Can Ozempic End Addiction? | Dhruv Khullar | Your Body on Tech  🔗 **Source:** [Can Ozempic End Addiction? | Dhruv Khullar | Your Body on Tech](https://share.snipd.com/episode/4fc31569-f5df-4343-9803-4b0717415d78) ## Highlights - **Patient Mary Quit Drinking After Ozempic Trial** - Mary joined a clinical trial for Ozempic and within weeks lost her taste for beer, switching from 18-beer binges to sobriety. - She lost 55 pounds over five months, came off the drug, and maintained sobriety and healthier habits afterward. Transcript: Dhruv Khullar Year, I met a woman I'll call Mary. Mary was 13 when she started drinking, and soon she could drink 18 beers in a sitting and barely seen bust. Her days became a blur of inebriation and hangover. Mary wanted to stop drinking. She tried alcohol rehab, Alcoholics Anonymous, a medication called Antabuse. None of them worked for her. One day, Mary was at a bar with a friend who also drank heavily. But that evening, Mary noticed that her friend had hardly sipped her drink. Her friend told her that she started taking Ozempic, and now she could barely drink two beers at a time. Mary was perplexed. She'd always thought of Ozempic as an obesity medicine. What did it have to do with drinking? But she decided to enroll in a nearby clinical trial that was studying whether GLP-1 medications like Ozempic could help people with alcohol addiction. Every week, researchers blindfolded her and injected her with a solution, either Ozempic or a placebo. Within weeks, Mary lost her taste for beer. She switched to white wine, and then she stopped drinking altogether. Many people talk about Ozempic as getting rid of the food noise inside their heads, those intrusive, unwanted, repetitive thoughts about eating. For Mary, it cleared out alcohol noise. It started to moderate her desire for drinking. It turned what was an overpowering emotional response into something that could be seen from a distance. Suddenly, she had the mental space to make changes in her life that she'd long wanted to. She started exercising. She improved her diet. She ended a difficult relationship. People know how much GLP-1s affect your body, she told me. I don't think they realize how much they affect your mind. Now, as a doctor, I have long wished that we had more to offer people who are struggling with an addiction. And hearing Mary's story, it's hard to overstate just how striking it was. GLP-1, or glucagon-like peptide 1, was first discovered way back in the 1980s. Scientists thought that it might be helpful to manage diabetes, but because the naturally occurring version of the molecule broke down within minutes, it was hard to turn into a drug. The big break didn't come until years later, when a scientist who was studying kilomonsters, of all things, found that the lizard's venom contained a similar peptide, and that peptide Could hang around for hours. His discovery catalyzed what would become the GLP-1 revolution. Now, for a long time, GLP-1 was thought to be mainly about digestion. But it's now clear that the medications affect much more than eating. They might have some of their most surprising effects not in the gut, but in the brain. Stories like Mary's have led scientists to consider whether these medications could be helpful for all sorts of addictions, from alcohol and cocaine to gambling and compulsive shopping. Research has found that GLP-1s might help people stop smoking, reduce their cravings for opioids, lead them to consume fewer drinks. As one neuroscientist put it, GLP-1s might be telling us that there is some type of universal pathology when it comes to addiction and that they are part of how we fix it. Now, that is a tantalizing prospect, that there's a general purpose key that unlocks the path to moderation. But that's what GLP-1s seem like they could be, moderation molecules. They don't extinguish our desires, but they help us keep them in check. And no one knows exactly why. One possibility is that they modulate what's called the brain's mesolimbic pathway, sometimes referred to as the reward system. Alcohol, nicotine, cocaine, social media, they all increase dopamine release in that pathway. And GLP-1s, they might be limiting the spikes of dopamine. So mice that are on the medications and given cocaine, they have smaller surges of dopamine, but they otherwise seem to maintain adequate amounts of the neurotransmitter. GLP-1s could be calming the water without draining the pool. At the other end, GLP-1s might make it easier to stop using a drug. Research that's currently under review has found that animals that are addicted to opioids and given a GLP-1, they have less activity in a part of the brain that's involved with withdrawal. So again, these medications could lead to moderation not just because they make a drug less pleasurable, but because they make abstinence less painful. Now at this point, we should probably moderate our own enthusiasm about the moderating effects of these medications. Like any drug, GLP-1s won't work for everyone. In fact, for some people, these so-called moderation molecules, they could have an alter ego as a desire dampener. Maybe some people lose interest in drugs or alcohol or food because they lose interest in pretty much everything, a condition known as anhedonia. It's also true that addiction is often a lifelong battle, but many people who start on a GLP-1, they come off it within months, whether because of side effects or costs or access. And even people who do manage to stay on the medications might ultimately develop a tolerance to them, such that their cravings for a drug ultimately return. And yet it is hard not to get excited about the potential for GLP-1s to treat addiction when you consider how little progress we have made. Every year, tens of thousands of Americans die of an opioid overdose. Since the turn the century, alcohol-related deaths have more than doubled. And it has been 20 years since the FDA last approved a medication for alcohol use disorder. The winding path of GLP-1s from Gila monster peptide to diabetes medication obesity drug to potential addiction treatment. It is a story of hope, but it's also a story with a lesson. The hope is that more people will gain the power to bring their wants and their motivations and their behaviors into greater harmony, and they will live many more years in good health As a result. ([Time 0:06:15](https://share.snipd.com/snip/bfbf4916-7a75-4ad1-8140-a36c3fd88dbd)) - **GLP-1s May Calm Reward Circuit Dopamine Surges** - GLP-1 drugs likely act beyond the gut by modulating the brain's mesolimbic reward pathway and blunting dopamine spikes from substances and behaviors. - Animal studies show smaller dopamine surges to cocaine and reduced withdrawal-related brain activity with GLP-1s. Transcript: Dhruv Khullar Now, for a long time, GLP-1 was thought to be mainly about digestion. But it's now clear that the medications affect much more than eating. They might have some of their most surprising effects not in the gut, but in the brain. Stories like Mary's have led scientists to consider whether these medications could be helpful for all sorts of addictions, from alcohol and cocaine to gambling and compulsive shopping. Research has found that GLP-1s might help people stop smoking, reduce their cravings for opioids, lead them to consume fewer drinks. As one neuroscientist put it, GLP-1s might be telling us that there is some type of universal pathology when it comes to addiction and that they are part of how we fix it. Now, that is a tantalizing prospect, that there's a general purpose key that unlocks the path to moderation. But that's what GLP-1s seem like they could be, moderation molecules. They don't extinguish our desires, but they help us keep them in check. And no one knows exactly why. One possibility is that they modulate what's called the brain's mesolimbic pathway, sometimes referred to as the reward system. Alcohol, nicotine, cocaine, social media, they all increase dopamine release in that pathway. And GLP-1s, they might be limiting the spikes of dopamine. So mice that are on the medications and given cocaine, they have smaller surges of dopamine, but they otherwise seem to maintain adequate amounts of the neurotransmitter. GLP-1s could be calming the water without draining the pool. At the other end, GLP-1s might make it easier to stop using a drug. Research that's currently under review has found that animals that are addicted to opioids and given a GLP-1, they have less activity in a part of the brain that's involved with withdrawal. So again, these medications could lead to moderation not just because they make a drug less pleasurable, but because they make abstinence less painful. ([Time 0:09:13](https://share.snipd.com/snip/3b8b72dc-55e5-43d8-a9b7-415839015738)) - **Discovery Path From Gila Monster To Broad Therapeutics** - The GLP-1 story demonstrates how obscure scientific curiosity can catalyze major medical advances, from Gila monster peptide to broad therapeutics. - Unexpected mechanisms revealed new indications beyond diabetes and obesity, prompting research into addiction. Transcript: Dhruv Khullar It is a story of hope, but it's also a story with a lesson. The hope is that more people will gain the power to bring their wants and their motivations and their behaviors into greater harmony, and they will live many more years in good health As a result. The lesson is about the unpredictability of medical progress. Discoveries like this one remind us why scientific curiosity, especially the kind that can seem obscure or impractical, why it matters so deeply. Because we don't know where the next big innovation will come from. We might not even recognize it when we first see it. ([Time 0:12:58](https://share.snipd.com/snip/c39f59c0-e9be-456e-9a18-4f4e25cd5d42)) - **Moderation Framed As A Physiological State** - GLP-1s recast moderation as a physiological state, suggesting restraint isn't only moral but biologically mediated. - This reframes ancient ideas about virtue (Aristotle) into modern neurobiology influencing behavior and desire. Transcript: Dhruv Khullar For thousands of years, we have seen moderation as a moral achievement. Aristotle argued that the path to a life well lived runs through moderation. Courage rests somewhere between cowardice and recklessness, generosity between stinginess and extravagance. He's often quoted as saying, it is best to rise from life as though from a banquet, neither drunken nor thirsty. Well, Aristotle never had a Dorito. He didn't have Krispy Kreme or McDonald's. He couldn't flip open TikTok and Instagram. There were algorithms that were fracking his attention. And ancient Greece was not beset by fentanyl and oxycodone. We have a society today in which the fundamental problem for many people has shifted from scarcity and boredom to excess and distraction. Our technology often seems purpose-built to tap into our most basic vulnerabilities. And the question now is how to bring our minds and our bodies and our environments into a more natural balance. GLP-1s, they suggest that Aristotle's moderation is not just a virtue, it is a physiological state. It isn't just about character, it is about biology. ([Time 0:13:48](https://share.snipd.com/snip/41778d1e-b110-47c4-8b98-ac6ce81548e2)) - **Use GLP-1s With A Plan To Manage Side Effects** - Proceed cautiously with GLP-1s: plan for side effects, cost, and potential discontinuation since many stop within a year. - Monitor for GI issues, psychological blunting or anhedonia, and prepare diet plus strength training to preserve muscle. Transcript: Dhruv Khullar Anytime people start talking about a wonder drog, we should approach that with some skepticism. And I have approached that with skepticism, and I've been surprised at how many times the evidence actually has supported their use for various conditions. But that being said, there are things that should still give us caution. So I think the first is that it can be hard for a lot of people to stay on these medications. Drugs only work if you take them, but at least in some studies, half or more of people come off these medications within a year of starting to take them. And so, of course, that is going to limit how effective they can be if people aren't able to stay on them. It's also possible that some people experience psychological side effects. There have been reports, not a lot of great research yet, but at least reports that people feel kind of a blunted mood or even anhedonia. They're not interested in doing the things that they used to do. And of course, that is potentially quite concerning if people aren't interested in kind of living the life that they want to be living. That's something that needs to be followed very closely. The cost is still a huge issue. The The sticker price can still be $1,000 or $1,300 a month. And so, as you can imagine, not a lot of people are going to be able to afford that. And finally, I would say GI side effects. In clinical trials, they seem to be pretty well tolerated. So maybe 5% or 10% of people have significant enough GI side effects to come off them. But that is potentially higher in the real world. ([Time 0:32:18](https://share.snipd.com/snip/3812f547-ad45-4eba-9245-ecbc0d53eb18)) - **Protect Muscle During Rapid Weight Loss** - Rapid weight loss on GLP-1s often includes muscle loss, risking frailty unless countered. - Khullar recommends combining GLP-1 use with high-protein diets and strength training to preserve muscle mass. Transcript: Dhruv Khullar Of the things that happens when you're on a GLP-1 is that often people are losing a lot of weight. And with that weight is going to be part loss of fat, but also loss of muscle. And losing a lot of muscle very quickly can be concerning for all sorts of reasons, but one of which is it can lead to frailty and people might be at higher risk for falls and other problems. And so the recommendation really is not just to take the GLP-1 isolation, but to do it along with the diet and exercise regimen. The diet should be a high-protein diet that allows you to preserve as much muscle as possible. And, of course, the exercise regimen should involve high levels of strength training so that people, when they're losing the weight, can preserve as much muscle as possible. ([Time 0:34:00](https://share.snipd.com/snip/27e266ef-6400-4c42-befb-ed0e94bb2f27)) - **Medications Aren't A Substitute For Social Change** - Widespread GLP-1 use shouldn't replace societal reforms; meds can help now but don't absolve addressing root causes like food systems, built environments, trauma, and poverty. - Khullar urges both treatment access and continued public-health efforts. Transcript: Dhruv Khullar Think that's a really important point, especially when it comes to children or adolescents. It's one thing to commit someone who is in their 50s or 60s to a medication that they're going to need to take for the rest of their life. It's quite different when someone is 10 or 15 or 20 years old. And so I do think it raises a really important set of questions about the treatment model here. You know, is it really the case that people are going to have to be on these medications for the long term? Or is there a way to use these GLP-1 medications as a bridge to other types of interventions? You know, I think the other thing that this raises for me is that, of course, as you're saying, when a medication is so powerful, it becomes tempting to use it and not continue to push on The more societal factors that are creating the epidemic that we're in. We're not addressing the root causes of obesity and diabetes and addiction. And that's the reason that we are using these medications in the way that we are. Of course, I'm the first to want to change the food system or the built environment or many of the other levers that we might want to work on to create a more healthful society. But it's also the case that we have been trying to do that for decades and not made a lot of progress. And so in the short term, you know, there are people who could really benefit from these medications today. ([Time 0:36:35](https://share.snipd.com/snip/ed3e07b4-7071-4e0d-825c-c58377b9418d)) - **Next Generation GLP-1s And Delivery Formats Are Coming** - Expect more GLP-1 variants and delivery formats soon, including multi-receptor drugs and oral formulations, expanding therapeutic options. - Companies are developing tri-agonists and formulations to reduce side effects and muscle loss. Transcript: Dhruv Khullar Think there's going to be more and more options for people on these medications. And so, you know, right now we have maybe two major types of GLP-1s that people are taking, semaglutide and terzepatide. There's already another medication that hits not just one receptor or two receptors, but three receptors, retitutride, that has completed phase three trials by Eli Lilly. I think there will be more versions that are oral versions as opposed to injectable versions. And so I just think there's going to be a lot more activity in this space, whether it's route of administration or trying to mitigate side effects or try to reduce some of the muscle loss That sometimes people experience. So I can see, you know, in the next five or 10 years that there are many versions of these medications and they're much more widely used. ([Time 0:39:43](https://share.snipd.com/snip/bb31a02b-5b47-4c54-8dfb-96af976ae084)) - **Explain Recommendations With Rationale And Storytelling** - Clinicians must couple evidence with clear rationale and storytelling to help patients navigate abundant health claims and direct-to-consumer access. - Dhruv recommends explaining why a recommendation matters, not just reciting evidence, amid misinformation. Transcript: Dhruv Khullar Think both are going to happen. I mean, I think there's going to be a lot more insistence that people are able to access these things even outside of the traditional medical system. I think one thing that it drives home for me is that as doctors or other clinicians, it's no longer going to be effective simply to state the evidence or to state a recommendation. That really has to come paired with a rationale, a perspective, you know, demonstration of why it is that the recommendation that we are giving is what it is. Storytelling, I think, is going to be a really important part of the future. I mean, it sounds old-fashioned, but really, because there's so much information out there, there's so much disparate information, it's very hard for people to sift through it all. It's also possible to get abstract in your thinking and not tie it back to real people's lives. When I'm in the hospital, I am interacting with the challenges that people are facing in a very real way. And in a way, so many of the challenges that are in society, not just medical, but more general, they find their way into the emergency room. They find their way into the hospital, whether it's misinformation or homelessness, whatever it might be. If you're able to tell a compelling story, if you're going to put together, synthesize things into a narrative, that can be really helpful in helping people put it all together. ([Time 0:43:27](https://share.snipd.com/snip/55ba890c-de53-4065-a45d-6991ff6a0013)) - **GLP-1s Could Have Helped A High Risk Patient Get Surgery** - Khullar recalled a high-risk taxi driver who lacked options for weight loss pre-GLP-1 and likely would have benefitted from the drug to become eligible for needed surgery. - This personal case illustrates GLP-1s as a bridge to life-saving interventions. Transcript: Dhruv Khullar You know, I remember many years ago caring for a taxi driver who had a really severe heart condition that needed surgery, but he was really high risk for surgery because of his weight And other medical problems. And the recommendation from the surgeon was that he needs to lose some weight and come back, and maybe they'll consider surgery at a later date. And everyone kind of knew that that would not be possible for him. And this was before GLP-1s were widely available. And I still think back to that experience and wonder if he had GLP-1s available. Would that have been something that could have kick-started his journey to weight loss and then getting the surgery that he needed? Certainly, I think it would have given him a much better shot than he had at the time. ([Time 0:47:42](https://share.snipd.com/snip/eefac537-6438-4164-b070-4a1c992bf181))