Can Ozempic and Similar Drugs Revolutionize Treatment for Substance Use Disorders? An Expert Perspective

Medications known as GLP-1 agonists have completely changed the way we treat obesity and diabetes. These drugs, like Ozempic and Wegovy, offer results that were previously only possible with surgeries such as bariatric operations. Over the past 20 years, as someone deeply involved in studying the neuroscience of what drives our eating habits and drug use behaviors, I’ve found these drugs to be some of the most promising new options for addressing cravings—not just for food, but potentially for substances like alcohol, opioids, and nicotine as well.

In recent times, GLP-1 agonists have become incredibly popular, so much so that almost two percent of Americans now have prescriptions for semaglutide, the active ingredient found in Ozempic. These medications first launched in 2005 targeting diabetes treatment, but soon doctors and patients noticed their profound effect on weight loss. Studies showed that users could drop significant weight over time, and the FDA eventually approved these drugs specifically for managing obesity. This surge in usage reflects how impactful these drugs can be in changing eating behaviors.

Many people taking semaglutide for weight loss have reported something surprising: alongside a reduced hunger for food, their urges to smoke or consume alcohol seemed to diminish as well. This aligns with what we understand about the brain's reward and motivation systems, which link pleasure from eating and drug use. GLP-1 agonists appear to influence these interconnected pathways, possibly weakening the pleasure associations with addictive substances.

One known way these drugs work is by imitating a natural hormone that signals to the body that it's full, which lowers appetite. But they also reduce the brain's connection between eating and enjoyment, decreasing cravings further. Current research at institutions like the National Institute on Drug Abuse supports this theory, showing that GLP-1 agonists lower interest in rewarding substances in animal models—rats treated with these drugs showed less inclination to consume cocaine or alcohol, and their brain’s dopamine response was muted during consumption.

While we’re still uncovering exactly how these medications influence brain circuitry in humans, they offer hope for creating new addiction treatments that directly address the brain’s motivation to use substances, moving beyond the symptom-relief approach that current therapies focus on.

Addiction remains a massive challenge in America. Despite millions struggling with substance use disorders, fewer than a quarter receive any form of treatment. The crisis has intensified in recent years, with overdose deaths reaching alarmingly high levels. Amid this, a breakthrough medication capable of targeting addiction’s core brain mechanisms could make a meaningful difference, especially amid the ongoing opioid emergency where many fatalities involve opioids.

Current medicines mainly help by dulling the pleasure of drug use or easing withdrawal symptoms. They often focus on specific substances—like nicotine or opioids—making the treatment very targeted. For instance, drugs like Chantix ease quitting smoking by acting on nicotine receptors, while medications such as methadone or buprenorphine relieve opioid withdrawal. However, these treatments don't always address the deeper brain circuits causing compulsive drug seeking.

What makes GLP-1 agonists exciting is their potential to work on those fundamental brain pathways that drive addiction itself, not just the surface behaviors or symptoms. This could change how we approach addiction treatment in the future.

Our brains have complex systems that motivate us to do things vital for survival—eating, social bonding, reproduction. Addiction hijacks these very systems, creating powerful links between the drug experience and the intense pleasure it triggers. Over time, the brain adapts, requiring more of the substance to feel the same hit, and making the addiction a dominant force over basic needs and other life priorities.

Interestingly, the processes motivating eating and those motivating drug use share many similarities in how they engage the brain’s reward circuits and hormonal signals, including dopamine. That’s why a medication that influences hunger and cravings could also tap into addiction pathways.

GLP-1 is a hormone that normally tells your brain 'you’re full' after eating, helping regulate food intake. In individuals with obesity or diabetes, this signal can be disrupted, leading to overeating. Drugs like Ozempic mimic GLP-1, restoring this fullness signal and also reducing dopamine-driven anticipation and cravings. This explains why someone on Ozempic might find a slice of cake at a party less tempting than before.

Given the overlap between hunger and addiction circuits, it makes sense that GLP-1 agonists could help reduce cravings for drugs as well, interrupting those strong motivational drives to misuse substances.

Still, it’s important to note that what works in animals doesn’t always work in people, and we need rigorous clinical trials to confirm these hopes.

So far, clinical research testing GLP-1 agonists against substance use disorders in humans has delivered mixed outcomes. Two placebo-controlled randomized trials—the gold standard in clinical research—offered some encouraging yet inconclusive results.

One study tested dulaglutide for smoking cessation but found no significant difference in quit rates after 12 weeks compared to placebo. Although disappointing, this doesn’t close the door on the potential benefits of GLP-1 drugs for addiction.

Another trial observed patients with alcohol use disorder who received the GLP-1 agonist exenatide. Over 26 weeks, overall alcohol consumption didn’t differ between the treatment and placebo groups. However, those participants with obesity showed a decrease in drinking, and brain scans revealed lowered reward-related activity across the treatment group, suggesting potential benefits under certain conditions.

These findings highlight the need for further studies, especially with newer, more potent GLP-1 drugs such as semaglutide, which are currently under investigation for various substance use disorders. We expect more results in the coming years that will clarify their potential role in addiction treatment.

Additionally, researchers are analyzing large datasets of electronic health records to examine whether patients prescribed GLP-1 agonists for diabetes or obesity have different rates or severities of substance use disorders compared to the general population. These observational studies could provide important real-world insights.

If ongoing research confirms the benefits of GLP-1 agonists for addiction, it could mark a major advancement by providing a single medication capable of supporting recovery from multiple types of substance use disorders. This is especially relevant as many people face addictions to more than one drug at the same time.

Such medications might be layered with existing treatments like methadone or buprenorphine to improve long-term success and retention in therapy. Currently, about half of people on opioid use disorder meds stop their treatment within six months, putting them at risk of relapse. Combining GLP-1 agonists could help sustain treatment adherence and improve outcomes.

Most importantly, breakthroughs in medication can shift how society views addiction. If we can demonstrate medically that addiction is a chronic brain condition responsive to treatment, it helps fight stigma and change the misconception that addiction is a moral failing or just a lack of willpower.

Knowing that science is uncovering new tools to support recovery brings hope to millions affected by substance use disorders and their loved ones. It underlines the importance of viewing addiction as a complex health issue that deserves compassion and medical attention, just like diabetes or heart disease.

So, whether you or someone you know is struggling with addiction, these emerging discoveries from the world of GLP-1 agonists offer a hopeful glimpse into future treatments that could assist more people in reclaiming their lives.