REVIEW OF: Lähteenvuo M et al, JAMA Psychiatry 2025;82(1):94–98

STUDY TYPE: Observational cohort study

Alcohol use disorder (AUD) is notoriously difficult to treat, with pharmacological options often underutilized or only modestly effective. But what if a medication already used for diabetes and obesity could help? Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) influence reward pathways and are emerging as promising candidates for substance use disorders (SUDs), including AUD.

This Swedish cohort study evaluated whether GLP-1 RAs reduce hospitalizations for AUD and other SUDs. Researchers used inpatient and outpatient records, plus sickness absence and disability data, to track 227,866 individuals diagnosed with AUD from 2006 to 2023. They compared periods when patients were prescribed a GLP-1 RA with periods when they were not. Each patient served as their own control, minimizing between-person differences, though this design also prohibits causal conclusions.

Semaglutide (Ozempic, Wegovy) was associated with the lowest risk of AUD hospitalization (adjusted hazard ratio [aHR] 0.64; 95% confidence interval [CI] [0.50, 0.83]) and SUD hospitalization (aHR 0.68; 95% CI [0.54, 0.85]). Liraglutide (Victoza, Saxenda) also reduced risk of AUD hospitalization (aHR 0.72; 95% CI [0.57, 0.92]) and SUD hospitalization (aHR 0.78; 95% CI [0.64, 0.97]). Dulaglutide (Trulicity) had no significant effect, and exenatide (Byetta, Bydureon) was excluded due to low use. (A lower aHR indicates greater treatment effectiveness.)

In contrast, standard AUD medications like naltrexone and acamprosate, taken together as a class, were not associated with significant reductions.

The study was not randomized, so reverse causality and unmeasured factors are possible. For example, patients starting GLP-1 RAs may be more engaged in care or motivated to change.

CARLAT TAKE
Semaglutide and liraglutide were both significantly associated with reduced hospitalizations. If you’re treating AUD in a patient who also has diabetes or obesity, consider discussing GLP-1 RAs with their primary care provider. The dual benefits for both addiction and metabolic health make this worth exploring, especially for patients at high risk for alcohol-related hospitalizations.