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One of my favorite sayings is that there are no silver bullets in medicine. If someone claims that a single treatment can cure everything from cancer to shingles, it’s basically always a scam and they just want your money. While we have found amazingly effective treatments—antibiotics for tuberculosis, antiretroviral therapy for HIV—any given drug almost always works for just one disease, and they typically come with many trade-offs to boot.
But the more we find out about Ozempic and related drugs, the more it seems to be the first time that I’ve been proved wrong about there being no silver bullets.
We all know that Ozempic, a GLP-1 receptor agonist medication, also called semaglutide, causes weight loss. On average, high-dose semaglutides, like in Wegovy, cause people to lose somewhere around 15 percent of their body weight. Obviously, this has important benefits for things like diabetes, which is the main condition semaglutide was originally created to treat, and it unsurprisingly is useful for cardiovascular disease as well, which can be exacerbated by high blood sugar and excess weight. It was something of a surprise, but perhaps not completely unexpected, when researchers found that semaglutide reduced the risk of heart disease for people even if they did not have diabetes.
But the newest study that has gone viral is an even more impressive outcome. Headlines are claiming that researchers have shown that semaglutide causes people with alcohol use disorder to feel fewer cravings and actually drink less booze. If true, this could have massive implications for how we treat—and even view—that disease.
Does the study hold up to the hype? I think this is one of the rare cases where I’m almost as optimistic as the media reports.
The new study was a randomized clinical trial. The researchers divided people into two groups, one that got semaglutide in the standard doses, and another who got a placebo. The participants then spent 10 weeks taking their assigned medication, with the researchers looking at both self-reported and laboratory-controlled drinking during the study.
The results are impressive. The primary outcome measure was laboratory self-administration. This is a type of test where people come into a lab and are given specific amounts of alcohol in controlled settings and allowed to drink until they want to stop (or, for safety, when they reach a set blood alcohol concentration). In these settings, people taking semaglutide drank 30 grams less alcohol on average, which is around three shots of vodka.
At a glance, this seems quite impressive. There are currently three approved treatments for alcohol use disorder, and they come with a variety of trade-offs. Adding a fourth treatment that also has proven benefits for the heart and kidneys would be a pretty big win.
Of course, there are drawbacks to this study. The sample size was extremely small: The researchers tested the treatment in just 48 people. The study didn’t have enough people to accurately measure the drug’s ability to help with abstinence from alcohol, which is one of the most important outcomes when it comes to substance use disorders. It was also too short to have much certainty of the long-term impacts of semaglutide.
The new study is fascinating, but it may not be replicated in larger pieces of research. I don’t want to overstate the findings; this is still a very preliminary paper which may not stand up to larger samples on more focused outcomes. Semaglutide also has well-known downsides which have to be taken into account whenever anyone uses the medication. There’s always some bad to go along with the good when it comes to health care interventions.
That being said, the findings are still remarkable because there just doesn’t seem to be anything that semaglutide doesn’t treat. It’s not any one study that makes semaglutide appear to be a silver bullet—it’s an entire constellation of research showing various ways in which it might help. It even reduces all-cause mortality for people who are obese but don’t have diabetes. I’ve recently worked with a team on a study showing that it may reduce blindness and other eye problems even in people who don’t have diabetes. And no, I didn’t receive money from a drug company for that work, or to say all this nice stuff.
We don’t know exactly why semaglutide would reduce alcohol cravings, much like we aren’t entirely sure why it stops people without diabetes from dying. It’s possible this is related to the complex interplay of the hormones that semaglutide and similar drugs act on. It’s also possible—perhaps even likely—that all of this is simply the result of weight loss. We know that drinking alcohol is associated with weight gain in a complex way, and it’s possible that simply losing weight could be helping people with their alcohol use. And again, it’s possible that this finding simply goes away when a larger pool of people are studied.
But it does seem like semaglutide is a pretty amazing medication that helps us in ways beyond weight loss that we are still figuring out. I still have to issue a big caveat: All of the promising data on those extra benefits may be noise. I may have to one day eat my words—that’s always true, to some extent, in science. But at the moment it looks like semaglutide—and related medications like tirzepatide and retatrutide— have some really cool benefits for people who take it.
