Pat Aussem. Welcome to Heart of the Matter. Great to have you on.
Well, thank you. It’s great to be here.
I remember reading anecdotally in newspapers, on social media, people who were trying GLP-1 drugs for weight loss. And started saying, “By the way, I have no cravings for alcohol.” That was the first inkling that these drugs, at least in some people, at least anecdotally, can work with people suffering from addiction.
Yes. Anecdotally, we’ve heard a lot about that. Reddit is full of comments of people who tried it and found that it’s really helped not only with alcohol, but with other substances as well. There have been some studies where they looked historically at medical charts and found that people who had obesity and diabetes who are also prescribed GLP-1 medications either they were drinking less or they had fewer opioid overdoses in fact. There are now a whole series of trials going on to try to ascertain how safe is it, how tolerable is it, what are the side effects, who’s it good for, who’s it not good for, and things of that nature.
Why do we think that GLP-1 drugs which were developed for people with diabetes are now being used for all sorts of people just to lose weight, why do we think these drugs might work when it comes to addiction?
We know that these medications work in a number of receptors across the body. Some are located in the pancreas, which is why it works for people that have diabetes, but there are a ton of them in the brain. It works in the reward center of the brain. I don’t think we know exactly how, but there are receptors for GLP-1 drugs in the nucleus accumbens, the hippocampus, all these different areas of the brain that are responsible for the way we see rewards. Drug use can be very rewarding until it’s not.
As is alcohol. This of course just confirms what we’ve always thought about addiction, which is that it’s a disease of the brain. But basically, it’s the reward system that it hijacks? Or does it stop the cravings? Does it just stop that chatter you’re talking about, that mental obsession?
I think it’s going to vary in terms of the person and their physiology, their genetic makeup, and so forth. For some people, it is going to reduce the number of cravings that they have and really make it so that they’re just not interested in it.
I had done a presentation a few weeks ago on harm reduction. In the course of the conversation I said, “There are different medications that are useful in treating alcohol use disorder, opioid use disorder, and nicotine.” I said, “Now we’ve got these GLP-1 drugs that are coming out and the studies that are going on to try and figure out are they going to be helpful or not.” After the presentation, this woman comes up to me and she said she had been overweight, she had been prescribed GLP-1 drugs. She was also using IV heroin.
Oh.
She said, “I had no interest in using heroin anymore.” And she said, “I don’t have any cravings.” It was just like, for lack of a better word, cold turkey stopping. She then said she no longer craves junk food either. She said it seemed like a miracle drug for her and she’s extremely happy with how healthy her life is.
I don’t need to tell you if there were a magic pill that could cure addiction, that would be massive.
It would be massive. Everybody is pretty exuberant over it because the thinking is that maybe these drugs will not only help with alcohol and opioids, but also stimulants. We don’t have a pharmacological treatment for stimulants. It could also help with cannabis use, and so forth.
But again, I’ve never found anything that works for everybody. One of the things we have to understand, what are the longterm effects? We really don’t know. What happens if they’re on it for a lifetime? We also don’t know what happens if you go off the medication at a certain point, do the cravings come back? Or has the brain healed in some way so that you don’t need to continue to take the medication?
Yeah, you raised a couple, actually several issues in that answer just now. Let’s start with continuing on for life. We know that when GLP-1s, and we’re talking drugs like Ozempic, Mounjaro, Wegovy. When these drugs are taken for weight loss, the minute you stop taking it, the weight comes back.
Right.
There’s a real question of if you’re taking these drugs for addiction, the minute you stop taking it, do the cravings come back?
Right. Right, for sure. Certainly, a big question. The National Institute of Drug Abuse is conducting a trial currently and they’re looking for adults that are 18-years and older with alcohol use disorder. They’re going to come to the facility for 20 weeks and they’re going to be there for two to six hours at a crack. They will be assigned either the placebo, which is a saline injection, or they’re going to get 2.4 milligrams of a semaglutide, a GLP-1 one medication. Interestingly enough, in this particular study, aside from looking at just the medication, they’re also going to be enrolled in a self-paced behavioral therapy course on a computer. I think that may be another part of this, in terms of not thinking that it’s a pill that’s just a magic answer. But that you may need some therapy to go with it to understand why did you get in this situation in the first place? What are you doing with the trauma that you had? What are you doing with the anxiety that you had? Hopefully, people don’t substitute other compulsive behaviors.
Right.
At one point, I was working in a psychiatric hospital and we had a lot of people who came in with bariatric bypass surgery. They came in to the psychiatric hospital because they were drinking too much. They substituted alcohol for food. In this case, with the GLP-1 drug, you would assume that there wouldn’t be that substitution. The person would lose the weight and they possibly would reduce their drinking. But we don’t know would they then develop some other kind of compulsive behavior? Maybe they turn to gambling, as an example.
Right.
Those are things we have to look at, too.
But it does raise the question, it doesn’t sound like GLP-1 drugs … Let’s just stick with the weight loss analogy right here. Because if the weight comes back on, it sounds like it’s not permanently rewiring the brain, or to use your term, healing the brain. If all the people who take GLP-1 drugs for weight loss gain the weight, it would seem to indicate that whatever that drug is doing to our brains isn’t permanent.
You’re right, you’re right. I think those are some of the things that longer term, we need to look at. Unfortunately, the studies that are underway at the moment, they’re not looking at a long-time horizon. You have a situation where perhaps they’re looking at six months out, a year out. But at the moment, we don’t have that long-term data to really understand how many people return to weight gain, how many people might be able to sustain their weight losses. Similarly, we’d want to look at the same situation with respect to substance use.
Here’s the other thing we don’t know yet and you mentioned this in your previous answer, the long-term effects of these drugs. These are brand new drugs, and a ton of people are taking them, especially in the United States where we have a lot of clinically obese Americans who are desperate to lose weight for a variety of reasons. Perhaps some people taking them who are not obese, just wanting to shed a few pounds. We can debate that another day, about whether or not you should be turning to a drug like this. But we don’t know the long-term effects of being on this drug. We basically have a massive experiment happening globally where all these people are taking these drugs for the last few years. We don’t know 10 years down the line what the effects might be.
That’s absolutely true. I think short term effects, people have talked about being bloated, having nausea, dizziness. Some people have vomited. There are some short-term side effects that I’m told-
They’re unpleasant. They’re unpleasant.
Yeah. They’re definitely unpleasant. I also have seen a concern raised, I was on one of the medication sites just looking at what they’re looking at in terms of side effects, and they mentioned thyroid problems, and potentially thyroid cancer.
Oh.
That may be a rare finding, but again, those are things that we don’t know. In addition to medication interactions and things like that, that I think we’re going to have to better understand.
The other thing is, which I think is important from a substance use standpoint, is that people who have a normal BMI, they’re at normal weight-
Body mass index you mean?
Right. They’re likely to lose weight. Many people who use substances are at a normal weight or they’re below weight and they don’t need to be losing more pounds. Then you wonder are they going to be given a medication to stimulate their appetite?
That’s a whole ‘nother drug.
Right, right.
And a whole ‘nother interaction with the human body.
Right.
The other thing you raised was the age of people. Obviously, we are the Partnership to End Addiction, we are here for families who are experiencing a crisis in their lives because they have usually a child, whether that be a teenager, a young adult, struggling with a substance use disorder. Right now, what’s the youngest age that doctors will give these GLP-1 drugs to for weight loss?
These medications had been prescribed for kids as young as 10 for diabetes, and 12 for obesity. And last year, there was a trial reported in the New England Journal of Medicine about using one of the GLP medications for children. The kids were between the ages of six and 12, and the results were promising, although I haven’t seen FDA approval for this age group. When it comes to substance use, the trials that I’m familiar with are all focused on adults, so people that are 18 and over. I think we just don’t have enough information about how these medications might impact adolescent development. The most important thing would be for a family to talk to their healthcare provider about whether their teen or young adult qualifies for it, and consider the benefits versus risks, not to mention including behavioral interventions. I also want to highlight another concern of mine, and that is the presence of illicit pharmacies selling these medications. A family seeking help for their child might turn to these sources without involving their pediatrician or primary care doctor, a decision that could have really serious and potentially harmful consequences.
You can understand though, the desperation of a parent wanting to help their child and turning to something like this that seems to be a miracle cure.
Sure. But interestingly enough though, in many cases it’s not stopping use. I think many families, their goal is “I want my loved one to be abstinent.” What we’re seeing at least in the clinical trials, which is different from anecdotal, but in the clinical trials we’re seeing a reduction in the number of drinks that people drink on a drinking day and a reduction in cravings. But it’s not like it’s making someone totally abstinent.
Aren’t the reasons for addiction more complicated though? When you talked about the fact that maybe therapy needs to be helpful. I don’t know, maybe I’m wrong. Are the reasons different that somebody picks up alcohol and begins to abuse it and becomes addicted? Or picks up a drug? Almost always I hear they want to numb out.
Right.
I don’t hear people saying, “I want to numb out with food.” I hear people saying maybe some similar, I don’t know. Do you think there are differences between the way people become addicted to junk food or eat too much, versus why people drink too much or turn to drugs?
It’s interesting because there are some people that would say that obesity is food addiction. It’s just a different form of addiction.
Maybe that’s true.
Right. When somebody’s having Oreo cookies, they eat an Oreo, it tastes great. They eat the second one, it tastes great. But the third, fourth, fifth one, the rest of the sleeve aren’t tasting great. You have to wonder why are you continuing to go through a package of Oreo cookies? Because it’s not the flavor. It triggers the dopamine system, which is the reward system in the brain. Not to the extent that substances do, but it certainly is important in terms of the reward system.
I think you talk about the magic pill, the magic bullet if you will, when I think of substances, they are an answer to a problem. If you think about trauma, escaping trauma, escaping boredom, relieving stress, maybe making you sleep better at night. Maybe improving your sex life. There are just so many things that substances can do for you in the short term. In the short term, it can be a great solution seemingly for many things. But over the long haul, it just causes so much devastation. Similarly, the weight gain that we’re seeing for so many people is devastating. Not to mention that it’s not only the weight gain, but the cardiovascular disease …
Right, all the health issues.
Yeah, all the health issues that go with it. I think just as someone with a substance use disorder needs to create an environment that is going to let them be successful, we need to do that just overall with, whether somebody’s obese or diabetic, or with a substance use disorder. As health issues, we need to think about not only the medications that can help, but what’s the environment that we’re going to create to allow that person to be successful?
Yeah. All right, you talked about the compounding and different places. Because listen, there was such demand for these GLP-1 drugs that patients who were trying to get it for weight loss couldn’t get it.
Right.
Are we seeing a proliferation of, I don’t know any other way to say it, fake GLP-1 drugs out there?
Yes, there is a proliferation of counterfeit drugs. Even the compounding pharmacies aren’t getting it right. There have been problems with dosing levels that have resulted in people being hospitalized. There are also concerns about them being contaminated with ingredients that shouldn’t be in there. There really is a concern about getting GLP-1 drugs from online pharmacies or compounding pharmacies.
All right. The advice from you on that is do not do this. Do not go to a compounding pharmacy, number one. Do not try and get these drugs and take them without a doctor’s supervision.
Right. Although interestingly enough, Elizabeth, I saw an ad today for an organization that was selling the drug online, it was $179 a month to start. Which is, if you’ve seen the price tag on these drugs, they can be $1000 a month. Right off the bat, it should tell you something is wrong. It said, “Just fill out this form and we will tell you whether you qualify for the medication or not.” They had three doctors on staff.
I looked at the credentials of the doctor that was on staff, and then I did a Google search. This person shows up in another place with totally different credentials. Her academic achievements and the schools she went to were entirely different-
Oh, wow.
… from one site to the next. Which leads me to believe that there’s just a lot of false advertising, people that are trying to take your money and run. You could end up with a product that could be very devastating for you. Yeah, I think the answer is if you are interested in these medications, to talk to your doctor about it. And to only get it if prescribed by your doctor.
I know the researchers that I have been following suggest that if you have diabetes and/or obesity and a substance use disorder, that it might be worth trying it. If it’s substance use alone, they would suggest that you stay with the FDA approved medications that we already have instead of trying the GLP-1 drugs. At least for now, until we get some more test results back.
But that leaves people suffering from addiction with very little when it comes to medication. At least, addiction to alcohol. There are medications that can help with opioid disorder. But people addicted to alcohol don’t have a lot of options when it comes to drugs. It’s behavioral and spiritual.
Right.
Recovery, I don’t know any alcoholic who’s gotten better or sober by taking a pill.
We do have naltrexone. Some people have tried naltrexone, which is a once-a-month shot, Vivitrol. It’s been effective for reducing their alcohol use. There are people that have been on Campral and Camprosate, which is a pill you take three times a day, it can reduce cravings. Disulfiram, Antabuse.
Antabuse just makes you really sick, it doesn’t help you.
It makes you really sick, right.
Yeah.
You really have to be committed to abstinence in order to be on Antabuse. Those are three that we have available now.
But Antabuse, my point is the reason there’s so much hope around these GLP-1 drugs is it reduces the craving for alcohol.
Right.
Is what anecdotal evidence has suggested. Antabuse just punishes you in a brutal way-
True.
… if you drink alcohol. It doesn’t reduce the cravings. It doesn’t do anything at all to solve the core issue of alcohol addiction.
Absolutely, I agree with you 100%. Topamax is another medication that’s used off-label that can help with cravings, just like Campral can help with cravings.
What is that drug?
Topamax? I believe it’s an anti-seizure medication. In any event, there are a few medications that are available.
The other thing is that I think it’s important for people to consider, especially families if you’ve got a loved one who’s drinking a lot, is really trying to encourage them to cut back. Any amount of alcohol that they’re drinking less than the current levels is a win. There are moderation management groups out there, there are these medications. Some people count their drinks and things like that.
For someone who has a severe alcohol use disorder, you’re right, the GLP-1 drug sounds like it’s going to be incredibly helpful. But we’ve got some other tools in the toolbox that we can look at, many of which are really underutilized. It would be great if physicians and other healthcare providers really, A, screened people. Because asking somebody, “You don’t drink too much, do you” is not the way to go.
Yeah, people rarely tell the truth.
Right, right.
How many drinks do you have a day? “Two,” when it’s more like four or five.
Right.
Yeah.
Screening and talking about the health consequences. Because some reports have come out and been more publicized recently about the link between alcohol use and various kinds of cancer and cardiovascular disease that I think a lot of people were unaware of. I know there’s been some discussion about putting labeling on alcohol about those problems. That’s up for another debate.
When will these studies of the GLP-1 drugs on alcohol addiction and drug addiction, when will those studies be done?
There was one that was completed in 2024 that was written about. That’s the one where there were 48 people in the study. Most of them were women, by the way, and they had a fairly high body mass index. They were obese. But they weren’t seeking treatment for alcohol use disorder. Their alcohol use disorder was defined as moderate. They got a relatively low dose, by the way, of the GLP drug. The standard does is 2.4 milligrams, they got .25 to begin with. Then ultimately, .5. On the very last week of the study, which was nine weeks long, they got 1 milligram, assuming that they could tolerate it. Anyway, long and short of that particular study was that it reduced their cravings and they had fewer drinks on days that they were drinking.
Other studies, the one that I mentioned that NIDA is doing, the National Institute of Drug Abuse, they’re looking at higher dosing and a much longer period of time.
And for people who have true alcohol addiction?
Right, right.
Okay. And people who might not be obese?
Correct.
Okay, that’s the study I think everybody is pinning their hopes on.
Right. You’ve got to be 18 or older to participate and you have to have an alcohol use disorder. An alcohol use disorder defined as mild, moderate, severe, depending on how many of the criteria that you meet for an alcohol use disorder. Do you have cravings? Do you drink more than you used to to get the same effect? How does it impact your relationships and your responsibilities, and things of that nature?
Anyway, that study is expected to be concluded within the next year or so. The researcher who was reporting on it, Dr. Stephanie Weiss, said that she hopes that we’ll have enough results within the next year or two in order to be able to provide people with meaningful conclusions about the effectiveness, and the tolerability and safety profile of these medications.
We really haven’t tested these drugs on people with normal body weight, right?
No.
That concern you raised a few moments ago about what happens when you give what’s commonly known and it’s commonly used as a weight loss drug, what happens when you give a weight loss drug to somebody who’s a normal weight? Are they going to waste away?
Well, they’re probably going to lose weight. Which is why I was saying then you’re in this thing about do you have to give them an appetite stimulant, some other kind of medication, in order to prevent them from losing weight?
Right.
Or I don’t know if there’s a way to change a GLP-1 drug in some fashion to parse it so that it gives you the anti-craving effect without the weight loss, which would be an interesting study as well.
This one study that NIDA’s doing, that’s it right now? No other studies of this?
No, there are several studies going on.
Okay, good.
Not only for alcohol, but also for other substances like opioids, cocaine, meth, cannabis, and so forth.
Another interesting aspect of all of this is they think it might help people with Parkinson’s or Alzheimer’s.
Really?
Because there seems to be some kind of cognitive effect that can be really helpful.
Here’s my final question. These drugs are expensive. They cost a ton of money. Right now, people are taking these drugs for weight loss and they know that they have to take them forever. Until, I hope this doesn’t happen, but unless there’s some sort of terrible negative side effect that emerges down the line. How do people afford this for the rest of their lives? You just quoted a price of 1000 bucks a month.
Yeah. It’s interesting. I think one of the hopes that some people are clinging to is the president talking about favored nations policies with respect to medications. We know these medications are significantly less expensive in other countries. I believe I’ve heard numbers as low as 80 to $100 a month.
No, it is. It is, it’s much cheaper in Europe.
The question is why is it that we are paying such exorbitant prices here?
For everything, not just GLP-1s.
Yes, there’s that. As opposed to what they’re paying in other countries. I think because there’s such a great interest in the medications, and if you look at the offsets. If you could get somebody to a healthy weight, as opposed to dealing with cardiovascular disease, or COPD, or sleep apnea, all the different things that come along with it. Or even if you look at the care that’s required for substance use disorder, it would be a great offset to the healthcare expenses that we’re seeing. The problem is that we tend to look at things in silos, as opposed to looking at the-
The whole picture.
Stepping back and looking at the whole picture, yeah.
One last question. Do the GLP-1s also show any anecdotal evidence of helping other kinds of “addictions?” Like shopping addiction, or I’m trying to think of another one. There’s all sorts of addictive behaviors that people engage in, it doesn’t have to be eating, or drinking alcohol, or taking drugs.
Right. It can certainly be gambling, it could be sex, it could be shopping, what have you. I have heard anecdotally that it can be helpful, but I haven’t seen anything in terms of research on that particular topic.
All right. Bottom line, big study happening right now. We’ll know in a year or two. This is not something you should do on your own or Google.
Exactly.
Don’t trust the website. You should go to your doctor and talk to your doctor about whether or not this is an option for you. If this study comes out positive for this drug to treat alcohol addiction, this really could be a game-changer, couldn’t it?
I think it’ll be revolutionary. The other thing that’s happening, by the way, is Eli Lilly has announced a pill version. Right now, they’re injections and the medication has to be refrigerated. It’s an injection once a week. For some people, especially people who are a little squeamish around needles and the refrigeration issue. Hopefully, the pill form could be less expensive and more accessible. That’s another thing on the horizon. They’re hoping to get approval for it I believe by the end of this year.
Revolutionary.
Indeed.
Pat, that is something else to even consider. Pat Aussem. Thank you. We’ll have you back. If there’s any news on how the study’s going, any early results, we will report them to our listeners. Thank you.
Thank you.