A turning point in addiction psychiatry?

There’s anecdotal reporting that semaglutide seems to ‘obliterate’ cravings across the board—for drugs, gambling, you name it. How much evidence do we have to support those kinds of claims?

That’s a very important question. In science, we usually move from preclinical models, like animal studies, to clinical trials in humans. But here, the process happened in reverse. We started observing dramatic effects in humans first, and now we’re trying to go back and understand the mechanisms behind them using animal models and cellular studies.

So right now, there’s a lot of “reverse translational” work happening to validate those human observations. Researchers are conducting preclinical studies to see how GLP-1 receptor agonists influence things like craving, cue reactivity and impulsivity. We’re even looking at how they affect executive function in areas like the prefrontal cortex.

For example, there are rodent models where GLP-1 receptor agonists appear to reduce voluntary alcohol consumption, prevent relapse and blunt stress-induced alcohol seeking. And when scientists examine the animals’ brains, they see reduced dopamine release and less activation in the reward centers. Obviously, we can’t directly observe that in human brains, but animal models help us infer what’s happening.

So yes, there’s growing evidence, and a lot of new studies, some even funded by the NIH, that are underway to further explore these effects.

Are there specific addictions or behaviors you’re most focused on in your research, such as alcohol or opioids?

I’ve always been drawn to studying addiction because it’s a psychiatric condition where you can actually measure behavioral outcomes that reflect brain changes. Unlike depression or anxiety, where diagnosis often relies on self-report or subjective clinical judgment, addiction offers more concrete data, like how much alcohol or how many drugs someone is using.

That makes it a powerful model for understanding brain-behavior relationships. We can test interventions and track outcomes in a quantifiable way. Plus, addiction models in animals are much more robust than for other psychiatric disorders like schizophrenia or depression.

As for GLP-1 drugs, the interest is expanding far beyond addiction. These medications are now being tested for cardiovascular benefits—lowering blood pressure, reducing cholesterol—and even for neurodegenerative conditions like Alzheimer’s and Parkinson’s.

What I find particularly promising about GLP-1 receptor agonists is their ease of use. They're taken just once a week, which helps a lot with treatment adherence—especially in addiction, where compliance can be a big barrier.

That said, they do come with side effects, such as nausea, GI issues and sometimes even a general loss of interest in things. But the flip side is, people often experience real improvements: less drinking, fewer cravings, fewer negative consequences. That early progress can motivate them to keep going.

It’s like trying to lose weight. If you see results fast, you’re more likely to stick with it. And that’s critical in addiction recovery. If patients feel even a little better, they’re more likely to stay on the medication and continue improving.

It sounds like this could be a massive discovery. What is its potential impact on public health?

It could be massive. Let me give you a little context from my clinical work. I run clinical trials for patients with alcohol and substance use disorders. One striking thing I’ve noticed is how the typical “phenotype” of addiction is changing. In the past, many people with severe addiction were malnourished and underweight. That’s no longer the case. Today, many patients are overweight or obese, partly due to poor diet and the changing food environment.

So now you have this new layer: people who are both addicted and struggling with weight or metabolic issues. And GLP-1 receptor agonists can help on both fronts. Patients may start to feel better physically even before they reach full abstinence. Losing weight, improving liver enzymes, feeling fewer withdrawal symptoms—it all reinforces their sense of progress.

And that’s one of the things I love about these drugs. They’re not just targeting the brain, there are concrete and measurable outcomes that are visible to the patient. That’s huge for patient engagement. When people see measurable improvements in their health, they’re more likely to stay motivated and continue treatment. It’s not some mysterious effect only your psychiatrist can explain. You can feel and see it happening in your own body.

What else about this developing topic is most important for the public to be aware of?

I think this is really important if you’re going to keep following this story: For the first time in decades, the pharmaceutical industry is showing serious interest in addiction. That hasn’t happened in a long time. The last medication approved for alcohol use disorder was the extended release formulation of naltrexone in 2006. It’s been 20 years!

But now, if you look at ClinicalTrials.gov, you’ll see a growing number of industry-sponsored studies in addiction psychiatry. And that’s a game-changer. It could lead to new tools and new medications for clinicians, and also to a growing body of scientific research in a field that’s been relatively stagnant.

One of the reasons this is happening is that the FDA has shifted its standards. In the past, a drug for addiction had to show it could lead to total abstinence. That’s a very high, and often unrealistic, bar. But now, the FDA accepts reduction in use as a valid clinical outcome. That opens the door to more practical, real-world treatments.

A lot of patients I see aren’t ready to quit drinking entirely, but they are ready to reduce their use. And now we can design trials and evaluate medications around those goals. That shift, combined with the effectiveness and versatility of GLP-1 drugs, is why I think this moment is so exciting.

We’re not just talking about a promising treatment; we’re looking at a potential turning point in addiction psychiatry and public health.