When Susan Akin first started injecting a coveted weight-loss drug early this year, the chaos in her brain quieted. The relentless cravings subsided — only they’d never been for food.
The medication instead dulled her urges for the cocaine and alcohol that caused her to plow her car into a tree, spiral into psychosis, and wind up admitted to a high-end addiction treatment center in Delray Beach, Fla.
Doctors at Caron Treatment Centers tried a novel approach for the slender 41-year-old by prescribing her Zepbound, part of a blockbuster class of obesity and diabetes medications known as GLP-1s. Federal regulators have not approved the drugs for behavioral health, but doctors are already prescribing them off-label, encouraged by studies suggesting that they could reshape addiction treatment.
Scientists caution that the research remains nascent. Health insurers do not cover the pricey drugs for that purpose. Addiction specialists say the medications might not be a cure but may work as a tool to quell addictive behaviors.
For Akin, the weekly shot helps her endure a world full of triggers. She can visit a gas station without wanting to buy beer or see sugar without dialing a cocaine dealer. The cravings linger but are muted, she said.
“I know when I’m due for my shot because I get a little antsy or irritable, or just kind of off,” Akin said. “But it has changed my life.”
Emerging science
As GLP-1 drugs for weight loss generate billions for pharmaceutical companies, researchers are exploring their potential for other purposes. Clinical trials have already shown that semaglutide, the active ingredient in Ozempic and Wegovy, can reduce the risk of heart attacks and treat liver disease.
These drugs appear to reduce cravings for food because they mimic a natural hormone that boosts insulin production, curbs appetite, and slows stomach emptying to create a feeling of fullness. Tirzepatide, the active ingredient in Zepbound, imitates a related hormone that enhances insulin release and amplifies appetite suppression.
The mechanism of how GLP-1s could also curb alcohol and drug cravings is not entirely understood. The medication may block release of dopamine, the chemical associated with reinforcing pleasurable activities, said Kyle Simmons, a professor of pharmacology and physiology at Oklahoma State University. The medications appear to be “turning down the gain on the reward circuitry in the brain,” Simmons said, possibly explaining why they have a broad effect on behavior.
The potential has ushered in a wave of research that includes whether the drugs help veterans with moderate to severe drinking problems, diabetic patients who smoke, and people addicted to opioids, among others.
Federally backed studies of patient records released since early 2024 have shown GLP-1 use in some patients who are diabetic or obese is associated with lower risks of alcohol abuse, cannabis use disorder, and opioid overdoses.
Associations alone do not prove that the weight-loss drugs are causing those changes, but small early clinical trials have shown promise. In one study published in February in JAMA Psychiatry, researchers found that problem drinkers who received a weekly semaglutide injection drank less and had fewer cravings for alcohol and cigarettes compared with those given a placebo.
Researchers at the National Institute on Drug Abuse and Simmons are running separate but similar double-blind clinical trials to measure whether the drugs curb alcohol cravings in patients with drinking problems. Researchers are charting brain activity to see how participants respond when exposed to alcohol cues and using virtual-reality headsets to measure how they respond to images of food. In the NIDA study, scientists have built a mock bar to observe how patients react to being near alcohol.
A spokeswoman for Eli Lilly, which manufactures Zepbound, said the company is considering clinical trials to assess the drug as a treatment for substance use disorders, including for alcohol and tobacco. Novo Nordisk, the maker of Wegovy and Ozempic, declined to say whether it would study the drugs’ effectiveness for addiction.
Medical treatments lacking
The use of GLP-1s for unapproved purposes is surging, including micro-dosing to promote longevity and wellness, despite little evidence supporting these lower doses. Researchers also caution that long-term use of the drugs — which can cause unpleasant stomach side effects — remain understudied.
Still, if GLP-1s prove effective at curbing cravings of different substances — and include behavioral addictions such as gambling and shopping — it “really opens up a whole new sort of therapeutic avenue that’s not been available before,” said Joji Suzuki, an addiction researcher at Brigham and Women’s Hospital in Boston.
An estimated 48 million Americans had a substance use disorder last year, according to federal researchers. More than 80,000 died of drug overdoses last year while more than 47,000 died from alcohol complications, according to federal estimates.
There are no approved medications to reduce cravings for other substances including cannabis, cocaine, or methamphetamine. For opioid addiction, medications such as buprenorphine or methadone are considered effective at staving off withdrawal and cravings, but carry stigma.
While the FDA has approved three drugs to reduce alcohol consumption, only 2 to 4% with alcohol-use disorder get any medication treatment, said Lisa Clemans-Cope, a researcher at the Urban Institute, a nonpartisan economic and social policy research group.
An affordability problem
Early research and anecdotal evidence proved enough for Steven Klein, a physician who specializes in addiction at Caron, to begin prescribing GLP-1s to his patients.
For Klein, the project is more than a professional curiosity: He is a recovering alcoholic who has long struggled with his weight. Three years ago, while in recovery and working as a pediatrician, Klein was prescribed the anti-diabetes drug Mounjaro for weight loss. He found the drug calmed his mind. “The voice that was talking to me about food was very similar to the voice that used to talk to me on drugs and alcohol,” Klein said.
Moved by his experience, Klein switched to addiction care and joined Caron, a high-end rehab center with facilities near Reading and in Atlanta, Washington, and Delray Beach.
He spearheads a pilot program that has prescribed GLP-1s to more than 130 patients in Pennsylvania and South Florida, most diagnosed with alcohol-use disorder and some who took stimulants.
Klein has also partnered with Open Doors, a nonprofit in Rhode Island that helps formerly incarcerated women reenter society, to begin offering GLP-1s through its recovery program.
“We see how hard it is for people to maintain their recovery long-term after they leave the support of our housing,” Open Doors Co-Executive Director Nick Horton said. “But with this medicine, I’m hopeful.”
Regina Roberts, a 41-year-old alcoholic in recovery, is living at an Open Doors facility after stints in rehab and a family court program after she lost custody of her teenage son. She has been sober since 2023 with the help of 12-step programs, therapy, and life-skills classes. But she faced frequent reminders of her past: walking past a liquor store, smelling alcohol on someone’s breath, cigarette smoke wafting in the air. When Open Doors told her about the promise of GLP-1s several months ago, she agreed.
“I figured, why not try it?” Roberts said. “I’ll take anything to help me stay on my road to sobriety.”
With her cravings dialed back, Roberts hopes to reunite with her teenage son and move out of Open Doors in a few months. But she’s unsure whether she can keep taking the medication; she can’t afford to pay out of pocket and Medicaid might not cover it.
At Caron’s Wernersville location, staff reduce costs by receiving semaglutides from compounding pharmacies, which can legally produce cheaper versions of name-brand mediations.
In the Delray Beach facility, most patients receive Zepbound through their insurance by “piggybacking” under FDA-approved uses, or by paying out of pocket with manufacturer discounts, said medical director Mohammad Sarhan. Those costs add to the price of rehab programs that can cost up to $100,000.
Akin, the Caron patient who is approaching one year sober, said she relies on her inheritance to pay nearly $1,000 every month for prefilled Zepbound shots. Akin could receive a modest discount in the coming months now that Eli Lilly, along with Novo Nordisk, announced they could lower direct-to-consumer prices as part of a deal struck with the Trump administration.
She considers Zepbound an essential drug like insulin.
“It’s not a cure. We have to do the work,” Akin said. “But it helps. It slows things down enough to the point where you don’t feel like you have to jump off a bridge or put your head in a cocaine plant to survive.”
