Despite the ongoing opioid (Fentanyl) epidemic in the USA, as well as in South Dakota, alcohol still remains the most prevalent substance of choice among individuals struggling with addiction. In fact, alcohol is still the leading substance of abuse, outranking opioids and all other drugs combined.[1]
Treatment of alcohol use disorder is a complex process as each person is unique, and there is no one-size-fits-all approach. At iRecover, our philosophy is to utilize all available methods and techniques to personalize treatment and maximize the chances of success for those undergoing rehabilitation and treatment. We also keep a close eye on the medical literature when new developments comes to light.
A promising new class of drugs, called Glucagon-like peptide analogues (GLP-1), is emerging as a potential option for those dealing with alcohol misuse and potentially other compulsive or addictive behaviors. There are several different types of GLP-1 agonists, but Semaglutide, which is sold under the trade names Ozempic or Wegovy is the one that is drawing most attention. These agents are rapidly gaining popularity in the US for managing obesity and diabetes.
The first GLP-1 agonists were introduced in April 2005, Semaglutide was introduced later in 2017, and there are several other GLP-1 analogues in the market. They differ mostly in their duration of action and how they interact with receptors in the brain and gut to produce their effects.
The GLP-1 agonists were initially developed as a drugs used to treat diabetes. It lowers blood sugar by promoting insulin release, slowing stomach emptying, increasing insulin sensitivity, reducing glucose secretion from the liver and it increases the metabolic rate in some patients. [2] It was soon discovered that beyond glucose reduction these medications also led to significant a significant weight loss in some patients.
Initially the weight reduction was attributed to side effects like nausea and prolonged fullness. However it became evident that these medications had additional mechanisms of action beyond the gastrointestinal tract and pancreas. Animal models have shown that these drugs work on the reward and motivation areas of the brain, which are the same areas where drugs of addiction and alcohol causes it’s pleasurable and addictive effects (craving and the motivation to seek the substance again). Patients on these medications reported decreased appetite, reduced food intake, and a lasting feeling of fullness after meals which explains it’s effect on weigh loss. Importantly many individuals who regularly drink reported an aversion for alcohol, no longer craving it, and when they drink they would be satisfied with only one glass of wine instead of the usual 3 or 4.
Furthermore, anecdotal evidence suggests that some patients experienced a reduction in certain compulsive behaviours such as skin picking, excessive shopping, and cravings for smoking.
The successful central effect of Semaglutide on addictive behaviour has been well studied on rats and mice with alcohol use disorder, and have shown positive outcomes.[3] [4][5]Nevertheless, it is crucial to acknowledge that humans differ significantly from lab animals, and alcohol use varies greatly among individuals. Thus animal studies cannot necessarily be extrapolated to humans. However two new studies are underway, specifically designed to examine the effects of the GLP-1 agonist Semaglutide on humans with clinically significant alcohol use disorder and with either simultaneous obesity[6] or cigarette smoking[7]. We hope these trials will provide valuable insight. We will report back once this studies is published in likely the next year.
However, a word of caution is necessary. While the internet is filled with numerous reports of successful weight loss and reduced alcohol use with these medications, it is important to note that the effects are reversible, and individuals who discontinue these medications may regain the weight they had lost. Additionally, potential side effects of these medications include pancreatitis, kidney injury, and a rare form of thyroid cancer. Nevertheless, the risks associated with these medications are low, and the benefits of improved blood sugar control, weight loss, and reduced alcohol use are likely to outweigh the potential risks.
Ongoing use of GLP-1 agonists will provide further insight into these matters as undoubtedly there will be more studies and reports from possible side effects (or none). In the meantime, I remain cautiously optimistic that this advancement will be beneficial to many individuals.
By: Dr. Hilgard Goosen - CEO iRecover US, Howard, South Dakota
[1]Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report [2] González-García I, Milbank E, Diéguez C, López M, Contreras C. Glucagon, GLP-1 and Thermogenesis. Int J Mol Sci. 2019 Jul 13;20(14):3445. doi: 10.3390/ijms20143445. PMID: 31337027; PMCID: PMC6678955. [3] Chuong V, Farokhnia M, Khom S, Pince CL, Elvig SK, Vlkolinsky R, Marchette RC, Koob GF, Roberto M, Vendruscolo LF, Leggio L. The glucagon-like peptide-1 (GLP-1) analogue semaglutide reduces alcohol drinking and modulates central GABA neurotransmission. JCI Insight. 2023 May 16:e170671. doi: 10.1172/jci.insight.170671. Epub ahead of print. PMID: 37192005. [4] Aranäs C, Edvardsson CE, Shevchouk OT, Zhang Q, Witley S, Blid Sköldheden S, Zentveld L, Vallöf D, Tufvesson-Alm M, Jerlhag E. Semaglutide reduces alcohol intake and relapse-like drinking in male and female rats. EBioMedicine. 2023 Jun 7;93:104642. doi: 10.1016/j.ebiom.2023.104642. Epub ahead of print. PMID: 37295046. [5] Marty VN, Farokhnia M, Munier JJ, Mulpuri Y, Leggio L, Spigelman I. Long-Acting Glucagon-Like Peptide-1 Receptor Agonists Suppress Voluntary Alcohol Intake in Male Wistar Rats. Front Neurosci. 2020 Dec 23;14:599646. doi: 10.3389/fnins.2020.599646. PMID: 33424537; PMCID: PMC7785877. [6] Klausen M, Fink-Jensen A. Does Semaglutide Reduce Alcohol Intake in Patients With Alcohol Use Disorder and Comorbid Obesity? (SEMALCO) https://www.clinicaltrials.gov/ct2/show/NCT05895643 [7] Hendershot C. Semaglutide for Alcohol Use Disorder 2022 October https://clinicaltrials.gov/ct2/show/NCT05520775
iRecover US is considered by many to be the top alcohol rehab and drug rehab in South Dakota. iRecover US employs evidence based treatment programs to provide the best alcohol addiction treatment and drug addiction treatment to all residents of South Dakota and the Mid-West. We accept insurance and self-pay options are available.
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