At a dinner party recently, someone poured my friend a glass of wine. It was a wonderful merlot, dark-fruited, a little spicy, the kind of wine that normally disappears.
She looked at it the way you might look at a plate of food after a heavy meal: not tempted, not disgusted, just … uninterested.
“I’m on Ozempic,” she said, almost apologetically. “I don’t really care about alcohol anymore.”
She wasn’t trying to quit. She didn’t swear off drinking. The desire had simply gone silent.
Since GLP-1 drugs entered widespread use, stories like my friend’s have multiplied — around dinner tables, on social media, and in clinics. Patients report that the pull of nicotine, alcohol, even gambling fades alongside their appetite.
The evidence is now catching up to the anecdotes. My colleagues and I conducted a study, published today in the BMJ, involving more than 600,000 people. We found GLP-1 drugs were associated with 50% fewer substance-related deaths, 39% fewer drug overdoses, and 26% fewer drug-related hospitalizations. They also reduced the risk of new substance use disorders across alcohol, opioids, cocaine, cannabis, and nicotine.
Randomized trials and registry studies across multiple countries converge on the same finding — including a Swedish study that found GLP-1 drugs associated with fewer alcohol-related hospitalizations than medications specifically approved for alcohol use disorder.
In animal studies, vervet monkeys — primates that, like humans, voluntarily drink alcohol — were given the GLP-1 drug semaglutide. They drank significantly less, not because alcohol made them feel ill, but because it had lost its appeal. The drug didn’t make alcohol aversive. It made alcohol uninteresting.
What is most striking is that these medications seem to work across all addictive substances. A drug designed for diabetes appears to quiet craving for substances with different mechanisms of action. That pattern suggests these addictions share a common biological driver, one we hadn’t been able to see until a drug revealed it.
To understand what that driver looks like in real life, consider what people taking GLP-1 drugs often describe: a quieting of “food noise” — the persistent, intrusive preoccupation with food that drives overeating. Something parallel is happening with addiction: a quieting of what I call “drug noise” — the relentless, unbidden craving that pulls a person back to a substance despite every intention to stop.
Drug noise is the signal these drugs appear to quiet — not for one substance, but for all of them.
Why would a drug designed for diabetes quiet drug noise? Because GLP-1 is not just a gut hormone. It is also produced in the brain, where its receptors are concentrated in regions that govern reward, motivation, and impulse control — the very circuits that are hijacked by addiction. GLP-1 drugs reach the brain and appear to reduce the rewarding pull of addictive substances. Animal studies suggest they also ease withdrawal — dampening not just the drive to use but the pain of stopping.
Addiction is not the first disease these drugs have forced us to rethink. For decades, obesity was treated as a lifestyle problem. Prior medications were largely ineffective, making it easy to blame the patient. Then GLP-1 drugs produced weight loss that prior interventions rarely achieved, and we began to see obesity for what it is: a chronic disease, treatable with medication, not a failure of discipline.
Addiction deserves the same rethinking. Treatments have been targeting substances one at a time, when the right target was craving, the engine that drives addiction across substances.
The cost of getting that wrong has been staggering: 80,000 overdose deaths in the U.S. in 2024 and about 178,000 deaths each year from excessive alcohol use. The nation’s response remains fragmented, often inadequate or nonexistent. For cocaine and methamphetamine addiction, no approved medication exists at all. The medications we do have for alcohol and opioid use disorders are decades old, modestly effective, and barely used. Fewer than 2% of people with alcohol use disorder receive any of them. We would not accept a 2% treatment rate for any other deadly disease. We accept it for addiction.
GLP-1 drugs may finally change that. They are the first class to show promise against multiple addictive substances simultaneously.
But critical questions remain. Whether craving returns when people stop taking them — and whether that return triggers relapse — is unknown. It is also unclear whether the effects on craving are independent of weight loss, and whether they hold over years of use or the brain develops neuroadaptation that erodes these benefits.
The drugs also carry side effects, including nausea, vomiting, and in rare cases pancreatitis and vision loss. And for a variety of reasons, many people stop taking them.
These drugs are not ready to be prescribed for addiction. We need trials that measure what matters: overdose, hospitalization, and death.
But for the millions already taking them for obesity who also struggle with alcohol, nicotine, or other substances, the evidence suggests they may be benefiting in ways no one expected. Early trial data suggest these drugs do not push people toward abstinence — they reduce consumption. For many patients, the goal is not to stop drinking entirely; it is to be free to drink like someone without addiction.
Back at the dinner party, my friend didn’t become a different person. She didn’t develop superhuman discipline. The cue simply lost its pull.
Craving is a biological signal — a drug noise. We are learning that this noise likely shares a common pathway across substances, one that GLP-1 drugs may be able to quiet. That possibility deserves rigorous trials — and may reshape how we treat addiction. Not one substance at a time. All of them at once. Enough quiet from the drug noise to choose.
Ziyad Al-Aly, M.D., is a physician and researcher at Washington University in St. Louis and chief of research at the VA Saint Louis Health Care System. He was named to the TIME100 Health for his research on long Covid.
