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Exploring semaglutide for alcohol use disorder: A review of clinical efficacy and neurobiological mechanisms
Journal article - Includes Student Work   Open access   Peer reviewed

Exploring semaglutide for alcohol use disorder: A review of clinical efficacy and neurobiological mechanisms

Arundhati N Nittur, Ava Belzar and Chandra Rai
Addictive behaviors, v 185, 108878
Feb 2027
DOI: https://doi.org/10.1016/j.addbeh.2026.108878
Featured in Collection :   Drexel's Newest Publications
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https://doi.org/10.1016/j.addbeh.2026.108878View
Published, Version of Record (VoR) Open Access via Drexel Libraries Read and Publish Program 2026 Open CC BY V4.0

Abstract

Aims To examine emerging clinical evidence, real-world data, and neurobiological mechanisms supporting the repurposing of semaglutide as a novel treatment for alcohol use disorder (AUD) Methods Of records identified, articles were selected based on clinical relevance to AUD outcomes and mechanisms of action. Included studies ranged from hypothesis-generating designs to confirmatory randomized controlled trials in non-treatment-seeking individuals and patients diagnosed with AUD, with several cohorts enriched for comorbid obesity. Results Randomized controlled trials demonstrated that once-weekly semaglutide significantly reduced alcohol cravings and drinks per drinking day, even in non-treatment-seeking populations. Large-scale cohort studies showed a reduction in AUD-related hospitalizations for patients on semaglutide compared to non-users. Dual agonists like tirzepatide also showed significant reductions in binge drinking odds and AUDIT scores, with reductions in alcohol craving and consumption appearing most pronounced among individuals with comorbid obesity or metabolic disease. Mechanistically, preclinical and early human data indicate GLP-1 receptor activity in the VTA and nucleus accumbens modulates mesolimbic reward circuitry to attenuate dopamine-mediated reinforcement, alongside indirect behavioral and satiety effects. Conclusions GLP-1 receptor agonists show early promise in reducing alcohol craving and consumption, particularly in individuals with comorbid metabolic disease. No GLP-1 receptor agonist currently carries FDA approval for alcohol use disorder, and all discussed clinical applications still remain investigational. Definitive randomized trials in AUD-only populations are still needed. Current evidence remains limited by small sample sizes, brief follow-up periods, self-reported outcomes, and potential confounding from weight loss.

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