
“The mechanism in the brain that regulates overeating overlaps with those responsible for the development and maintenance of addiction, including alcohol disorder,” he says.
The role of dopamine
Studies in animals, as well as a few in people, offer tantalizing clues to how this mechanism works for both food and alcohol.
Imagine for a second taking a bite of a chewy chocolate cookie. It’s buttery and very sweet.
That first bite triggers the release of dopamine inside the part of your brain that controls your motivation, says neuroscientist Alexandra G. DiFeliceantonio, an assistant professor at Virginia Tech. “That dopamine essentially tells you, ‘Hey, do that again!’ Take another bite.’ ” And you want another bite. Maybe even another whole cookie. It’s hard to stop.
Now imagine you’re a beer lover and you take a big gulp of a cold IPA on a hot day. It also triggers a dopamine spike in the motivation center of the brain — just like the cookie.
“Dopamine in the striatum [the brain’s motivation center] is the motivation and learning signal for everything. Not just for food,” DiFeliceantonio says. “All addictive drugs increase dopamine there. That’s a common thing.”
And so after the first taste of beer, the dopamine tells you, “Do it again! Have another gulp.”
But studies have found that in animals and people, GLP-1 drugs reduce the release of dopamine in this region when you eat something sweet and fatty, or when you consume alcohol. “The drug talks with our brain and says, ‘We’ve had enough food here. So let’s slow down. Let’s have less appetite, let’s have less food. Less alcohol,” says NIDA’s Leggio.
So you don’t really feel like another bite of cookie, or as J. Paul Grayson said, “I didn’t feel like guzzling. I just really felt like sipping it.”
Oftentimes, now, he doesn’t even feel like drinking at all. “When I still had wine or chocolate in the refrigerator, sometimes I would think, ‘Oh, I should have some wine. I should have some chocolate.’ But there just wasn’t anything that made me get up and go to the refrigerator,” he explains.
The “horse has already left the barn”
Ozempic’s potential to reduce alcohol consumption is now so well known that some people are seeking out the drug to help with their drinking, says Christian Hendershot.
“We’re also hearing about clinicians prescribing for that reason,” he says. “In many ways this is really kind of the indication that the horse has already left the barn. This is something that’s already appearing to happen, whether we like it or not.”
But NIDA’s Leggio advises against this off-label use of Ozempic and Wegovy. “It’s too early,” he says. Ozempic may not work against alcohol for everyone, including people who don’t have obesity.
So far, there has only been only one small randomized controlled study, looking at whether another GLP-1 drug could treat alcohol use disorder in people in general, as compared to cognitive behavioral therapy. This drug, called exenatide, isn’t as potent as semaglutide (Ozempic) at inducing weight-loss or penetrating inside the brain. In the study, the drug reduced drinking in people with obesity, but it actually increased drinking in people who don’t have obesity.
“We don’t know why,” Leggio says. One hypothesis is that the semaglutide caused people to lose weight even though they had normal weight and that led them to seek more calories through drinking, Leggio says.
“But that’s only speculation,” he adds. “We have to realize that no medication is going to work for everybody, and it’s very important to identify the sub-class of patients for who this medication might work.”
And he notes, in the end, maybe a newer version of the GLP-1 drugs might work better for treating addictions than diabetes.
Elisabet Jerlhag at the University of Gothenburg notes that people with obesity tend to have less severe side effects while taking semaglutide than people who don’t have obesity. “With these drugs there’s also a risk of developing pancreatitis,” she says. “A person with alcohol use disorder may be at [elevated] risk for pancreatitis. So a doctor would need to monitor that.”
On the other hand, if you have diabetes and you want to curb your alcohol intake then definitely talk to your doctor about the option of semaglutide, Leggio says. “Even more so if you have obesity and alcohol use disorder. Absolutely. Speak with your doctor.”
“Many days I don’t drink at all”
Meg Johnston’s weight-loss medication has reduced her desire to drink. “Alcohol just doesn’t sound as appetizing or appealing,” she says.
Nicole Jackson
That’s exactly what Meg Johnston, age 37, did about a month ago. During COVID, she also gained weight. “I make this joke that food was the only thing that brought me joy,” she says. But she also drank much more. “I would drink out of boredom, just total boredom.”
So she began taking semaglutide at the end of June. A part of her goal was to curb drinking. “I was hoping that I would be one of the people that the drug affected this way,” says Johnston, who’s a real estate agent in Washington, D.C.
And indeed, the drug has not disappointed her. “Many days I don’t drink at all,” she says. “It’s hard to explain why. Alcohol just doesn’t sound as appetizing or appealing. And now my tolerance is lower, too.
“This has been a welcome change for me,” she adds. “During those first couple of weeks of taking the drug, I was very much focused on not vomiting and making sure I continue to have bowel movements. I just knew alcohol was going to make me feel terrible afterwards.”
People taking weight-loss drugs Ozempic and Wegovy report a dampening of the urge to drink. Here’s how the drugs curb cravings and what that could mean for helping treat addiction.
Summary: Semaglutide, or Ozempic, a medication used for type 2 diabetes and obesity, may also be effective in treating alcohol dependence.
The drug reduced alcohol relapse drinking and overall alcohol intake in rats by more than half. Semaglutide acts on the GLP-1 receptor and is taken in tablet form once a week.
Clinical studies are needed to confirm the findings in humans, but the results offer promising insights into potential additional treatment options for alcohol dependence.
Key Facts:
Semaglutide, a medication approved for diabetes and obesity, demonstrated significant reductions in alcohol consumption and relapses in alcohol-dependent rats.
The medication acts on the brain’s reward system, particularly the nucleus accumbens area, potentially reducing the alcohol-induced reward.
While further research is needed, the study suggests that semaglutide could be beneficial for individuals with both overweight and alcohol dependence.
Source: University of Gothenburg
The medication semaglutide, which is currently used in the treatment of type 2 diabetes and obesity, might also be an effective medication for alcohol dependence.
In a study from the University of Gothenburg, the drug reduced alcohol relapse drinking and alcohol intake in rats by more than half.
The results of the study are published in the scientific journal eBioMedicine.
Semaglutide is sold under brand names such as Ozempic. Since this medication has been approved for the treatment of obesity, demand has increased, which has resulted in difficulties in procuring the drug in recent times.
There is anecdotal evidence of patients with obesity or diabetes saying that their craving for alcohol has lessened since they started taking the drug.
Today, individuals with alcohol dependence are treated with a combination of various psychosocial methods and medications. Four approved medications are available. Since alcohol dependence is a disease with many causes, the efficacy of these medications varies, and so it is important to develop additional treatment medications.
Reduced relapses
Semaglutide is a long-acting substance that patients only need to take once a week. This is the first medication to act on the GLP-1 receptor that can be taken in tablet form.
In the study, alcohol-dependent rats were treated with semaglutide, which significantly reduced their alcohol consumption and even reduced the drinking of alcohol in conjunction with relapses.
Relapses comprise a major problem for individuals with alcohol dependence, as an individual who has abstained from alcohol for a period relapses and drinks more than before the withdrawal.
In the study, the treated rats cut their alcohol intake in half compared to animals that did not receive treatment. One interesting finding in the study was that semaglutide reduced alcohol intake equally in both male and female rats.
Animals and humans
The study reports a strikingly good effect, although clinical studies will be required before the medication can be used for alcohol dependence, and such studies take time. Moving forward, the medication may be of most benefit to patients suffering from both overweight and alcohol dependence.
According to the researchers it is likely that these results will carry over to humans, as results from other studies on alcohol dependency medications made with the same research model have shown similar effect in humans as in rats.
“There are, of course, differences in conducting studies on animals and humans, and these must always be taken into account. However, in this case, there is a previous study on humans in which an older version of the diabetes medications that act on GLP-1 was found to reduce alcohol intake in overweight individuals with alcohol dependence,” says Elisabet Jerlhag, professor of pharmacology at Sahlgrenska Academy at the University of Gothenburg.
Mechanisms in the brain
The current study also examined why the medication reduces alcohol drinking. The results indicate that reduced alcohol-induced reward could be a contributing factor. In the study, semaglutide affected the brain’s reward system in mice, to be more exact the nucleus accumbens area of the brain, which is part of the limbic system.
“Alcohol activates the brain’s reward system, resulting in the release of dopamine, something that is seen in both humans and animals. This process is blocked by the medication in mice, and with our interpretation, this could cause a reduction in the alcohol-induced reward,” says Cajsa Aranäs, doctoral student at Sahlgrenska Academy at the University of Gothenburg, who is responsible for much of the work behind the study presented here.
The alcohol industry has been thriving despite a streak of threats: the legalization of marijuana, a trade war with China that has hampered U.S. exports, the rise of the sober-curious movement.
Now a new risk, one few investors or companies are publicly acknowledging, could pressure sales: weight loss drugs.
Eli Lilly & Co.’s Mounjaro and Novo Nordisk’s Ozempic and Wegovy have gained popularity as a fast way to lose weight thanks to celebrities such as Khloe Kardashian and Elon Musk. Most people who take GLPs shed at least 5% of their body weight and, depending on the therapy, more than half can lose as much as 20%. Newer drugs promise to push those numbers even higher.
But they don’t only curb cravings for food. For some, these new weight-loss drugs also seem to dampen the rewards of addictive substances, whether that’s nicotine, opioids or alcohol — America’s longstanding favorite vice. Scientists have shown that rats, mice and monkeys drink less when given certain GLP1 therapies and are studying whether the same effect can be seen in humans and, if so, understand its scope.
Early readings from Wall Street analysts suggest that could have a dramatic impact on the alcohol industry. Weight loss drugs may not carry the same threat to the alcohol industry as, say, Prohibition, but companies and investors would be wise to start strategizing about how they will adapt as more people begin to take the drugs.
A survey conducted by Morgan Stanley’s AlphaWise research unit found that people consumed 62% less alcohol while taking weight loss drugs. Among those consuming less, 22% said they stopped drinking alcohol entirely. Meanwhile, the firm expects the number of people taking obesity drugs to grow nearly fivefold over the next 10 years to about 7% of the U.S. population, or 24 million people. That’s roughly the size of Texas.
By 2025, the firm estimates an overall 1.8% reduction in alcohol consumption from weight loss drugs. For perspective, the U.S. alcohol industry amounted to $197 billion in 2022, according to market intelligence firm IWSR. A reduction of almost 2% could amount to a $3.5 billion loss in sales.
To be fair, those are just estimates. No one has a true handle yet on the long-term impact of these drugs. But obesity medicine specialists say many patients who take them mention an aversion to alcohol. And even those who still drink socially consume a much more modest amount. The desire simply isn’t there. Moreover, the feeling of fullness after, say, one beer makes a second round unappealing.
Take the experience of Shannon Lee, an Oregon-based digital marketing professional who says that before going on Mounjaro, she’d drink about four glasses of wine or beer each week. But any craving for alcohol pretty much vanished after her very first dose and she can count on two hands the number of drinks she’s had in her 15 or so months on the drug. “It’s rendered me speechless,” she says. “I looked forward to drinking beer, going out to dinner with friends and having a glass of wine. Now, I’m the designated driver because I just have no interest in it.”
That could create a strong draw for people trying to manage their weight while also recognizing they’ve slid into unhealthy drinking habits. Recent data show women in midlife are increasingly struggling with alcohol; meanwhile, a recent poll by KFF showed that the same group is more aware of and more interested in trying GLP1s than men.
The potential threat of weight loss drugs to alcohol demand comes as the alcohol industry is flying high on pandemic-driven growth and renewed interest in premium spirits, wine and beer. Brown Forman, which produces spirits including Jack Daniels whiskey, Herradura tequila and Woodford Reserve bourbon, increased its annual revenues between 2019 to 2023 by 27% to $4.2 billion. In the last four years, London-based spirits company Diageo has seen its tequila business quadruple, surpassing its vodka sales, Chief Executive Officer Lavanya Chandrashekar told investors in an earnings call earlier this month.
Alcohol companies should redouble their efforts to test out new products as consumers become more mindful of health. Nearly every large company has dabbled with nonalcoholic or low-calorie options such as Boston Beer Company’s low-calorie Truly Hard Seltzer or Molson Coors’ new mocktail line Roxie. The dawn of the Ozempic era should only light the fire under them to bulk up their health-conscious offerings faster.
There are some caveats. For starters, many forecasts optimistically assume significant and lasting uptake of the drugs. While it’s true GLP1s must be taken chronically for maintenance, a major unknown is whether people are willing or can afford to be on them for life — or even for more than a year or two. Insurance coverage for the treatments has been spotty and while increasing evidence of their health benefits could open up access for some, consistent and affordable access will remain a near-term barrier.
And these drugs won’t necessarily change the way people eat or drink, but the amount they eat and drink. For food and alcohol companies, that might mean doubling down on premiumization — charging more for a higher quality product in a smaller container.
Certainly, alcohol companies aren’t facing a cliff. Even though consumers are increasingly moderating their alcohol, they’re choosing low-alcohol drinks over nonalcoholic ones, according to IWSR. Alcohol will likely continue to be a part of ritual gatherings for meals and time together with friends and family. It just might play a smaller part.