Table of Contents
Introduction: A New Frontier in Addiction Treatment
Substance use disorders are a major public health problem. They affect people of all ages, races, and backgrounds. These disorders involve the repeated use of drugs or alcohol, even when it causes harm to health, relationships, or daily life. Substance use disorders can lead to serious health issues, including liver disease, heart problems, mental health conditions, and even death. The burden on families, healthcare systems, and communities is large. Despite the need, many people with substance use disorders do not get the help they need. Treatments exist, but they do not work for everyone. Many people relapse, even after getting treatment. This has led scientists and doctors to search for new and better treatment options.
Semaglutide is a medication that has recently gained attention, not for addiction, but for weight loss and diabetes. It is a GLP-1 receptor agonist, which means it works like a natural hormone in the body to control blood sugar and appetite. It was first approved to help people with type 2 diabetes manage their blood sugar levels. Later, it was approved to treat obesity because it helped people lose a large amount of weight. As more people began using semaglutide, doctors and researchers noticed something surprising. Some people reported that they also lost interest in alcohol, smoking, or other substances they used to crave. These stories led to more scientific studies.
Now, researchers are exploring whether semaglutide can help people with substance use disorders. The idea may seem strange at first. After all, semaglutide was not made to treat addiction. But scientists are learning that some of the brain systems involved in hunger and appetite are also involved in addiction. The same parts of the brain that make people crave food can also make people crave drugs or alcohol. This overlap has sparked great interest in the medical community. If semaglutide can reduce cravings for food, maybe it can reduce cravings for other things as well.
Early studies in animals have shown promise. Rats and mice given semaglutide used less cocaine, drank less alcohol, and showed less interest in nicotine. These findings suggest that semaglutide affects the reward centers in the brain—the same areas involved in both eating and addiction. Some small studies in humans have also begun. While results are still limited, a few have shown that semaglutide may lower alcohol use in people who are overweight or obese. More studies are needed to confirm these findings and to see if they apply to other types of addiction.
The growing interest in semaglutide for substance use disorders is part of a larger effort to find new ways to treat addiction. Current treatments include counseling, support groups, and medications like methadone or naltrexone. These treatments help, but they are not perfect. Many people still struggle. A new type of medication that works on the brain in a different way could be an important tool. If semaglutide proves to be helpful for addiction, it could change the way doctors approach treatment.
Semaglutide is not yet approved for substance use disorders. Its use in this area is still experimental. But the idea that one drug could help with both obesity and addiction is exciting to researchers. It shows how different parts of medicine can come together in new and unexpected ways. Understanding how semaglutide works in the brain may lead to new treatments—not just for addiction, but also for mental health and behavior issues that are tied to reward and self-control.
As research continues, it is important to look at the science closely. Semaglutide may offer hope, but careful studies are needed to know who might benefit, how it works, and what the risks are. The link between semaglutide and substance use disorders is still new, but it may be the start of a new direction in addiction treatment.
What Is Semaglutide and How Does It Work?
Semaglutide is a medication that was first made to help people with type 2 diabetes. It has also been approved to help with weight loss. Semaglutide works by copying a hormone in the body called GLP-1, which stands for glucagon-like peptide-1. This hormone is naturally made in the intestines. After eating, the body releases GLP-1 to help control blood sugar levels and signal that the body is full.
Semaglutide is part of a group of medicines called GLP-1 receptor agonists. A receptor agonist is a substance that binds to a receptor in the body and activates it. In this case, semaglutide activates the GLP-1 receptors in different parts of the body. These include the pancreas, stomach, and brain. When semaglutide activates these receptors, it helps the body lower blood sugar levels, slows down how fast the stomach empties, and makes people feel full longer after eating.
How Semaglutide Helps With Blood Sugar
For people with type 2 diabetes, semaglutide helps the pancreas release insulin when blood sugar is high. Insulin is the hormone that moves sugar from the blood into cells where it can be used for energy. At the same time, semaglutide lowers another hormone called glucagon, which raises blood sugar levels. This balance between insulin and glucagon helps keep blood sugar in a safer range.
How Semaglutide Helps With Weight Loss
Semaglutide also works on parts of the brain that control hunger and food cravings. When the GLP-1 receptors in the brain are activated, the brain gets signals that the body has had enough food. This leads to a feeling of fullness or satiety. People taking semaglutide often report eating less without feeling very hungry, which helps with weight loss. Semaglutide also slows down how quickly food leaves the stomach, so people feel full for a longer time after eating.
This combination of helping to control blood sugar and reduce hunger makes semaglutide a powerful tool for managing both diabetes and obesity. But recently, researchers have started to ask whether these same effects might also help people who struggle with substance use disorders (SUDs).
How Semaglutide Affects the Brain
One of the most interesting parts of semaglutide is how it acts on the central nervous system (CNS). Unlike many medications for diabetes, semaglutide can cross the blood-brain barrier. This means that it can move from the bloodstream into the brain. Once inside the brain, semaglutide can affect areas that control not only hunger, but also reward, mood, and motivation.
The mesolimbic system is one of these areas. It is a pathway in the brain that plays a major role in reward and pleasure. This system involves chemicals like dopamine, which is often called the “feel-good” chemical. Dopamine is released when someone eats tasty food, wins a prize, or uses a drug like alcohol or cocaine. People with substance use disorders often have changes in this system that make it harder to feel pleasure from normal activities, which leads them to keep using drugs.
Some early studies suggest that semaglutide might affect dopamine in this reward system. It may reduce how rewarding certain substances feel, or lower the urge to seek out those substances. This could make it easier for people to avoid drugs or alcohol.
A Medicine That Affects More Than Just Hunger
The effects of semaglutide on both the body and the brain make it different from many other medicines. It acts in several ways:
- It controls blood sugar by helping the pancreas and liver.
- It reduces hunger and food intake by slowing the stomach and signaling the brain.
- It may change how the brain responds to rewards and cravings.
Because of these wide-ranging effects, semaglutide is now being studied not only for diabetes and obesity but also for conditions like addiction, binge eating disorder, and even depression. While more research is still needed, the way semaglutide works gives scientists good reasons to explore these possibilities.
Understanding how semaglutide works helps explain why it may have an effect on substance use. The brain systems it affects in appetite and fullness are closely linked to the same systems involved in addiction and craving. By calming those systems down, semaglutide could become a useful tool in the treatment of substance use disorders in the future.
What Are Substance Use Disorders (SUDs)?
Substance Use Disorders, or SUDs, are medical conditions that happen when a person keeps using a substance even though it is causing harm to their health, relationships, or daily life. These substances can include alcohol, nicotine, prescription drugs, or illegal drugs like cocaine or heroin.
SUDs affect the brain and behavior. They can lead to strong urges to use a substance, even when someone wants to stop. Over time, the brain changes, and it becomes harder to feel pleasure without the substance. This makes quitting very difficult, even if the person understands the risks or wants to stop using.
How Substance Use Becomes a Disorder
When someone uses a substance, it often starts with a choice. For example, a person may drink alcohol at a party or take a painkiller for an injury. But with repeated use, the brain begins to rely on the substance. This leads to changes in how the brain works. Eventually, the brain starts to “need” the substance to feel normal.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is used by doctors to diagnose mental health conditions. It describes SUDs based on 11 criteria. These include:
- Taking the substance in larger amounts or for longer than planned
- Wanting to stop but being unable to
- Spending a lot of time getting, using, or recovering from the substance
- Having strong cravings
- Failing to meet responsibilities at work, school, or home
- Continuing to use despite relationship problems
- Giving up activities that were once important
- Using the substance in dangerous situations, like while driving
- Continuing use even when it causes physical or mental harm
- Developing tolerance (needing more to get the same effect)
- Experiencing withdrawal symptoms when not using
If a person meets two or three of these criteria, the condition is considered mild. Four or five means it is moderate. Six or more is considered severe.
What Happens in the Brain During Addiction
SUDs change how the brain’s reward system works. Normally, the brain releases a chemical called dopamine when something good happens, like eating or spending time with loved ones. Dopamine makes people feel happy and encourages them to repeat the behavior.
When someone uses a substance like alcohol, opioids, or cocaine, the brain releases a much larger amount of dopamine. This creates a powerful feeling of pleasure or a “high.” Over time, the brain starts to rely on the substance to release dopamine. Natural rewards, like food or friendships, may no longer bring the same level of joy. This leads to cravings and compulsive use.
The brain also becomes less sensitive to the substance. This means the person needs more of it to feel the same effect—a process known as tolerance. At the same time, stopping use becomes harder because of withdrawal symptoms like anxiety, sweating, nausea, or trouble sleeping.
Common Substances That Cause SUDs
Many substances can lead to addiction. Each one affects the brain in a different way:
- Alcohol slows down brain activity. It affects judgment, coordination, and mood. Long-term use can damage the liver, heart, and brain.
- Nicotine, found in tobacco, is highly addictive. It causes a short-term feeling of calm or alertness. It raises the risk of cancer and heart disease.
- Opioids include prescription painkillers like oxycodone, as well as heroin. They cause a strong sense of euphoria but can slow breathing and lead to overdose.
- Stimulants such as cocaine or methamphetamine increase energy and alertness. They also raise the risk of heart attack and severe mental health problems.
- Cannabis may lead to addiction in some users. It can affect memory, learning, and mood, especially in young people.
Each substance affects people differently, but all can lead to long-term brain changes and serious health risks.
The Impact of SUDs
SUDs do not only affect the person using the substance. Families, communities, and healthcare systems are also impacted. Addiction can lead to job loss, family breakdown, and financial problems. It is also a major cause of crime, overdose, and early death.
Understanding that SUDs are medical conditions—not moral failures—is important. They are chronic illnesses that require proper treatment and support, just like diabetes or heart disease. With the right help, recovery is possible.
Is There a Biological Link Between Obesity and Addiction?
Obesity and addiction may seem like two very different problems. One involves eating too much food. The other involves using harmful substances like alcohol, drugs, or tobacco. But research shows that both may share common brain pathways. These pathways affect how the brain handles reward, pleasure, and self-control.
Shared Brain Circuits and Reward
The brain has a reward system that helps people feel pleasure. This system uses a chemical called dopamine. Dopamine is released in the brain when someone eats tasty food, takes drugs, or does something enjoyable. The more dopamine released, the better the person feels. Because of this, the brain learns to repeat those actions.
Both overeating and drug use increase dopamine in a part of the brain called the nucleus accumbens. This part plays a major role in wanting and liking. In people with obesity or addiction, the brain may release too much dopamine at first. But over time, it may become less sensitive. As a result, the person may need more food or higher drug doses to feel the same pleasure. This cycle can lead to compulsive behavior.
Cravings and Impulse Control
Cravings are strong urges to eat or use substances. These urges are linked to changes in the prefrontal cortex. This part of the brain helps with decision-making and impulse control. In both obesity and addiction, this area often does not work as well. That makes it harder to resist temptations. For example, a person may know that eating junk food or smoking a cigarette is unhealthy. But they still may do it because the brain struggles to stop the craving.
Brain scans have shown that people with obesity or addiction often have similar patterns of brain activity. They show less activity in the prefrontal cortex and more in the reward system. This means they are more likely to act on impulse and seek out rewarding things, even when they know it might harm their health.
Food as a Substance of Abuse
Some scientists use the term “food addiction” to describe eating behaviors that look like drug addiction. This happens when a person keeps eating high-sugar, high-fat foods even when they are not hungry. These foods can cause strong dopamine responses. Over time, the brain may become dependent on those responses, just like it can with drugs or alcohol.
Not all experts agree on using the word “addiction” for food. But there is growing evidence that for some people, the brain responds to certain foods in the same way it responds to addictive substances. These people may show signs such as withdrawal when trying to cut back, or loss of control around specific foods.
The Role of GLP-1 in Both Conditions
GLP-1 (glucagon-like peptide-1) is a hormone that helps control appetite and blood sugar. It also affects parts of the brain involved in reward. Drugs like semaglutide mimic GLP-1 and are used to treat obesity and diabetes.
Recent studies suggest that GLP-1 may also reduce cravings for drugs and alcohol. This may be because it changes how the brain’s reward system works. Since both overeating and addiction involve the same circuits, a drug that helps one might help the other. That is why semaglutide and other GLP-1 drugs are now being studied for use in treating addiction.
Understanding the Link Matters
Knowing that obesity and addiction share the same brain pathways helps researchers find new ways to treat both. It also helps explain why some people may struggle with more than one type of addictive behavior. A person who overeats may also have problems with alcohol or smoking. This is not a matter of weak willpower. It is often linked to how their brain is wired.
Understanding these shared links allows for better treatment plans. It opens the door for new medications like semaglutide to be used in more than one area. But more research is still needed to know how these drugs affect the brain long-term.
What Does Current Research Say About Semaglutide and Substance Use?
Semaglutide is a medicine approved to treat type 2 diabetes and obesity. It works by copying a natural hormone in the body called GLP-1 (glucagon-like peptide-1). This hormone helps control blood sugar, slow down digestion, and reduce hunger. While semaglutide is mainly used for blood sugar and weight control, researchers have started to explore whether it might also help people who struggle with addiction.
Substance Use Disorders (SUDs) are medical conditions where a person cannot control their use of alcohol, drugs, or other substances. These conditions affect the brain’s reward system. People with SUDs may feel strong cravings, have trouble stopping, and continue to use substances even when they cause harm. Many scientists believe semaglutide might help reduce these cravings by affecting the same parts of the brain involved in addiction.
Animal Studies and Early Evidence
Most of the early research on semaglutide and addiction comes from studies on animals. These studies have shown that semaglutide can change the way animals respond to drugs and alcohol. For example, in several studies, rats that were given semaglutide drank less alcohol than usual. In one study, semaglutide was given to rats trained to press a lever to get alcohol. After treatment, the rats pressed the lever less often, suggesting they were less interested in drinking.
Similar effects have been seen with other substances. In some experiments, rats given semaglutide also used less cocaine and nicotine. These findings suggest that semaglutide may reduce the desire to use these drugs. Researchers believe the drug might be working by reducing how rewarding the substance feels in the brain. If the brain gets less reward from the drug, the urge to take it again may become weaker.
Research on Humans
While studies on animals are helpful, it is important to understand how a drug works in people. So far, research in humans is limited but growing. One small clinical trial looked at people with alcohol use disorder. The participants were given semaglutide or a placebo (a fake treatment). The people who took semaglutide reported fewer cravings for alcohol and drank less compared to the placebo group. However, this study involved only a small number of people, and the follow-up time was short. More research is needed to confirm these results.
Another area of interest is how semaglutide might affect people who smoke. Smoking is one of the most common forms of addiction. In animal studies, semaglutide has reduced nicotine use. Some early reports in humans have suggested that people taking semaglutide for weight loss or diabetes may feel less desire to smoke. However, these reports are not part of large scientific studies, and the link is not yet proven.
At this time, there are no large clinical trials focused on using semaglutide to treat cocaine or opioid addiction in humans. Most of the information about these drugs comes from studies with rats or mice. This early research is promising, but scientists need to test the drug in real-life settings to understand how it works in people with different types of substance use problems.
Limits of Current Research
While the results from early studies are encouraging, there are many things still unknown. Most studies so far are small, short-term, or done in animals. It is unclear how well semaglutide would work over a longer period of time in people with severe addiction. It is also not clear whether it works the same way for different substances.
Another issue is that semaglutide is not currently approved for treating addiction. Doctors may use it “off-label,” but this means using the drug for a purpose that is not officially approved. More large, well-designed clinical trials are needed before semaglutide can be widely used for treating substance use disorders.
Semaglutide may also work differently in people depending on their health, genetics, or the type of addiction they have. For example, a person addicted to alcohol may respond differently than someone addicted to opioids or cocaine. More studies are needed to understand who might benefit the most from this treatment.
Research on semaglutide and substance use is still in its early stages. Animal studies show that semaglutide may reduce drug and alcohol use. Small human studies suggest it might help reduce cravings and use of alcohol or nicotine. However, more research is needed to know if semaglutide is safe, effective, and helpful for treating addiction in the long term.
How Might Semaglutide Influence Cravings and Reward-Seeking Behavior?
Semaglutide is a medicine often used to treat type 2 diabetes and obesity. It helps control blood sugar levels and reduces appetite. Recently, scientists have started looking into how semaglutide might also affect the brain in ways that could help people with substance use disorders. This section explores how semaglutide may reduce cravings and lower the urge to seek out addictive substances.
Affecting the Brain’s Reward System
Semaglutide works by activating GLP-1 receptors. These receptors are found not only in the pancreas and gut but also in the brain. In the brain, they are located in areas responsible for motivation and pleasure, especially the mesolimbic system. This system includes brain regions such as the ventral tegmental area (VTA) and the nucleus accumbens (NAc).
These areas play a key role in the way the brain responds to rewards. When someone eats something tasty or uses a drug like nicotine or alcohol, these areas release a chemical called dopamine. Dopamine creates feelings of pleasure and makes people want to repeat that action. Over time, repeated use of drugs can cause the brain to release too much dopamine, leading to addiction. People then begin to crave the drug, even when it causes harm.
Semaglutide may reduce the release of dopamine in response to drugs. Animal studies have shown that semaglutide lowers dopamine levels in the brain’s reward areas when exposed to addictive substances. As a result, the brain may not respond as strongly to the drug, and the desire to keep using it becomes weaker.
Reducing Cravings and Motivation to Use
Cravings happen when the brain remembers the pleasure from a drug and wants to feel that way again. Triggers like stress, certain people, or specific places can bring on these cravings. When semaglutide reduces the brain’s response to those triggers, the cravings may also decrease.
In some animal studies, rats given semaglutide showed less interest in alcohol or nicotine, even when they had easy access to it. This may mean semaglutide changes the way the brain reacts to the “wanting” of the drug. Interestingly, semaglutide does not seem to take away the feeling of pleasure (“liking”) completely, but it lowers the strong urge to go out and get the substance (“wanting”).
This is different from other addiction treatments that block the enjoyable effects of a drug. Instead, semaglutide may work by making the brain less focused on getting the drug in the first place. This could help people avoid relapse, especially during early recovery when cravings are often strongest.
Improving Self-Control and Reducing Impulses
Many people with substance use disorders struggle with impulse control. This means they may act without thinking, especially when faced with temptation or stress. Some research suggests that semaglutide might also help with this issue.
GLP-1 receptors are found in the prefrontal cortex, the part of the brain that helps with decision-making and self-control. When these receptors are activated, the brain may be better able to manage urges and delay acting on them. In studies with animals, those treated with GLP-1 drugs were more likely to avoid risky or impulsive behaviors. If this also works in people, semaglutide could support better control over drug-seeking actions.
Early Evidence From Human Studies
Most of the research so far has been done in animals. However, a few small human studies and reports have shown that people taking semaglutide or other GLP-1 drugs sometimes report feeling fewer cravings for alcohol or tobacco. Some people also say they lose interest in these substances without trying to quit.
Though promising, this evidence is still early. Larger clinical trials are now being planned or started to test semaglutide in people with addictions. These studies will help researchers understand how the drug works in real-world settings and whether it is safe and helpful as part of addiction treatment.
Semaglutide may help reduce cravings and reward-seeking behavior by working on brain pathways that control motivation, pleasure, and self-control. It seems to lower the brain’s response to addictive substances, reduce dopamine release, and help people resist urges. While the results from early studies are hopeful, more research is needed to confirm these effects in humans and to understand how semaglutide might fit into addiction treatment programs.
What Substances Have Been Studied in Relation to Semaglutide?
Semaglutide is a medication that was first approved to treat type 2 diabetes. Later, it was also used to help people lose weight. Scientists have recently begun looking at semaglutide to see if it might help people who struggle with addiction. Research in this area is still new, but early studies have shown interesting results. Some of the most studied substances in connection with semaglutide include alcohol, nicotine, cocaine, and opioids. Each of these substances affects the brain’s reward system. Semaglutide appears to influence similar brain areas, which is why researchers are testing its potential for substance use disorders.
Alcohol
One of the most studied drugs in this field is alcohol. Alcohol affects the brain’s dopamine system, which plays a major role in feelings of pleasure and reward. In both animal and human studies, semaglutide seems to lower the desire to drink alcohol.
In rat studies, animals given semaglutide drank less alcohol than animals that were not given the drug. The same effect was found with other GLP-1 receptor agonists. This suggests that semaglutide may reduce the rewarding effects of alcohol. It might also lower cravings or the urge to drink.
Small studies in humans are now starting to test whether semaglutide can help people with alcohol use disorder. Some early findings suggest that people taking semaglutide report drinking less alcohol. These results are promising, but the studies are small and not yet conclusive. Larger clinical trials are needed to confirm if semaglutide can help treat alcohol addiction safely and effectively.
Nicotine
Nicotine is the drug found in tobacco products. It is one of the most addictive substances and is responsible for many health problems, including cancer and heart disease. Semaglutide and similar drugs have been tested in lab animals to see if they affect nicotine use.
In studies with rats, semaglutide reduced the amount of nicotine the animals wanted to take. It also lowered their interest in working for nicotine rewards. This suggests that semaglutide may weaken the brain’s response to nicotine, making it less rewarding. This could help explain why people might feel fewer cravings when using semaglutide.
There is very little human research so far on semaglutide and nicotine. Still, these early animal studies suggest that semaglutide may hold promise for helping people quit smoking or avoid relapse. More testing in people is needed before this can be confirmed.
Cocaine and Other Stimulants
Cocaine is a powerful stimulant that increases dopamine levels in the brain very quickly. This creates strong feelings of euphoria, followed by a crash. These rapid changes in brain chemistry make cocaine very addictive.
Animal studies have tested whether semaglutide affects how much cocaine rats will take. Rats that were given semaglutide pressed levers less often to receive cocaine. This means they were less motivated to take the drug. The animals also showed lower interest in cues linked to cocaine, such as lights or sounds that signaled the drug was coming. These findings suggest that semaglutide might reduce both the craving for cocaine and the brain’s response to drug-related triggers.
Studies in people have not yet been done for cocaine and semaglutide, but the results from animal research have raised interest in starting clinical trials. Scientists hope to learn whether semaglutide could help people reduce their use of stimulants or prevent relapse after treatment.
Opioids
Opioids include drugs like heroin, fentanyl, morphine, and prescription painkillers. These drugs cause euphoria and pain relief by binding to opioid receptors in the brain. Opioid use disorder is one of the most serious substance problems today, with high rates of overdose and death.
Research on semaglutide and opioids is more limited compared to other substances. There are very few studies so far. One reason might be that opioids act through a different pathway than the dopamine system that GLP-1 receptor agonists usually affect. However, some researchers believe semaglutide may still play a role. It could lower overall drug cravings or reduce stress-related drug-seeking behavior.
More studies are needed to explore how semaglutide might affect opioid use, especially in people who are also dealing with obesity or diabetes. Until more data is available, it is too early to say whether semaglutide could be used for opioid use disorder.
So far, semaglutide has shown the most promise in studies related to alcohol and nicotine. Animal research suggests it can also affect how rats respond to cocaine. Research on opioids is still very limited, and more studies are needed. While early results are hopeful, especially in lab settings, much more work is needed before semaglutide can be used to treat addiction. Scientists are working to understand how this medication changes the brain and behavior related to drug use. As larger and longer-term studies are done, clearer answers should emerge.
What Are the Risks or Concerns of Using Semaglutide in SUD Treatment?
Semaglutide is a medication that is mainly used to treat type 2 diabetes and obesity. It helps lower blood sugar and supports weight loss by making people feel full and reducing appetite. It does this by copying a natural hormone in the body called GLP-1 (glucagon-like peptide-1). Because semaglutide affects parts of the brain that control hunger and reward, researchers are now studying it for possible use in treating substance use disorders (SUDs). While early results are promising, there are also several important risks and concerns to think about before using semaglutide for addiction.
Side Effects and Safety Concerns
Semaglutide is known to cause several side effects, some of which can be serious. The most common side effects are nausea, vomiting, diarrhea, constipation, and stomach pain. These usually happen when someone starts the drug or increases the dose. Although these symptoms are often mild, they can make it hard for people to keep taking the medication, especially those already struggling with health or mental health issues.
There are also more serious side effects to consider. In some people, semaglutide may raise the risk of pancreatitis, which is swelling and irritation of the pancreas. This condition can be painful and dangerous. Signs include severe stomach pain that may spread to the back, along with nausea and vomiting. There is also a small risk of gallbladder problems, such as gallstones, which may require surgery if they cause blockages.
In rare cases, semaglutide has been linked to kidney problems, especially in people who become very dehydrated due to vomiting or diarrhea. If a person with a substance use disorder already has kidney issues—perhaps from long-term alcohol use or other causes—this could be a serious concern.
There are also concerns about a possible link between semaglutide and thyroid tumors, including a rare type called medullary thyroid cancer. So far, this link has mostly been seen in animal studies, and the risk in humans is not fully known. Because of this, semaglutide is not recommended for people with a personal or family history of certain thyroid cancers.
Off-Label Use Without Enough Evidence
Another concern is that semaglutide might be used for substance use disorders before there is enough evidence to prove that it works. This is known as “off-label” use, which means using a drug for a purpose that is not yet approved by health authorities like the FDA. While doctors are allowed to prescribe drugs off-label, doing so without strong scientific support can be risky.
There are only a few early studies looking at how semaglutide affects drug or alcohol cravings in humans. Most research so far has been in animals. Until there are large, well-designed human studies, it is not clear how well semaglutide works for addiction, how long it should be taken, or what the safest doses are. Using semaglutide too soon for SUD treatment may give people false hope or take attention away from treatments that already have proven benefits.
Mental Health and Co-Occurring Conditions
People with substance use disorders often have other health problems at the same time. These may include depression, anxiety, or bipolar disorder. Many also have liver problems, especially if they drink alcohol heavily. It is important to know how semaglutide interacts with these conditions.
For example, the way semaglutide works in the brain might affect mood or cause unexpected changes in mental state. Right now, there is not enough research to know if semaglutide is safe for people with mental illness. Careful monitoring would be needed, especially in the early weeks of treatment.
People with liver damage may also face higher risks when using semaglutide. The liver helps process many medications, and if it is not working well, drugs can build up in the body and cause harm. Some studies have not yet tested semaglutide in people with serious liver disease, so it is unclear whether it is safe for that group.
Risk of Misuse or Poor Monitoring
Since semaglutide is known for weight loss, there is also concern that it could be misused or over-prescribed, especially in places where addiction and obesity often overlap. If people believe semaglutide can treat many problems at once—such as drug use, food addiction, and weight gain—they may push to use it without proper care or oversight.
Without the right kind of follow-up, some people may stop other important treatments, such as counseling or medications that have already been shown to work well for substance use disorders. Using semaglutide without full support could reduce the chances of real recovery.
Need for Caution
Until more research is done, doctors and patients must be very careful when thinking about semaglutide for treating substance use. The drug may offer help for some people, but the risks—especially side effects, off-label use, and unknown long-term safety—must be taken seriously. Researchers are still learning how it works in people with addiction, and there are many unanswered questions.
Only well-designed clinical trials can show whether semaglutide is a safe and effective part of addiction treatment. Until then, it should not replace proven methods, and any use in this area should be closely supervised by healthcare professionals.
Could Semaglutide Be Used Alongside Other SUD Treatments?
Substance Use Disorders (SUDs) are often complex. Many people with SUDs need more than one type of treatment to get better. Current treatment plans often include a mix of medication, counseling, and behavioral support. These methods work together to help people manage cravings, avoid relapse, and build a stable life. Since semaglutide is being studied as a possible new option for treating addiction, an important question is whether it could safely and effectively be added to these current methods.
Working Together with Behavioral Therapy
Behavioral therapy is one of the main tools for treating SUDs. It includes methods like cognitive behavioral therapy (CBT), motivational interviewing, and group support programs. These therapies help people understand their behavior, learn how to avoid triggers, and build coping skills.
Semaglutide may help make these therapies more effective. Early research suggests that semaglutide might lower cravings and reduce reward-seeking behavior in the brain. If people feel fewer urges to use drugs or alcohol, they may be better able to focus during therapy and stay in treatment longer. While semaglutide would not replace therapy, it could support the process by making cravings less intense.
Using Semaglutide with Medication-Assisted Treatment
Medication-Assisted Treatment (MAT) is a common approach for opioid and alcohol use disorders. It uses medicines like buprenorphine, methadone, or naltrexone. These medications work by reducing withdrawal symptoms, lowering cravings, or blocking the effects of drugs. MAT has been shown to improve treatment success and reduce the risk of overdose.
If semaglutide is proven to reduce cravings for substances, it might be used alongside MAT. However, this idea needs careful study. Doctors would need to understand how semaglutide interacts with other medications. For example, semaglutide slows down how quickly the stomach empties. This could change how other medicines are absorbed in the body. Also, semaglutide and MAT drugs could have overlapping side effects, like nausea or dizziness, which may be more serious when taken together.
Even though no major drug interaction has been confirmed yet, it is important to test how semaglutide behaves when used with MAT medicines before using them together in treatment plans.
Supporting Weight Loss and Overall Health
Many people with substance use problems also struggle with poor nutrition, weight gain, or obesity, especially after they stop using drugs or alcohol. Semaglutide is already approved for weight management. It helps people feel full sooner and eat less.
In people recovering from SUDs, semaglutide might help support better physical health. Better health can also improve mental health, which may make recovery more stable. This means that semaglutide could offer both physical and psychological support during addiction recovery.
Still, care must be taken. Not everyone with SUDs is overweight. Some may be underweight or malnourished. In these cases, semaglutide might not be helpful and could even make things worse. So, it would be important for doctors to decide who is a good fit for this kind of treatment.
Building New Treatment Plans
If semaglutide becomes part of SUD treatment in the future, doctors and researchers would need to create new plans for how to use it. These plans would need to answer important questions, such as:
- How long should people take semaglutide?
- Should it be started at the same time as therapy or later?
- How can doctors measure whether it is helping with addiction symptoms?
Clinical trials would be needed to test these questions in real patients. Treatment guidelines would also need updates based on the results of these trials.
Safety and Monitoring
Even if semaglutide shows benefits, it must be used with caution. Doctors would need to monitor patients closely. This includes watching for side effects, checking for drug interactions, and making sure the person is still doing well in therapy or other treatments. Regular follow-ups would help keep people safe while trying this new approach.
Adding semaglutide to current treatments for substance use could offer new hope, but it should always be done carefully and under medical supervision. The goal is not to replace what already works but to build on it and make recovery more successful for more people.
Conclusion: Is Semaglutide a Viable Option for Addiction Medicine?
Substance use disorders affect millions of people around the world. These disorders can involve alcohol, nicotine, opioids, cocaine, and other drugs. They cause serious harm to health, relationships, and daily life. Treating these conditions is very difficult and often takes a long time. Many people relapse even after getting help. Current treatments include counseling, behavior therapy, and medications. Still, many patients do not fully recover or continue to struggle with cravings.
Semaglutide is a medicine that has gained attention for its strong effects on weight loss and blood sugar control. It was first approved to treat type 2 diabetes. Later, it was approved for treating obesity. Semaglutide works by acting on a hormone called GLP-1. This hormone helps control hunger, blood sugar, and insulin levels. Scientists have found that GLP-1 also plays a role in the brain’s reward system. This is the same system involved in addiction. Because of this connection, researchers have started to explore whether semaglutide could help reduce cravings for drugs or alcohol.
Research on semaglutide and addiction is still in the early stages. Some animal studies show that semaglutide can reduce the desire for alcohol, nicotine, and even cocaine. A few small studies in people suggest similar results. For example, some individuals taking semaglutide report less interest in drinking alcohol. Others say they feel fewer urges to eat unhealthy foods, which may be related to how semaglutide affects the reward centers in the brain. However, these studies are limited. They often involve small groups or short time periods. More data is needed to understand how semaglutide truly affects substance use.
There is a possible biological link between obesity and addiction. Both conditions involve changes in how the brain responds to rewards. People with obesity and those with substance use disorders may show similar patterns of brain activity. This includes stronger cravings and weaker self-control. Because semaglutide helps control food cravings, it might also help with drug or alcohol cravings. The drug may affect brain areas like the ventral tegmental area (VTA) and nucleus accumbens. These areas are important in how people experience pleasure and motivation.
Even though semaglutide shows promise, it is not yet proven to work for addiction. The medicine has side effects, including nausea, vomiting, and stomach pain. Some people may also have more serious problems, like inflammation of the pancreas or gallbladder. It is important to study whether these risks increase when the drug is used in people with substance use disorders. People with addiction often have other health issues that could make treatment more complicated.
Another question is whether semaglutide can be used with other addiction treatments. Most experts agree that a combination of therapy and medication works best. Semaglutide could one day be added to these treatment plans, but it should not replace existing options. It is also unclear how semaglutide would interact with medications like methadone, buprenorphine, or naltrexone. These drugs are already used to treat opioid and alcohol addiction. Careful testing is needed to make sure these combinations are safe and helpful.
Large clinical trials are needed to find out if semaglutide can be used in addiction medicine. These studies must include many people over long periods of time. They should look at how well the drug works and how safe it is. Researchers also need to learn which patients might benefit most. Not everyone with addiction may respond the same way. Factors like age, gender, type of substance used, and mental health history could make a difference.
Until more is known, semaglutide should be seen as an experimental option for addiction. It is not approved for this use, and doctors should be careful about giving it for off-label reasons. At the same time, the idea of using one drug to help with multiple brain-based conditions is exciting. If future studies show strong and safe results, semaglutide could become a powerful tool in treating addiction.
The connection between semaglutide and substance use is a new area of science. It offers hope, but it must be backed by solid evidence. The path forward requires careful research, patient safety, and a clear understanding of how the drug works in the brain. Only then can it be known if semaglutide is truly a helpful part of addiction medicine.
Research Citations
Hendershot, C. S., Bremmer, M. P., Paladino, M. B., Kostantinis, G., Gilmore, T. A., Sullivan, N. R., … Klein, K. R. (2025). Once-weekly semaglutide in adults with alcohol use disorder: A randomized clinical trial. JAMA Psychiatry, 82(4), 395–405.
Fink-Jensen, A., Wörtwein, G., Klausen, M. K., Hansen, L., & Knudsen, G. M. (2024). Effect of the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide on alcohol consumption in alcohol-preferring male vervet monkeys. Psychopharmacology.
Quddos, F., Hubshman, Z., Tegge, A., Majid, M., & Richards, J. (2023). Semaglutide and tirzepatide reduce alcohol consumption in individuals with obesity. Scientific Reports, 13(1), 20998.
Richards, J. R., Dorand, M. F., Royal, K., Mnajjed, L., Paszkowiak, M., & Simmons, W. K. (2023). Significant decrease in alcohol use disorder symptoms secondary to semaglutide therapy for weight loss: A case series. Journal of Clinical Psychiatry, 85(1), 23m15068.
Wang, L., Volkow, N. D., Berger, N. A., Davis, P. B., Kaelber, D. C., & Xu, R. (2024). Associations of semaglutide with incidence and recurrence of alcohol use disorder in real-world populations. Nature Communications, 15(1), 4548.
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Questions and Answers: Substance Abuse Disorders and Semaglutide
A Substance Use Disorder is a medical condition characterized by an uncontrollable use of a substance despite harmful consequences, leading to significant impairment or distress.
Common substances include alcohol, opioids (like heroin or prescription painkillers), stimulants (such as cocaine or methamphetamine), cannabis, and sedatives.
Diagnosis is based on criteria in the DSM-5, including impaired control, social impairment, risky use, and pharmacological indicators like tolerance and withdrawal.
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used to treat type 2 diabetes and obesity. It improves blood sugar control and promotes weight loss.
No, semaglutide is not currently approved by the FDA for treating SUDs, though it is being studied for its potential to reduce cravings and compulsive behaviors.
Preliminary research suggests that semaglutide may affect brain reward pathways, possibly reducing cravings for addictive substances like alcohol or nicotine.
Treatments include behavioral therapies (e.g., CBT, motivational interviewing), medications (like methadone, buprenorphine, or naltrexone), and support groups (e.g., AA or NA).
While not standard practice, clinical trials are exploring semaglutide in combination with traditional therapies to assess safety and effectiveness in reducing addictive behaviors.
Common side effects include nausea, vomiting, diarrhea, constipation, and decreased appetite. Serious but rare side effects include pancreatitis and gallbladder problems.
Because semaglutide may regulate reward-driven behavior and appetite, researchers believe it could help manage compulsive substance use similarly to how it helps reduce overeating.
Dr. Judith Germaine
Dr. Jude (Germaine-Munoz) Germaine, MD is a family physician in Springfield, New Jersey. She is currently licensed to practice medicine in New Jersey, New York, and Florida. She is affiliated with Saint Josephs Wayne Hospital.