GLP-1 drugs reduced addiction risk across every substance studied in 600,000 veterans

Washington University School of Medicine in St. Louis

Patients taking GLP-1 medications for weight loss often describe something they call "food noise" going quiet. The persistent mental chatter about eating, the pull toward the refrigerator, the preoccupation with the next meal: it fades. The craving loses its volume.

A new study from Washington University School of Medicine in St. Louis suggests that GLP-1 drugs may quiet a broader signal. Not just food noise. Drug noise. The relentless pull toward whatever substance a person is addicted to.

Published in The BMJ, the study analyzed health records of 606,434 U.S. veterans with type 2 diabetes and found that GLP-1 receptor agonists were associated with reduced risk of substance use disorders across every major category of addictive substance tested, and with dramatically fewer overdoses and drug-related deaths among people who already had addictions.

Not one substance at a time, but all of them

Previous studies had shown associations between GLP-1 use and lower rates of individual substance use disorders. Patients reported losing interest in alcohol. Observational data linked GLP-1 treatment to fewer opioid overdoses. But those studies examined substances one at a time. No study had asked the broader question: do GLP-1s work against addiction across the board?

The WashU team split their study population into two groups. The first, 524,817 veterans with no history of substance use disorders, were tracked to see who developed new addictions. The second, 81,617 veterans with pre-existing substance use disorders, were monitored for serious harms: emergency department visits, hospitalizations, overdoses, deaths, and suicidal behavior.

Both groups were compared against veterans taking SGLT2 inhibitors, a different class of diabetes medication that does not act on GLP-1 receptors.

14% lower risk of new addiction, 50% fewer drug deaths

Among veterans without prior substance use disorders, GLP-1 use was associated with a 14% reduced risk of developing any substance use disorder over three years. The reductions were consistent across individual substances: 18% for alcohol, 14% for cannabis, 20% for cocaine, 20% for nicotine, and 25% for opioids. In absolute terms, that translated to seven fewer new diagnoses per 1,000 GLP-1 users.

Among veterans with existing addictions, the effects were larger. After three years, GLP-1 users had 30% fewer substance-related emergency department visits, 25% fewer hospitalizations, 40% fewer overdoses, and 50% fewer drug-related deaths compared with the SGLT2 group. That translated to 12 fewer serious harm events per 1,000 GLP-1 users.

The uniformity of the effect across substances is what makes the finding notable. Existing addiction treatments are substance-specific. A nicotine patch does not help with alcohol. Methadone does not address cocaine. There is no medication that works against all addictive substances. For methamphetamine, there is no approved pharmacological treatment at all.

A craving that does not discriminate

Senior author Ziyad Al-Aly, a clinical epidemiologist at WashU Medicine and chief of research at the VA Saint Louis Health Care System, argues the cross-substance signal points to a shared biological pathway underlying addiction. GLP-1 receptors exist in brain regions that modulate reward processing. The drugs may not be acting against any specific substance but against the craving itself, the common neurological driver that pulls people toward whatever they are dependent on.

If that interpretation is correct, GLP-1 drugs would represent a fundamentally different approach to addiction treatment: targeting the shared biology rather than the individual substance.

Caveats and what comes next

This is an observational study, not a randomized trial. The researchers used an emulated target trial design and multiple sensitivity analyses to reduce bias, but they cannot rule out confounding from unmeasured factors like socioeconomic status, motivation to change behavior, or overall health consciousness.

The study population was predominantly older men from the VA system, which limits generalizability to younger populations, women, and people without diabetes. Subgroup analyses showed consistent results in women, but the sample was small.

The comparison group, SGLT2 inhibitor users, was chosen because both drug classes treat diabetes but work through different mechanisms. Whether SGLT2 inhibitors themselves have any effect on addiction risk (positive or negative) is unknown, which could affect the interpretation of the relative risk reduction.

Al-Aly argues the findings support clinical trials testing GLP-1 drugs specifically for addiction, including trials large enough to measure effects on overdose and death. With millions of Americans already taking these medications and use expanding rapidly, even modest effects on addiction could have population-level significance.