The Role of Glucagon-Like Peptide-1 Receptor Agonists in Prompting a Meaningful Improvement in Alcohol Use Disorder

Abstract

Emerging research suggests a potential role for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in alcohol use disorder (AUD), because GLP-1 receptors are present in the brain regions involved in dopamine signaling and the human reward system. We present the case of a man prescribed GLP-1 RAs for obesity who had concomitant AUD. A 34-year-old man was referred to a family medicine clinic for medication therapy management of obesity. His medical history was notable for bipolar disorder, class 2 obesity, and obstructive sleep apnea (OSA). His Alcohol Use Disorders Identification Test score indicated high-risk alcohol use. Over the course of 10 months using an injectable GLP-1 RA (semaglutide), the patient showed a clinically significant decrease in both body weight and alcohol consumption. Although this patient initially sought care for weight loss goals to improve quality of life and symptoms of OSA, after 10 months of treatment with semaglutide he reported a considerable decrease in alcohol consumption leading to mental, social, and home life improvements. Our aim in presenting this case is to illustrate the potential benefit of GLP-1 RAs for decreasing alcohol consumption levels in a patient with multiple comorbid conditions. The case adds to the growing body of evidence supporting the exploration of GLP-1 RAs for the treatment of AUD. Additionally, it underscores the need to enhance AUD screening efforts within family medicine clinics to identify high-risk persons and provide timely interventions.

Introduction

Alcohol use disorder (AUD) is highly prevalent in the United States, affecting more than 29 million of the 133 million persons who consume alcohol, with more than 60 million reporting binge drinking within the past month. ¹ Despite the impact of AUD, less than 10% of persons with AUD report receiving treatment in the past year and only 2% use pharmacotherapy. ² The Alcohol Use Disorders Identification Test (AUDIT) is a validated clinical screening tool that assesses alcohol consumption patterns, frequency of binge drinking, and alcohol-related consequences. ³ Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for weight management and type 2 diabetes, emerging research suggests a potential role for GLP-1 RAs in AUD. GLP-1 receptors are present in the brain regions involved in dopamine signaling and the human reward system.^{1,2,4 -8} Here, we describe the case of a 34-year-old man who was referred to our family medicine clinic for obesity management and whose AUD responded to GLP-1 RAs. Our aim is to illustrate the potential benefit of GLP-1 RAs for decreasing alcohol consumption levels in patients with substantial comorbid conditions.

Case Presentation

A 34-year-old man was referred to our family medicine clinic in August 2024 for medication therapy management of class 2 obesity and hypogonadism. His body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) was 37. His medical history was also notable for bipolar disorder and generalized anxiety disorder, both managed by an outside psychiatrist, and obstructive sleep apnea (OSA), all of which were well controlled. Although he did not directly disclose alcohol use, his AUDIT score was 27, indicating high-risk alcohol use.

He was initiated on a common GLP-1 RA, semaglutide (Ozempic; Novo Nordisk), 0.25 mg subcutaneously once weekly for weight loss and testosterone 100 mg intramuscularly once weekly for hypogonadism. Semaglutide was titrated to 2.4 mg weekly by May 2025. At that time, his BMI had decreased to 28.6, and his AUDIT score had improved to 7, a decrease of 20 points. Furthermore, the patient reported no alcohol withdrawal symptoms.

The patient described his perspective as follows: “Over the past 4 years, I struggled with significant weight gain and what many would call excessive drinking. I drank socially, at home—anytime—and once I started, I couldn’t stop. It impacted my relationships, especially with my partner and close family. I started semaglutide hoping to kick-start weight loss after hearing about others’ success. What I didn’t expect was how it completely removed my desire to drink. Before semaglutide, I’d often have 4 to 6 drinks a day over several days each week. Now, I might have half a beer a month. Semaglutide has transformed more than my weight—it’s improved my mental state, reduced my dependency on alcohol, and helped me feel more balanced, present, and in control of my life.”

Discussion

Current literature suggests a correlation between GLP-1 RA use and reduced alcohol-related behaviors. Studies have demonstrated decreased incidence of alcohol intoxication in patients with AUD, ¹ reduced stimulating and sedating effects of alcohol, ⁶ and a nearly 50% reduction in alcohol consumption among persons enrolled in concurrent weight loss programs. ⁷ Although behavioral therapy remains the cornerstone of AUD treatment, it requires active patient engagement, which can be a substantial barrier to adherence. ⁸

This patient initially sought care to address weight loss goals to improve his quality of life and symptoms of OSA. Due to feelings of shame, he did not disclose his alcohol use before beginning semaglutide. The patient described his marriage as previously strained, with alcohol use being a central factor, and reported having a prior driving under the influence citation (DUI). The patient met the first 9 of the 11 criteria for AUD in the DSM-5. ⁹ After 10 months of treatment, he reported a substantial reduction in alcohol consumption. This decrease improved his home life, reduced the risk of repeat DUIs, and improved management of his bipolar disorder. AUD frequently coexists with bipolar disorder, often worsening mood symptoms, prolonging withdrawal, and increasing suicide risk. ¹⁰ At the start of semaglutide treatment, the patient reported consuming approximately 15 alcoholic drinks per week, including weekly binge episodes of 9 or more drinks in 1 sitting. After 10 months of treatment with semaglutide for weight loss, his alcohol consumption decreased to half of a beer, once a month. Improved control of both his alcohol use and his bipolar disorder after use of semaglutide contributed to a meaningful improvement in his overall quality of life. Emerging evidence indicates that GLP-1 RA therapy can improve anxiety and depression symptoms. It is possible that improved mood in this patient with bipolar disorder also contributed to his decreased alcohol use. ¹¹

This case is notable because of the patient’s complex comorbid conditions, including bipolar disorder and severe AUD. At baseline, the patient’s AUDIT score was 27, placing him in the highest risk category for AUD, in which referral to specialty treatment is recommended. After treatment with semaglutide, his AUDIT score was 7, which put him in the risky use category. This score, however, may underestimate the true extent of his improvement, because a full year has not yet elapsed since semaglutide initiation. His current alcohol use patterns, if sustained, could further reduce his AUDIT score to 1, indicating low risk. A 20-point reduction in AUDIT score represents a clinically significant improvement in alcohol consumption and is positively reflected in the patient’s enhanced mental health, interpersonal relationships, and quality of life.

Conclusion

In this case, the patient did not disclose his alcohol use due to feelings of guilt and stigma and did not actively seek treatment for AUD. However, after initiating semaglutide for weight loss, he experienced a significant, unintended reduction in alcohol cravings and consumption. This case adds to the growing body of evidence supporting the exploration of GLP-1 RAs for the treatment of AUD. Additionally, it underscores the need to enhance AUD screening and diagnostic efforts within family medicine clinics to identify persons at high risk and provide timely interventions. ¹²