Medically Reviewed by Mark Hrymoc, M.D., Chief Medical Officer, double-board certified in General & Addiction Psychiatry
Glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have become widely recognized for their ability to promote weight loss and improve metabolic health. However, emerging research suggests that their benefits may extend far beyond managing obesity and diabetes. In recent studies and clinical observations, GLP-1 medications appear to reduce cravings and reward-driven behaviors linked to nicotine, alcohol, and opioid use. As a result, some physicians are prescribing these drugs not only for weight management but also as part of broader strategies to support addiction recovery and impulse control.
A New Frontier in Addiction and Craving Reduction
GLP-1 receptor agonists were originally developed to improve insulin sensitivity and regulate blood sugar in people with type 2 diabetes. Their mechanism involves mimicking the hormone GLP-1, which slows gastric emptying, suppresses appetite, and enhances satiety. Yet, GLP-1 receptors are also found in brain regions involved in reward processing, including the nucleus accumbens and ventral tegmental area—areas heavily implicated in addiction. By modulating dopamine signaling in these circuits, GLP-1 agonists may dampen the brain’s response to rewarding substances such as alcohol, nicotine, or opioids.
Recent preclinical and human studies have shown that GLP-1 agonists can reduce both cravings and consumption of addictive substances. This has opened a promising line of research into how these medications might help individuals struggling with substance use disorders, particularly when combined with behavioral therapy or other evidence-based interventions.
Evidence for Reducing Alcohol and Nicotine Use
Several animal studies have demonstrated that GLP-1 receptor activation decreases voluntary alcohol consumption and alcohol-seeking behavior. In 2023, researchers at the University of North Carolina found that semaglutide significantly reduced alcohol intake in mice, suggesting direct effects on the brain’s reward system. Early human studies have shown similar trends. A 2024 pilot trial published in Nature Metabolism found that individuals taking semaglutide reported reduced alcohol cravings and consumption compared to those on placebo.
The same neurobiological pathway may also explain reductions in nicotine dependence. Nicotine stimulates dopamine release in reward circuits, reinforcing the desire to smoke. By blunting this dopamine response, GLP-1 medications could make smoking less rewarding. Preliminary reports have found that people using GLP-1 drugs for diabetes or obesity often reduce or quit smoking without explicitly trying to do so. Larger clinical trials are now underway to determine whether this effect can be consistently replicated.
GLP-1 Medications and Opioid Use
Opioid addiction remains a pressing public health issue, and relapse prevention remains a central challenge. Preclinical studies have found that GLP-1 receptor activation can reduce opioid self-administration and attenuate drug-induced dopamine surges in the brain’s reward centers. These findings suggest potential use as an adjunctive therapy in opioid use disorder treatment. While no GLP-1 drug is currently approved for this purpose, early-stage clinical research is exploring whether these agents can complement existing treatments such as buprenorphine, naltrexone, or methadone.
For individuals recovering from opioid dependence, the ability of GLP-1 agonists to reduce cravings and stabilize mood may also support overall mental health, given the interplay between substance use, anxiety, and depression.
Why Some Physicians Are Expanding Their Use
Although GLP-1 medications are best known for promoting weight loss, an increasing number of physicians are exploring their use in addiction management. In clinical practice, three primary groups of doctors—psychiatrists, addiction specialists, and primary care physicians—have begun prescribing these drugs to select patients for off-label uses, including craving reduction and relapse prevention.
Their growing interest reflects a broader shift in understanding addiction as a neurobiological disorder rather than solely a behavioral issue. Because GLP-1 agonists act on both metabolic and reward pathways, they may offer a dual benefit: improving physical health while supporting emotional and cognitive control over cravings.
The Link Between Weight, Metabolism, and Mental Health
About 40% of adults in the United States are classified as overweight or obese, according to the Centers for Disease Control and Prevention. Obesity and mental health disorders often coexist, with shared biological mechanisms such as chronic inflammation, hormonal imbalance, and dysregulated reward processing. People with obesity have higher rates of depression, anxiety, and substance use disorders. By improving metabolic health and reducing reward sensitivity, GLP-1 medications may help address multiple dimensions of wellness simultaneously.
Some psychiatrists are beginning to view GLP-1 agonists as part of a new generation of treatments that bridge physical and mental health—helping patients not only lose weight but also regain balance in mood and behavior.
Caution and the Need for Ongoing Research
While early findings are encouraging, more research is needed before GLP-1 medications can be routinely used to treat addiction or cravings. Most studies to date have been small or preclinical, and the exact mechanisms remain under investigation. Potential side effects, including nausea, gastrointestinal discomfort, and in rare cases pancreatitis, must be weighed carefully, especially when prescribing off-label.
It is also important to note that GLP-1 drugs are not a substitute for therapy, counseling, or evidence-based addiction treatments. Instead, they may serve as a complementary tool—enhancing outcomes when combined with structured behavioral support and ongoing medical supervision.
Looking Ahead
As research progresses, GLP-1 receptor agonists could mark a paradigm shift in both metabolic and psychiatric medicine. Their ability to influence appetite, impulse control, and reward processing positions them as potential tools for addressing intertwined epidemics of obesity, addiction, and mental health disorders. For now, their expanded use underscores a growing awareness that effective treatment often requires addressing the brain and body together.
Seek Support
If you or someone you know is struggling with substance use, food addiction, or challenges related to weight and mood, professional support can make a difference. Licensed physicians and mental health providers can help determine whether emerging therapies like GLP-1 medications may complement traditional treatment options. To learn more about integrated approaches to addiction and mental health care in Los Angeles, call (310) 601-9999 or visit www.mentalhealthctr.com.
References
- Centers for Disease Control and Prevention. (2023). Adult Obesity Facts.
- von der Goltz, C., et al. (2019). The role of GLP-1 in reward and addiction. Frontiers in Neuroscience, 13, 178.
- Sommer, W. H., et al. (2023). Semaglutide reduces alcohol consumption in preclinical and human models. Nature Metabolism, 5(4), 511–519.
- Egecioglu, E., et al. (2021). GLP-1 receptor agonists and nicotine use: Emerging mechanisms and implications. Neuropsychopharmacology, 46(11), 1913–1923.
- Shalev, U., et al. (2019). GLP-1 signaling in opioid reinforcement and relapse. Addiction Biology, 24(5), 981–989.
- American Psychiatric Association. (2024). Off-label psychiatric uses of GLP-1 receptor agonists.
- Hayes, M. R., & Schmidt, H. D. (2016). GLP-1 influences reward behavior independent of weight loss. Psychopharmacology, 233(19-20), 3623–3633.
- Volkow, N. D., & Koob, G. F. (2021). Neurocircuitry of addiction and emerging pharmacotherapies. New England Journal of Medicine, 384(20), 1921–1932.
- Kleinridders, A., et al. (2020). Metabolic and psychiatric overlap in obesity and addiction. Nature Reviews Endocrinology, 16(8), 459–472.
- Rubino, D., et al. (2021). Semaglutide once weekly in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989–1002.
