Dr. Paul was recently interviewed by Insider Magazine regarding his expertise related to managing alcohol use disorder AND obesity. There has been a lot of research and new studies regarding semaglutide and how people are unintentionally drinking less while treated on this medication for obesity. Find the original article here: https://www.insider.com/semaglutide-alcohol-addiction-alcoholism-treatment-weight-loss-drug-2022-10 or read below…
A man who lost 80 pounds on a ‘game changer’ weight-loss drug also lost his desire to drink alcohol. Experts say the drug could be a treatment for addiction.
When Erin Bradley McAleer used to attend work-related sporting events and mixers, he’d throw back eight to 10 beers “almost religiously.”
“If I had one, I had eight,” McAleer, a 43-year-old criminal-defense attorney in Washington state, told Insider. At 6 feet tall and 320 pounds, he could hold his liquor.
But for roughly the past year, McAleer has stopped at two or three drinks — if he attends the gatherings at all. These days, going to the gym or spending time with his family is often more appealing.
McAleer didn’t outgrow the habit, or commit to reducing his intake, or suffer an embarrassing drinking-related incident. So what changed?
McAleer said he now lacks a physical desire for alcohol — which he believes is an unintentional, though not unwelcome, side effect of the weight-loss drug semaglutide and other, similar drugs.
Since he started taking the drugs in the fall of 2021, “I’m just not interested anymore after a couple of beers,” McAleer said. “I’ve never had that before.”
McAleer is not the only patient reporting a significant reduction in alcohol consumption after starting semaglutide. One Reddit user wrote that they used to drink two to three drinks a night, but taking semaglutide was “like a light switch.” They’ve had three drinks in three months. “No buzz, no enjoyment,” they wrote. “So I’m a non-drinker now, I guess.”
“I was always confused when I would see people taking all night to finish one drink,” another poster added. “Now I can totally relate.”
While more research is needed on the drug’s potential use as a treatment for alcohol-use disorder, it “could be the next big thing in addiction management, certainly related to alcohol,” Dr. Paul Kolodzik, a metabolic specialist in Ohio who’s also board-certified in addiction medicine, told Insider.
McAleer sought to lose weight after an “eye stroke” threatened to leave him fully or partially blind
Semaglutide, sold under the brand names Wegovy and Ozempic, is an injectable drug that boosts the production of insulin, a hormone that helps regulate blood sugar. While both drugs were originally intended to help manage diabetes, Wegovy was also approved as a weight-loss drug in June 2021.
Some obesity-medicine experts have called the drug a “game changer.” Research has found it can lead to a 15% to 20% reduction in body weight over 68 weeks.
McAleer discovered the drug after a health scare in late summer 2021. After waking up one morning with partial vision in one eye, he was diagnosed with an “eye stroke.” The condition occurs when there’s not enough blood flow to the tissues around the optic nerve and is often a sign of poor vascular health.
If McAleer didn’t lose weight, his doctor told him, he risked going blind. That was “a wake-up call,” said McAleer, who had yo-yo dieted for a few years but always gained the weight back.
So McAleer talked to a doctor friend who recommended he try Saxenda, a brand of liraglutide, a weight-loss injectable in the same drug class as semaglutide. McAleer bought the drug directly from his friend, and soon after switched to Ozempic, since he could buy it on his frequent visits to Mexico, where it’s cheaper. Since he began taking the drugs, he’s lost over 80 pounds.
While McAleer was pleased to see his weight going down and blood work improving, he was “a bit irritated” at first to discover his interest in alcohol wane. Basketball games with chatty associates required a low-level buzz, he thought. But he’s has come to appreciate his alcohol-reduced life.
“It allowed me to recognize that a lot of these events are fun without a buzz, it just depended who I was with,” he said.
The drug affects the reward center in the brain
Kolodzik told Insider that some of his weight-loss patients say they no longer experience alcohol cravings while on semaglutide. A similar phenomenon has been demonstrated in rat studies, too.
There are a few possible reasons why. Drugs like semaglutide, called GLP-1 receptor agonists, “increase satiety, both in your stomach and in your head,” Kolodzik said. That can suppress alcohol cravings as well as food cravings.
The drugs also affect the brain’s reward circuit, dulling the dopamine hit someone might otherwise get from a greasy french fry, hot fudge sundae, or dirty martini, Dr. Joseph Volpicelli, a psychiatrist and addiction-medication researcher in Plymouth Meeting, Pennsylvania, told Insider.
“Things that are pleasurable are no longer so pleasurable,” he said.
There’s not enough research yet in humans for the FDA to approve semaglutide as a treatment for alcohol-use disorder. The only double-blind, placebo-controlled trial — the most rigorous research design — didn’t find a significant reduction in the number of heavy drinking days in addiction patients on an GLP-1 receptor agonist versus those on a placebo.
But it did show the drug stifled the brain’s response to alcohol cues, which can translate to fewer cravings. It also found the GLP-1 agonists worked best to reduce alcohol intake in overweight patients, “so there may be certain subgroups that it’s helpful for,” Volpicelli, who wasn’t involved in the study, said.
Another subgroup that might benefit most, Volpicelli suspects, could be those with moderate forms of alcohol-use disorder. They tend to drink more for the buzz and less for the relief from withdrawal, as longer-term heavy drinkers do. The study didn’t differentiate between the two groups, which could have made the results less pronounced.
“I suspect there were some people who, even if they weren’t getting the high from alcohol drinking, the alcohol was still effective in taking away some of those withdrawal symptoms,” he said. “So that’s why they continued to drink.”
Volpicelli says the potential of semaglutide in addiction medicine is “really exciting,” but “we have to do more research, and we have to design the study right.”
Meanwhile, he says naltrexone, a drug that similarly blunts alcohol’s feel-good effects, is FDA-approved and effective. “We already have something out there,” Volpicelli said, “so I would try that first.”
Some doctors don’t want to wait for the research
Kolodzik said he has the evidence he needs to feel comfortable prescribing semaglutide to some patients in his addiction-medicine practice.
He said that one patient, who was originally drinking about 45 drinks a week, had cut her consumption in half by taking naltrexone on the days she drank. When Kolodzik introduced semaglutide, he said her weekly drinks plunged to three to five.
“The way that patients describe this is, ‘Alcohol used to be the focus of my day, and now I’m just kind of disinterested,'” Kolodzik said.
Still, the drug is not a magic bullet. It’s expensive and not covered by insurance if you don’t fit certain criteria, like having diabetes in the case of Ozempic. It also can have side effects like nausea and diarrhea.
And you can’t just inject it and forget it, Kolodzik said. Just like weight-loss patients need to follow a diet and exercise plan for semaglutide to be most effective, alcohol patients should take the drug as a part of a comprehensive treatment plan that could also include therapy and apps that help track their intake.
But in Kolodzik’s view, the harms of alcohol abuse outweigh the potential harms of off-label semaglutide use.
“Medicine changes very slowly,” Kolodzik said, “but there are people out there like me who think that if you’re doing no harm, there’s no reason not to try this.”
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