Semaglutide reduced alcohol cravings and heavy drinking days in a small but rigorous clinical trial. The February 2025 JAMA Psychiatry study (n=48) found that low-dose semaglutide significantly reduced the amount of alcohol consumed, weekly cravings, and frequency of heavy drinking compared to placebo.
This is the first randomized controlled trial to show these effects in humans. A separate Swedish registry study of 227,866 people found semaglutide users had 36% lower risk of alcohol-related hospitalization.
The Study: UNC Chapel Hill RCT
Published in JAMA Psychiatry on February 12, 2025, this was the first Phase 2, double-blind, randomized controlled trial testing semaglutide specifically for alcohol use disorder.
Study Design
- Participants: 48 adults with alcohol use disorder (not seeking treatment)
- Demographics: 71% female, average age 39.9 years
- Duration: 9 weeks of treatment
- Dosing: 0.25 mg/week (weeks 1-4), 0.5 mg/week (weeks 5-8), 1.0 mg (week 9)
- Lead Institution: University of North Carolina at Chapel Hill
What They Measured
Researchers used both laboratory-based alcohol self-administration tests and real-world drinking metrics collected at weekly clinic visits.
The Results
| Outcome | Finding | Effect Size |
|---|---|---|
| Alcohol consumed (lab test) | Significantly reduced | β = -0.48 (medium-large) |
| Peak breath alcohol | Significantly reduced | β = -0.46 (medium-large) |
| Weekly alcohol craving | Significantly reduced | β = -0.39 (p = 0.01) |
| Drinks per drinking day | Significantly reduced | β = -0.41 (p = 0.04) |
| Heavy drinking days | Greater reduction over time | β = 0.84 (p = 0.04) |
| Average drinks per day | No significant difference | — |
| Number of drinking days | No significant difference | — |
"We've known for some time from animal studies that GLP-1 receptor agonists reduce alcohol intake and motivation to consume alcohol. This is the first controlled trial showing potential efficacy in humans with alcohol use disorder."— Dr. Christian Hendershot, Director of Clinical Research, USC Institute for Addiction Science, UNC Health Newsroom
The Swedish Registry Study
A separate study published in JAMA Psychiatry in November 2024 analyzed Swedish national health records to look at real-world outcomes.
Study Details
- Sample: 227,866 individuals with alcohol use disorder
- Follow-up: Median 8.8 years
- Design: Within-individual comparison (each person as their own control)
Key Findings
| Medication | Alcohol Hospitalization Risk | Any Substance Use Hospitalization |
|---|---|---|
| Semaglutide | 36% lower (aHR 0.64) | 32% lower (aHR 0.68) |
| Liraglutide | 28% lower (aHR 0.72) | 22% lower (aHR 0.78) |
| Other GLP-1s (exenatide, dulaglutide) | No significant effect | No significant effect |
"Among patients with AUD and comorbid obesity/type 2 diabetes, the use of semaglutide and liraglutide were associated with a substantially decreased risk of hospitalization due to AUD. This risk was lower than that of officially approved AUD medications."— Lähteenvuo M, et al., JAMA Psychiatry, 2025
How Might This Work?
GLP-1 receptors aren't just in the gut — they're also found in brain regions involved in reward processing. Researchers believe semaglutide may reduce the rewarding effects of alcohol by modulating dopamine pathways in the brain's reward centers.
Dr. Klara Klein, co-author of the UNC study and endocrinologist at UNC School of Medicine, notes: "Preclinical studies suggest that these effects are likely mediated in the brain and involve changes in reward processing."
Important Limitations
- Small sample size: Only 48 participants in the RCT
- Short duration: 9 weeks of treatment
- Low dose: Did not reach the full therapeutic dose (2.4 mg/week for weight loss)
- Not treatment-seeking: Participants weren't actively trying to quit drinking
- Observational limitations: The Swedish study can only show associations, not causation
What This Means
These results are promising but preliminary. The FDA has not approved any GLP-1 medication for alcohol use disorder, and larger, longer trials are needed.
Currently, only three medications are FDA-approved for AUD: disulfiram (Antabuse), naltrexone, and acamprosate. All are significantly underutilized.
If semaglutide is eventually approved for AUD, its existing popularity for weight loss could help reduce the stigma barrier that limits uptake of current AUD medications.
"Alcohol is accountable for 5.1% of the global burden of disease and approximately 178,000 U.S. deaths per year. A significant proportion of American adults have met criteria for alcohol use disorder at some point in their lives — yet relatively few seek or receive treatment."— UNC Health, citing World Health Organization and U.S. Surgeon General data
The Sources
Primary Studies
- Hendershot CS, et al. "Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial." JAMA Psychiatry. 2025;82(4):395-405.
- Lähteenvuo M, et al. "Repurposing Semaglutide and Liraglutide for Alcohol Use Disorder." JAMA Psychiatry. 2025;82(1):94-98.
Press & Expert Commentary
- UNC Health Newsroom: "Semaglutide Shows Promise in Reducing Cravings for Alcohol, Heavy Drinking"
- Science Media Centre: Expert Reactions to the JAMA Psychiatry Study
- AJMC: "GLP-1s Could Help Reduce Alcohol Addiction, Study Finds"
Background Sources
- NIH/NIAAA: Alcohol Use Disorder Statistics in the United States
- ClinicalTrials.gov: NCT05520775 (trial registration)
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Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. GLP-1 medications are NOT FDA-approved for alcohol use disorder. If you struggle with alcohol, please consult a healthcare provider or contact SAMHSA's National Helpline at 1-800-662-4357.
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