The Addiction Psychologist Dr. Joseph Schacht - Can We Leverage GLP-1s for Substance Use Disorder?
Mar 11, 2026
Dr. Joseph Schacht, an addiction researcher and clinician-scientist, explores whether GLP-1 medications could alter substance use. He explains GLP-1 biology, drug development, and why these drugs might affect reward pathways. The conversation covers current human trial findings, safety and equity concerns, cost and access, and practical clinical questions about who might benefit and how to pair medications with behavioral care.
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Semaglutide Sparked The GLP-1 Boom
- Semaglutide (Wegovy/Ozempic) showed ~15% average weight loss after a year, driving massive clinical and public interest.
- That dramatic weight result shifted GLP-1s from diabetes niche drugs to mainstream obesity treatments.
Why People Suspect GLP-1s Reduce Drinking
- Anecdotes arose that people on GLP-1s reported reduced alcohol craving and consumption.
- Preclinical rodent studies already showed GLP-1 agonists reduce alcohol intake and motivation, suggesting shared reward pathways for food and alcohol.
Early Human Trials Show Mixed But Promising Results
- Human trials are early but promising: one small semaglutide trial (Hendershot) reduced drinks per day and heavy drinking with large effect sizes (~d=0.6–0.7).
- Other trials (exenatide negative overall, smoking cessation trial mixed) show mixed results; more large trials are pending.