A systematic review of five clinical trials found that three out of five showed GLP-1 receptor agonists significantly reduced substance use (alcohol and nicotine), suggesting a potential new role in addiction treatment.
3 of 5 trials positiveThree out of five randomized clinical trials showed GLP-1 receptor agonists significantly reduced substance use (alcohol and nicotine) in patients with substance use disorders
What the researchers found
From an initial screen of 1,218 studies, only 5 randomized trials met the inclusion criteria, incorporating 630 total participants treated with exenatide (3 studies) or dulaglutide (2 studies).
Of the five studies assessing therapeutic effects on substance use disorders, three demonstrated a significant decrease in substance use, specifically for alcohol and nicotine. Three studies also reported on metabolic outcomes, showing notable reductions in body weight, BMI, and HbA1c in the GLP-1 receptor agonist-treated groups.
Why it matters
Substance use disorders are notoriously difficult to treat, with high relapse rates and limited pharmacological options. The finding that GLP-1 receptor agonists — drugs already widely prescribed and well-characterized — may reduce alcohol and nicotine use opens an exciting new therapeutic avenue. GLP-1 receptors are present in brain reward circuits, providing a biological rationale for why these drugs might dampen addictive behaviors alongside their metabolic effects.
How the study worked
Systematic review following PRISMA guidelines. Researchers searched MEDLINE, Scopus, and Cochrane Library for randomized clinical trials of GLP-1 receptor agonists in patients diagnosed with substance use disorders. The primary outcome was the therapeutic effect on substance use disorder; secondary outcomes included weight, BMI, and HbA1c changes. From 1,218 initial results, 507 passed title/abstract screening, and 5 met full inclusion criteria.
What this study cannot tell us
Only five trials met inclusion criteria, making the evidence base very small. The total of 630 participants limits statistical power. Only two GLP-1 receptor agonists (exenatide and dulaglutide) were studied — newer drugs like semaglutide were not included. The review could not perform a meta-analysis due to heterogeneity. Two of five studies did not show significant effects. The studies focused on alcohol and nicotine — other substance use disorders were not represented.
How to read the evidence
This is a systematic review of randomized controlled trials, which is normally high-quality evidence. However, the inclusion of only 5 small trials with 630 total participants, heterogeneity across studies, and mixed results (3/5 positive) significantly limits the strength of conclusions. This represents early, suggestive evidence rather than definitive proof.
When this study was published
Published in 2024, this review captures the earliest wave of clinical trial evidence on GLP-1 drugs for addiction. The field is rapidly evolving with larger trials underway, so this review represents a snapshot of a fast-moving research area.
The bigger picture
The intersection of GLP-1 biology and addiction neuroscience is one of the most exciting emerging research areas. Observational data has shown that patients on GLP-1 drugs report reduced cravings for alcohol, nicotine, and other substances. This systematic review represents the first attempt to synthesize the randomized trial evidence, and while the evidence base is small, the positive signals from 3 of 5 trials are encouraging enough to justify larger, dedicated addiction trials.
Questions still open
- Would newer, more potent GLP-1 receptor agonists like semaglutide show stronger effects on substance use disorders?
- What is the mechanism by which GLP-1 drugs reduce addictive behaviors — is it through brain reward circuits, metabolic improvement, or both?
- Could GLP-1 receptor agonists be effective for opioid or stimulant use disorders, not just alcohol and nicotine?
Common questions
How might GLP-1 drugs help with addiction?
Should people take GLP-1 drugs to treat addiction right now?
Read the original research
Potential role of glucagon-like peptide-1 (GLP-1) receptor agonists in substance use disorder: A systematic review of randomized trials.
Drug and alcohol dependence, 264, 112424
Citation
Martinelli, Silvia; Mazzotta, Alessandro; Longaroni, Mattia; Petrucciani, Niccolò. (2024). Potential role of glucagon-like peptide-1 (GLP-1) receptor agonists in substance use disorder: A systematic review of randomized trials.. Drug and alcohol dependence, 264, 112424. https://doi.org/10.1016/j.drugalcdep.2024.112424