Patients start glucagon-like peptide-1 (GLP-1) drugs expecting to think less about food. They did not expect to think less about alcohol. The nightly drink became easier to skip. Cigarettes felt less urgent. Cannabis, gambling, or compulsive shopping sometimes lost their pull. As “food noise” quieted, another possibility emerged: Perhaps these drugs were turning down craving itself.
At first, these reports might have seemed like coincidences. Instead, they sparked new research. Scientists are now using animal studies, brain scans, health records, and clinical trials to see whether these metabolism-affecting drugs also affect the brain systems behind cravings. Semaglutide and other GLP-1 medications are not cures for addiction, but the idea that they could help is now being taken seriously.
The most important shift came in 2026, when The Lancet published a 26-week randomized, placebo-controlled trial of 108 treatment-seeking adults with moderate-to-severe alcohol use disorder and obesity. Everyone received cognitive behavioral therapy; half also received semaglutide 2.4 mg weekly.
Heavy drinking declined in both groups, but more with semaglutide. Heavy drinking days fell by 41.1 percentage points from baseline, compared with 26.4 points with placebo. Other alcohol-related and physical outcomes also improved. Side effects were mainly temporary gastrointestinal symptoms.
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There are important limits to these findings. The people in the study had obesity, wanted treatment, and got therapy. So, the results may not apply to people without obesity or those not looking for help. Even so, this trial shifted the conversation from interesting stories to solid evidence.
A 2025 randomized trial in JAMA Psychiatry studied low-dose semaglutide in 48 adults with alcohol use disorder. It did not improve every weekly drinking measure, but it reduced alcohol consumed during a laboratory session, drinks per drinking day, and weekly craving.
A 2022 exenatide trial in JCI Insight was negative with respect to its primary outcome overall, yet brain imaging showed less reactivity to alcohol cues. Exploratory analyses suggested greater benefit among participants with obesity. A Swedish registry study in JAMA Psychiatry later linked semaglutide and liraglutide with fewer alcohol-related hospitalizations among people with alcohol use disorder and obesity or type 2 diabetes.
Taken together, these results suggest something important: GLP-1 drugs might not cure addiction, but they could make cravings less powerful. Recovery often depends on what someone can do in the moment between feeling an urge and acting on it.
Why might a metabolic drug affect craving? GLP-1 is widely recognized as a gut hormone that helps regulate insulin, slows stomach emptying, and promotes feelings of fullness. However, it is also a key player in a gut-brain network that influences reward, motivation, stress, and habit formation. A 2026 review in Biological Psychiatry highlighted how GLP-1 signaling extends throughout the brainstem, limbic system, and mesolimbic pathways. Its receptors are present in key reward areas, including the ventral tegmental area and nucleus accumbens.
To further understand this, it is useful to distinguish between “liking” and “wanting.” Liking refers to the pleasure a substance provides, while wanting is the powerful urge to obtain it. In addiction, the urge to seek a substance can persist long after the pleasure fades. Everyday cues such as a bottle, a familiar street, a message, or a stressful moment can all spark sudden, intense cravings. GLP-1 medications might quiet that craving signal. They do not make a glass of wine taste bad, but they can make it seem less important.
In 2026, BMJ published a cohort study drawn from more than 600,000 U.S. veterans with type 2 diabetes. Compared with people starting sodium-glucose cotransporter-2 (SGLT-2) inhibitors, those starting GLP-1 drugs had lower recorded risks of several substance use disorders. Among veterans with an existing disorder, GLP-1 use was associated with fewer emergency visits, hospitalizations, overdoses, and substance-related deaths. Observational studies in Molecular Psychiatry and JAMA Network Open have also linked semaglutide with fewer new or recurrent cannabis use disorder diagnoses and a lower risk of opioid overdose among patients with type 2 diabetes and opioid use disorder.
On the other hand, the nicotine research is a good reminder to stay cautious. In a 2026 study of 24 daily smokers, semaglutide lowered cigarette cravings and weight, but did not reduce the number of cigarettes smoked or change the main lab results.
A drug that lowers harmful cravings brings up another question: Could it also reduce healthy desires? Some patients have reported feeling emotionally flat or less interested in everyday pleasures, such as socializing, hobbies, or even enjoying favorite foods. While these accounts are not universal, they raise concerns about a possible blunting of positive motivation or enjoyment. A 2025 meta-analysis in JAMA Psychiatry found no overall rise in psychiatric problems and generally stable or better quality of life among GLP-1 users. That is reassuring, but the analysis may not capture subtle or individual changes in emotional experience. As a result, providers still need to watch closely for signs that patients are losing interest in activities they previously enjoyed or experiencing diminished emotional range. Ongoing research is needed to better understand these potential side effects and ensure that the benefits of reducing unhealthy cravings do not come at the cost of overall well-being.
In summary, GLP-1 drugs are promising but not proven treatments for addiction. They should not replace established medicines, therapy, harm reduction, recovery support, stable housing, or care for trauma and depression. Lowering cravings is not the same as treating physical dependence or withdrawal. As research continues, the challenge will be to harness the benefits of these medications without losing sight of the complexity and individuality of recovery.
This essay is cited in the KevinMD record on GLP-1 drugs.
Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.
