Alcohol, Opioids, Tobacco: The Diet Drug Ozempic Emerges as a Promising Star in Addiction Treatment

Introduction: From Diet Pills to "Addiction Treatment"

GLP-1 receptor agonists (a class including "Ozempic" and "Wegovy") have gained attention for their appetite suppression and weight loss effects. It has been suggested that GLP-1 also acts on the brain's reward system, potentially reducing "addictive behaviors" such as alcohol, drug, and nicotine use. A review on this topic was published in the Journal of the Endocrine Society and introduced by the Endocrine Society in a press release on October 9, with ScienceDaily covering it on October 26.OUP Academic

What Was Found? Evidence in Three Lines

1. Alcohol: In 2025, JAMA Psychiatry published an RCT on low-dose semaglutide (9 weeks, n=48). Significant reductions were observed in some measures such as laboratory drinking self-administration and craving. The study concluded that larger trials are needed due to its small scale.JAMA Network

2. Previous Drug (Exenatide): A 2022 RCT's primary analysis showed no significant difference overall. However, exploratory findings suggested reductions in heavy drinking days and total intake in the obese subgroup.insight.jci.org

3. Opioids & Nicotine: Numerous preclinical data suggest suppression of self-administration and relapse models. Early clinical trials are also underway.OUP Academic
   
   

Mechanism: Satiety Hormones Tune Reward Circuits

GLP-1 is a gastrointestinal hormone that also acts centrally (in the hypothalamus and midbrain dopamine systems) to control "on/off" desires. Obesity and addiction share some neurobiological pathways, and the hypothesis is that GLP-1 signaling can brake not only eating impulses but also drug and alcohol reinforcement learning. The review and related articles meticulously organize this overlap.ScienceDaily

Current Status in Data (Strict Version)

• JAMA Psychiatry RCT (Published 2025/4/1)
  Semaglutide 0.25–0.5mg/week, 48 non-treatment-seeking adults with AUD, 9 weeks. Reduction in intake at final lab self-administration, with some decrease in craving. Frequency of drinking days showed no clear intergroup differences, concluding that larger and longer trials are needed.JAMA Network

• Exenatide RCT (2022)
  Primary analysis showed no significant difference overall. However, in the subgroup with BMI≥30, reductions in heavy drinking days and total intake were observed. Differences in dopamine transporter findings were also reported.PubMed

• Review (2025, Journal of the Endocrine Society)
  Organizes positive signals from preclinical and early clinical studies in alcohol, opioids, and tobacco, while emphasizing many unresolved issues.OUP Academic

• Ongoing/Related
  Trials exploring semaglutide dosing and long-term outcomes are registered and ongoing (e.g., NCT05520775).ClinicalTrials.gov
  
  

What Is Fact and What Is Hope

• Facts (Small but Starting to Reproduce):

  • Reduction in lab self-administration and craving with semaglutide (short-term, small-scale).JAMA Network

  • Suggested effect of exenatide in the obese group.PubMed

• Still Hope (Needs Further Verification):

  • Long-term abstinence maintenance, relapse prevention, and impact on hard endpoints such as mortality and hospitalization.

  • Real-world effectiveness of opioids and nicotine (currently mainly preclinical and early trials).OUP Academic

• Important Note: Caution is needed in expanding off-label use. Issues such as effect size, optimal dosing, withdrawal risks, cost-effectiveness, and supply shortages involve policy, ethics, and equity considerations.endocrine.org
  
  

How Has Society Reacted? — A Summary of Social Media Atmosphere

With major media outlets reporting (Reuters, The Guardian, People, etc.), discussions on X (formerly Twitter) and Reddit converged into the following four poles:Reuters

1. Hopeful Group: "Family has suffered from addiction. Welcome more options."

2. Cautious Group: "9 weeks, n=48 is not conclusive. Long-term RCTs needed."

3. Equity & Resource Group: "GLP-1 is already hard to obtain. Expanding to addiction treatment will lead to price hikes and supply shortages."

4. Voices from Those Affected (Experiences): Posts sharing experiences of "reduced alcohol cravings" and "also smoked fewer cigarettes" were numerous (countered by notes on large individual differences). ※Experiences are not scientific evidence.Reuters

Note that primary information from clinical trials is available as open access. It is important to confirm the limitations of the text without being swayed by the headlines.PMC

Implications for Medical Practice: What Can Be Done Now / What Cannot

• What Can Be Done

  • Consider GLP-1 within indications for patients with AUD/OUD/TUD (tobacco) with comorbidities (obesity, type 2 diabetes, etc.), while systematically monitoring changes in drinking and smoking behaviors (consider research participation).OUP Academic

  • Continue lifestyle guidance and psychosocial interventions. Do not rely solely on medication.

• What Cannot Be Done Yet

  • Prescribe GLP-1 as a first-choice standard treatment widely for AUD/OUD/TUD (lack of evidence).

  • Long-term maintenance effects and optimal dosing are not established. The side effect profile, such as GI symptoms, also requires accumulation of knowledge in addiction patients.insight.jci.org
    
    

Why This News Is "Big" — Structural Background

Globally, access to addiction treatment is low (as of 2023, less than one in four received treatment). Even with moderate effectiveness, the addition of a highly accessible pharmacological strategy is not insignificant, according to perspectives from the endocrinology and addiction fields.ScienceDaily

Summary

GLP-1 is transitioning from a drug for appetite to a tuner of reward circuits. Initial RCTs in alcohol