Balance Is Key

This realization about semaglutide has been a long time coming, although it has been hinted at for a while. And quite a realization it is. In a field where few treatments really grab on and take hold, here is a substance that works for roughly half the people who use it for that purpose:
People taking semaglutide had 50% to 56% decreased odds of either becoming alcoholic or relapsing into alcoholism, researchers reported recently in the journal Nature Communications.
Dennis Thompson interviewed sources who call the GLP-1 drug a “much-needed extra option.” Semaglutide and its family could be the hot new therapeutic method for the treatment of AUD (alcohol use disorder). This hope is based on a meta-analysis that utilized the records of “nearly 84,000 patients with obesity, as well as about 600,000 patients with type 2 diabetes.” That’s a lot of bodies and a lot of information.
In both sets of data, researchers found consistent reductions in alcoholism among people treated with semaglutide.
Other recent news, from the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and The Scripps Research Institute, confirms that semaglutide reduces alcohol consumption and binge-like drinking in a rodent model of alcohol misuse, and that “GLP-1 receptor agonists show potential for treating people with alcohol use disorder.”
The same parts of the brain that dictate people’s eating habits “overlap extensively” with the parts that like to drink alcohol, and semaglutide has shown itself to be more adept at curbing abuse than other GLP-1 receptor agonists. And, it works equally well for male and female mice and rats.
For AddictionNews, Steve O’Keefe has been following since last year the quest to apply semaglutides like Ozempic to alcoholism, nicotine, and drug addiction.
One big problem has been that “Formulating drugs that have the desired effects of weight loss without harsh or dangerous side effects is a monumentally difficult task.” Again, in “Does Ozempic Cause Weight Loss By Making People Sick?,” he wrote, “Anecdotal evidence suggests that taking GLP-1 agonists such as Ozempic and Wegovy, causes weight loss by generating a continuous level of sub-clinical nausea.” In other words, to borrow terminology from the cyber world, it seems that the harshness might be not a bug, but a feature.
He related how journalist Johann Hari had used GLP-1 drugs for months and kept a meticulous diary of side effects in order to write a book about the experience. That experience included both a 42-pound weight loss and a constant temptation to give up the experiment because of the psychological side effects.
Many people who have elected to use these drugs just for weight loss have struggled with the physical side effects. In one study, the nausea and gastrointestinal tract misery caused more than half the subjects to quit. Some were simply not losing enough weight to make it worth the pain, while around one-fifth found the side effects to be intolerable in any case.
Another category of patients, however, has less choice in the matter. In a GLP-1 study with more than 700 type 2 diabetes patients, about a third dropped out, half of them citing an inability to tolerate the adverse gastrointestinal effects.
In another post, O’Keefe speculates about why the pharmaceutical industry has not eagerly co-opted the potential miracle that GLP-1 drugs hold out the promise of becoming. After all, they impact the reward pathways for food, alcohol, and addictive drugs. They ease withdrawal symptoms. Even setting aside the illegal addictive substances and considering only nicotine and alcohol, it would seem like a golden opportunity.
But then, there is the intestinal distress, a drawback serious enough to cause so many experimental subjects to disqualify themselves from the trials. Apparently, the secret to unlocking the full potential benefits of GLP-1 drugs in the addiction field must lie in making a person just sick enough to quit his original substance, but not sick enough to quit the GLP-1.
As with so many areas of life, the key seems to be balance. It’s Goldilocks and the Three Bears all over again. One bowl of porridge is too hot and one bowl is too cold and thank goodness, the temperature of one bowl is just right.
Written by Pat Hartman. First published July 5, 2024.
Sources:
“Another Study Suggests GLP-1 Meds Could Ease Alcoholism,” USNews.com, July 2, 2024.
“Semaglutide shows promise as a potential alcohol use disorder medication,” NIH.gov, March 13, 2024.
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