As weight-loss drugs like Ozempic revolutionize weight loss, scientists hope they may also be life-changing for alcohol addiction. The drugs are one of several approaches doctors and psychiatrists hope will revolutionize the treatment of what’s known as alcohol use disorder. Their work comes amid findings that even moderate drinking comes with risks, including a link to certain types of cancer.
Joe Schacht, co-director of the Division of Addiction Science, Research and Prevention at the University of Colorado Anschutz Medical Campus for alcohol addiction, offered an overview of the research on weight-loss drugs for alcohol addiction, other potential treatments, and the overall risks of drinking.
Weight-loss drugs:
The history of weight-loss drugs like Ozempic and alcohol addiction:
“These are medications, of course, that have been available for five or six years now. They are prescribed to treat obesity, to cause weight loss and also for diabetes to control blood sugar for folks with diabetes.
And the really interesting thing is people who have been taking these medications for those purposes have also reported that they are less interested in alcohol and that when they drink they are satisfied with having only one or a few drinks. And these are often folks who would normally drink much more than that.”
Why the drugs may work for addiction to alcohol:
“These are medications that affect the GLP receptor (Glucagon-Like Peptide-1 Receptor). Those receptors are all over your body. They’re largely in your stomach and your gastrointestinal tract. And so when GLP-1 binds to those receptors, it makes you feel full.
You’ve also got those receptors in parts of the brain and binding to those receptors may control your desire for things, your desire to eat, but also potentially, and this is what we’re so interested in my field, the desire to drink alcohol. And so we think that perhaps these medications may be particularly effective because they may drive down what we call craving or the kind of uncontrollable urge to have a drink.”
Will insurance pay to use drugs to treat alcohol use disorder?
“It’s unfortunately unlikely that insurance is going to cover that and these medications are very expensive. Right now they’re protected by patents. On average, taking Ozempic or the sister medication Wegovy or a newer medication called Mounjaro (all those are approved for obesity and/or diabetes) taking those medications is going to cost about $1,200 a month. And so if insurance is not covering that, that is very expensive, but it is possible that a physician could write these already for alcohol use disorder or for controlling alcohol craving.”
The research on weight-loss drugs for alcohol use disorder:
“A study was just published in a journal called JAMA Psychiatry demonstrating that Wegovy or Ozempic, reduced drinking in people with alcohol use disorder. That’s the first clinical trial evidence we have that these medications could have that effect. There are also four more ongoing trials of this medication for drinking, including one that we’re conducting at the University of Colorado. If enough of those trials are also positive, if they also show an effect of reducing drinking or reducing alcohol craving, it’s possible that the Food and Drug Administration could approve this medication for alcohol use disorder…
This is not a medication that is going to make you abstinent from alcohol. This is a medication that is going to reduce how much you drink and…reduce potentially your craving for alcohol. That reduction is going to be on the order of several drinks per day. And so typically we think that someone may be at risk for alcohol use disorder if they’re drinking in the range of 20 or more drinks per week. That would mean on average they’re drinking maybe three or four drinks per day. And this medication in the results that were just published, and typically for medications that are effective for alcohol use disorder would reduce that by maybe two drinks per day on average.”
For those interested in being a subject in a trial:
“We have an ongoing trial at the University of Colorado of an oral form of semaglutide, so Wegovy and Ozempic … and those are injectable medications. You get an injection once a week. We’re testing an oral form of the drug where you take a pill once a day. We are accepting patients currently for that trial.”
Other drugs for alcohol use disorder:
“Currently, there are three medications that are approved by the FDA for treating alcohol use disorder. All of those medications have relatively small effects on alcohol use. One of them is a very old drug. It was approved in the fifties. It’s called Antabuse or disulfiram. It’s a drug that makes you feel physically ill if you drink alcohol. It blocks the metabolism of alcohol and causes essentially the symptoms of a hangover. If you have even a single drink when you’re taking it, all you have to do is not take the medication in order to not feel those effects, and so it’s often very difficult for folks to continue to want to take that when they know that it’ll cause that sort of an effect.”
Exploring psilocybin/psychedelic mushrooms as a treatment for alcohol addiction:
“There is indeed some research demonstrating that [it could be beneficial]. This goes back a very long way in alcohol and addiction treatment. There were studies going on in the 1960s and seventies of psilocybin and other psychedelic medications for alcohol and addictive disorders demonstrating similar kinds of things. And then all of that research was shut down by federal regulations that prohibited the use of the substances in federally funded research. And there’s suddenly been a resurgence of that kind of research in the last 10 years or so.
Colorado embarks on a legal landscape allowing people to use psychedelic mushrooms in “healing centers”:
“The thing that we’re excited about in our field is the potential to partner with some of those healing centers to study folks who are using psilocybin and understand whether it affects things like how much they drink or how depressed or anxious they feel after acute use of the drug.
Why psychedelics may work with alcohol addition:
“When you look at the older literature from the 1960s and 1970s, what people were reporting was that it led to this sort of reconsideration of the role of alcohol and there’s actually some recent data on cigarette smoking with this as well. And these studies are typically conducted where you take the psychedelic and then you engage in some really intensive psychotherapy while you’re under the effects of the drug. And people report these sort of epiphany-like moments afterwards where they say, I don’t think that I want to have this part of my life.”
Another potential treatment for addiction to alcohol – ‘low intensity focused ultrasound’ (LIFU):
These are ultrasonic waves that are used in medical imaging. For example, if you are pregnant and you want to see the fetus, you can use ultrasound and produce an image from that. You can use those same ultrasound waves and apply them to the brain. And what you can do is control the activity of nerve cells, neurons in the brain.
There is some emerging research to suggest that stimulating different parts of the brain can affect alcohol and other drug use. This is research coming from West Virginia University demonstrating that in people in opioid treatment programs, low-intensity focused ultrasound stimulation of the brain profoundly reduced their alcohol and opioid use as well as craving again for those substances. So we are planning to begin a small pilot trial at the University of Colorado of this technology for people with alcohol use disorder to see if it reduces their alcohol use and their alcohol craving.”
Latest findings on the effects of alcohol on health:
“For a long time, there was some belief in the medical field that moderate alcohol use was actually healthy…and we encouraged folks to drink a glass of red wine or two every night. And in particular, it was thought that it might improve cardiovascular health. Some of this belief came from some of these large studies of people who drank alcohol that seemed to suggest that people who were moderate drinkers were physically healthier. But one of the problems with that old research was that the people who were not alcohol drinkers in those studies were often not drinking because they had a history of alcohol use disorder and problems with alcohol. And so they had already accumulated health problems related to that alcohol use but were being included in a group that was purported to have no alcohol use.
And so when that research started to separate out that group of people who were currently not drinking but had drank often quite heavily in the past, the numbers changed, and what we started to see was that in some ways there was no healthy amount of alcohol consumption – that even relatively small amounts of alcohol use were associated with increases in risk for many health problems and in particular many different types of cancer.”
Weighing the risk of drinking alcohol:
“Every time we get in the car in the morning, we assume some level of risk, right? And we’re comfortable sometimes with saying, I’m going to take on that risk because I don’t want it to take me five hours to get downtown this morning. Similarly, I think alcohol is such an integrated part of our social fabric that I think it’s perfectly fine to say, I’m going to accept some small increase in my risk for whatever these things are in exchange for enjoying that amount of alcohol.
At the same time, I would say we increasingly understand that drinking more than maybe 10 drinks a week really starts to escalate that risk, and so below that amount, we’re talking about small increases in something that is relatively unlikely to happen over the course of your life. Beyond that, we start to talk about larger and larger increases, and there I would start to think that the risk-reward trade-off is no longer worth it.”
On funding research on alcohol addiction and treatment:
“Almost everything I’ve talked about today is research that was originally funded by the National Institutes of Health, the NIH, and I would just encourage folks to understand how much return on investment we get for that kind of spending in our country. The trial that I mentioned going on right now with oral semaglutide at the University of Colorado is an NIH-funded trial. The trial that was just published recently in JAMA Psychiatry and Effects of Semaglutide was an NIH-funded trial. And so that kind of spending on medical research has so many benefits in their society. I really hope that we can see our way towards maintaining that kind of support for research and for science in the political climate today
Alcohol and addictive disorders are enormously expensive for our society. They cause all of the kinds of problems that you just mentioned. They affect our economic productivity. People are not able to work when they have these disorders or not work to their full potential. And so any kinds of treatments that we have that can reduce the costs to society from these problems, I think are just enormously beneficial.”