GLP-1s linked to fewer alcohol-related hospitalisations for people with alcohol or substance use dependence

Two separate studies have report that GLP-1s are linked to fewer alcohol and substance related hospitalisations for people with alcohol or substance use dependence.

In the first study, published in The Lancet Psychiatry, people with type 2 diabetes were hospitalised less frequently for alcohol or substance use disorders while undergoing treatment with GLP-1 receptor agonists, according to a large Swedish registry study involving the Central Institute of Mental Health (CIMH).

For the first time, researchers examined how the observed associations changed after the medication was discontinued. They found that the reduction in alcohol-related hospitalisations was still detectable for up to six months after treatment ended but was no longer evident after 12 months.

For the study, researchers analysed health registry data from 167,026 people with type 2 diabetes in Sweden, one of the largest to date on this topic. The researchers compared periods during which the same individuals were treated with GLP-1 receptor agonists with periods during which they received no treatment. They also examined the first six months and the period from six to 12 months after discontinuing the medication.

During treatment with GLP-1 receptor agonists, alcohol- and substance-related hospitalisations were less frequent than during treatment-free periods. For alcohol-related hospitalisations, this association remained statistically significant during the first six months after treatment ended. However, during the period from six to 12 months after discontinuation, there was no longer statistically significant evidence of the previously observed reduction in hospitalisation rates. For substance-related hospitalsations, the researchers found no statistically significant associations after discontinuation, either in the first six months or during the period from six to 12 months.

"Until now, little was known about how the observed associations develop after treatment ends. Our results suggest that they do not persist and that they diminish within a year," explained Dr Patrick Bach, research group leader at the Central Institute of Mental Health and lead author of the study. "The findings suggest that the potential effects of this class of drugs on addiction-related behaviours appear to be reversible."

The researchers see the results as an indication that the period following the end of treatment warrants special attention.

"The data underscore the importance of careful monitoring and follow-up of patients after the end of treatment with GLP-1 receptor agonists," Bach cautioned.

The researchers point out that this is an observational study. The results therefore do not allow conclusions about cause and effect. Furthermore, the study included only people with type 2 diabetes. Further studies are needed to better understand the underlying mechanisms and the potential implications of these findings for the treatment of alcohol and substance use disorders.

In the second paper, the use of newer GLP-1 receptor agonists (semaglutide or tirzepatide) for obesity or diabetes among people with alcohol use disorder was associated with a reduction in alcohol-related hospital admissions, according to a study published online in the open-access journal British Medical Journal (BMJ) Open. The findings suggest a potential role for the drugs semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) in the treatment of alcohol use disorder.

While GLP-1 receptor agonists are used primarily to treat type 2 diabetes and obesity, there have been reports of reduced alcohol consumption among patients taking the drugs, prompting the authors to investigate the potential impact on alcohol-related hospitalizations among adults with alcohol use disorder.

The study compared alcohol-related hospitalisations among 40,703 adults with alcohol use disorder and type 2 diabetes or obesity who started a newer GLP-1 receptor agonist (semaglutide or tirzepatide) or a comparator drug between January 2018 and December 2024.

Participants were split across four trials involving clinically distinct populations—the antidiabetic medication (ADM) trial, anti-obesity medication (AOM) trial, medications for alcohol use disorder with type 2 diabetes (MAUD- T2D) trial, and medications for alcohol-use disorder with obesity (MAUD-obesity) trial.

Compared with participants taking an active comparator drug, those taking GLP-1 receptor agonists had a lower risk of alcohol-related hospital admission during all four trials.

Use of GLP-1 receptor agonists was associated with a 26% lower risk of alcohol-related hospital admission than other diabetes medicines during the antidiabetic medication (ADM) trial, and a 32% lower risk than other obesity medicines during the anti-obesity medication (AOM) trial.

In the MAUD trials, the active comparators were drugs for alcohol use disorder, including acamprosate, disulfiram and naltrexone. Compared with taking drugs for alcohol use disorder, GLP-1 receptor agonist use among adults with type 2 diabetes was associated with a 63% lower risk of alcohol-related hospital admission during the trial. Among adults with obesity, GLP-1 receptor agonist use was associated with a 65% lower risk of alcohol-related hospitalisations.

The authors acknowledge several limitations to their study. Most importantly, alcohol use disorder is undercaptured due in part to stigmatization, and when documented, it may also be recorded variably, with lower reporting in areas of high social deprivation.

Alcohol-related outcomes may have been undercaptured because they were defined using diagnosis codes and laboratory testing for alcohol exposure. The study captured hospitalizations from treatment initiation to discontinuation in a trial environment, so treatment effects in an average clinical setting may differ.

Finally, there may have been some confounding related to socioeconomic status, underlying clinical stability or alcohol use disorder severity, and health care engagement, as newer GLP-1 receptor agonists are higher-cost therapies and patients with access to these medications may differ from comparator groups.

The risk of residual confounding was greatest in the MAUD trials, as reflected by the reduced risk of non-alcohol-related hospitalizations with GLP-1 receptor agonist use. The authors say the results of the MAUD trials should be interpreted with greater caution because there were also high rates of treatment discontinuation, increasing the potential for bias.

Nevertheless, the authors conclude, "Initiation of newer GLP-1 receptor agonists among patients with alcohol use disorder was associated with a lower observed risk of alcohol-related hospitalisation, with similar associations across populations with type 2 diabetes and obesity.

The findings of the first study were reported in the paper, ‘Association of GLP-1 receptor agonists with alcohol use disorder-related and substance use disorder-related hospital admissions during treatment and after discontinuation: a Swedish register-based within-individual observational study’, published in The Lancet Psychiatry. To access this paper, please click here

The findings of the second study were reported the in the paper, 'Association between GLP- 1 receptor agonists and alcohol- related hospitalisations among adults with alcohol use disorder: multi- target trial emulation study', published in BMJ Open. To access this paper, please click here