Ozempic Might Help You Drink and Smoke Less

Neuroscientists hope that semaglutide, the active ingredient in Ozempic and weight-loss drug Wegovy, may be more potent than older diabetes drugs to curb addictive behavior. Those older drugs have shown promise in animal studies, but had mixed results in trials with people.

An effective drug for alcohol-use disorder could have a big public-health impact, according to doctors. But they warn that long-term data is needed to reveal side effects in people with this condition, and that the current cost of Ozempic and Wegovy could make these particular drugs impractical for broad use.

A self-described “heavy drinker,” Michael McCluskey had struggled with obesity for years. But after he was prescribed Ozempic for potential prediabetes linked to his weight two years ago, he shed 120 pounds—and the urge to regularly consume alcohol.

The 59-year-old who resides in Nova Scotia, Canada, realized his heavy drinking habits had shifted after he read reports from other Ozempic takers. “It just sort of clicked off,” he said.

McCluskey said he would typically have four-to-five drinks a day but after starting Ozempic, he only drinks a handful of times a year. Looking back, he feels the shift kicked in about six months on the drug. 

Drugs like Ozempic mimic the hormone GLP-1 that is naturally released from the intestines and helps regulate glucose levels and suppress hunger. 

It is also naturally produced in the brain stem—affecting activity of many brain regions, including those involved in impulse control, memory formation and reward, according to neuroscientists and endocrinologists. 

GLP-1 reduces the response of the brain’s reward system to dopamine, a molecule involved in motivation and reward, according to Scott Kanoski, a University of Southern California neuroscientist who has studied GLP-1’s effects on the brain. 

These changes lead to reductions in binge-eating-like behaviors in rodents, Kanoski and his team have shown. Rats injected with exenatide and liraglutide—two older diabetes drugs in the GLP-1 category—ate less. Then the scientists reversed the effect by injecting a GLP-1 blocker into the brains of rats, after which the rodents ate more. This suggests the GLP-1 drugs directly affected behavior by acting in the brain, Kanoski said.  

It isn’t just food and alcohol—animal studies have shown that rodents consume less of a range of potentially addictive substances when treated with GLP-1 drugs.

“We’re talking about a class of medications that could have efficacy in treating a variety of addictions: cocaine, opioids, nicotine, alcohol, all different addictive drugs with very different pharmacology,” said Heath Schmidt, a neuroscientist studying addiction at the University of Pennsylvania School of Nursing and School of Medicine, who has published studies showing older GLP-1 drugs decrease cocaine, opioid and nicotine use in rodents. Semaglutide may be more potent because it is better than older drugs at reaching the brain, or because it is longer-lasting than older drugs, Schmidt said.  

After showing that semaglutide decreased binge drinking behavior in mice and rats in a study published last month, physician-scientist Dr. Lorenzo Leggio is aiming to launch a U.S. trial this year to test semaglutide in people who are overweight or obese. Another trial under way at the University of North Carolina will test semaglutide in people with alcohol-use disorder who also smoke. 

Tap to View

Nearly 30 million teens and adults in the U.S. have alcohol-use disorder, but the three drugs approved by the U.S. Food and Drug Administration for the condition don’t work for everyone, said Leggio, who studies addiction at the National Institutes of Health. Some 40% of people who receive treatment relapse after the first three years. 

“We have to wait for randomized control data to be able to say something for sure,” says Dr. Anders Fink-Jensen, a psychiatrist at the University of Copenhagen, who is recruiting 100 people with alcohol-use disorder and obesity for a trial of semaglutide in Denmark. Fink-Jensen receives funding for research from the Novo Nordisk Foundation, a major investor in the pharmaceutical company Novo Nordisk, which makes Ozempic and Wegovy, as well as from the company itself.

A few years ago when Fink-Jensen tested exenatide in people with alcohol-use disorder, he found it reduced drinking compared with a placebo in a subgroup of people who were obese, but not across the trial group as a whole. 

Still, when both groups were shown photos of alcoholic beverages, brain imaging picked up less activity in the reward centers of people who had taken exenatide, compared with the placebo group. “Imaging data we have suggests there is something going on in the brain,” Fink-Jensen said. The study was published in October.

For reasons neuroscientists don’t completely understand, the effects on brain activity and behavior aren’t permanent. “The brain is a mysterious place,” Kanoski said. If people stop taking the drug, they can relapse. 

That is what happened to one participant in Fink-Jensen’s study, who struggled to cut back on his drinking for nearly three decades.

A few weeks into starting exenatide for the trial in 2018, his alcohol cravings stopped, and his quality of life improved: He was able to remember conversations, became more attentive at his job, and he slept well. But some months after the trial ended and he stopped taking exenatide, he started drinking again. Eventually he opted to go to rehab and has been sober since.  

If large long-term studies show these drugs can treat alcohol-use disorder, that could have big impacts on the healthcare system, according to Dr. Brian P. Lee, an AUD specialist, liver-transplant physician and assistant professor of medicine at the University of Southern California Keck School of Medicine. 

“If you’re able to treat both obesity and alcohol use at the same time, you could just imagine the effects from a public health standpoint,” he said. 

Still, Lee is waiting on data around side effects before he is ready to prescribe Ozempic to his patients. Patients who have AUD tend to also be malnourished, he said, so taking a drug that decreases appetite and causes changes in diet could exacerbate that. “We have to be very cautious about potential risks,” he said. 

So far, researchers haven’t yet documented any psychiatric side effects in people or animals taking GLP-1 drugs due to changes in dopamine signaling, GLP-1 experts said. 

Cost is another barrier. Naltrexone, a drug commonly prescribed for AUD, is as little as $1 a day, or about $30 a month, according to Dr. Paul Linde, a psychiatrist and medical director of Ria Health, a telehealth alcohol-use disorder treatment provider. GLP-1 drugs can cost hundreds of dollars a month by comparison. 

“If we can get better availability on a cost basis,” Linde said, “it has the potential to revolutionize the treatment for alcohol-use disorder.”

Some drugs initially approved to treat Type 2 diabetes are now being used for weight loss. WSJ’s Daniela Hernandez explains how they work, their side effects, and concerns over unintended consequences. Illustration: Elizabeth Smelov

Write to Nidhi Subbaraman at [email protected] and Daniela Hernandez at [email protected]