In my previous post on AddictionNews, I began summarizing a deep dive in The New Yorker by Dr. Dhruv Khullar, a professor at the Weill Cornell Medical College, concerning the use of GLP-1 drugs such as Ozempic, Wegovy, Mounjaro, and Zepbound for the treatment of substance use disorders (SUDs).

In the first half of his article, Dr. Khullar visits the laboratory at the University of Colorado Anschutz, where Dr. Joseph Schacht uses fMRI to examine the brains of people with alcohol use disorder (AUD) who are being treated with GLP-1 drugs. Their “fire in the brain” — the alcohol noise, like food noise — subsides. The brain quiets. The usual cues don’t light it up like before.

This might be the physical confirmation of the phenomenon of displacement: a literal buildup of energy in the brain that is looking for an outlet in order to alleviate stress. With drug addiction, the stress can be caused by abstinence from the drug. When a behavior or substance is used to dissipate that unease, it can become habit-forming.

In an interview on The Brian Lehrer Show, Dr. Khullar describes addiction as a battle of first-order desires vs. second-order desires. The first-order desires are the hedonic pleasure or relief that comes from indulgence. The second-order desires are the wish not to indulge or not to be addicted. The battle between these two is a classic stress generator that drives the “fire in the brain,” the need for displacement.

In the second half of his survey in The New Yorker, Dr. Khullar posits GLP-1 as a “moderation molecule,” something that dampens desire for everything. He asks:

Maybe some people who take GLP-1s lose interest in drugs and alcohol because they lose interest in everything.

He turns to anecdotal evidence again: A woman who loses her interest in gardening, along with her appetite for food, while using GLP-1 drugs for weight loss. Other users report a loss of interest in sex, a lack of enjoyment with family, and a loss of optimism about the day ahead. As to whether GLP-1 drugs increase suicidal ideation, the research shows yes, they do, and no, they don’t.

Dr. Khullar interviews Dr. Kent Berridge, a professor of psychiatry and neuroscience at the University of Michigan, who refers to GLP-1 drugs as “dopamine limiters.” Mice on GLP-1 drugs experience smaller dopamine surges from cocaine than mice not using the drugs.

Dr. Khullar then visits Dr. Patricia “Sue” Grigson-Kennedy, director of the Addiction Center for Translation at Penn State’s College of Medicine. Dr.  Grigson-Kennedy is also conducting research with rats on GLP-1 drugs and addiction. She has found that not only do GLP-1 drugs make using fentanyl less pleasurable, but they also decrease the pain of withdrawal.

This led to a trial with human participants from a residential addiction treatment center. Ten patients received a placebo, 10 received liraglutide. The group receiving the GLP-1 drug reported 45% less cravings. This has led to a trial involving hundreds of people in outpatient addiction treatment programs receiving GLP-1 drugs.

One reason GLP-1 drugs are so effective for weight loss, notes Dr. Khullar, is that your hunger does not increase even as the weight comes off. Normally, abstinence is a struggle, but GLP-1 drugs seem to take the effort out of moderation. “GLP-1s are doing something kind of more fundamental to our reward system,” he told Brian Lehrer.

While the anecdotal evidence is great and the clinical evidence is starting to mount, Dr. Khullar recommends a cautious approach to using GLP-1 drugs for addiction treatment. He notes in particular that:

• More than half the people prescribed GLP-1 drugs stop taking them, either due to side effects or cost or both.

• The cravings come back within a few months of ceasing GLP-1 drugs. So the noise may get quiet, but it’s still there under the surface.

• There are virtually no long-term studies on the impacts of taking GLP-1 drugs, and only recently have researchers started tracking the effects on sex drive, birth rate, divorce, or other lifestyle changes impacted by the lack of desire.

Is semaglutide a miracle moderation molecule, or does it succeed by making life less interesting? Stay tuned to AddictionNews, your source for timely reporting on GLP-1 drugs and addiction.

Written by Steve O’Keefe. First published March 2, 2026.

Sources:

“Can Ozempic Cure Addiction?,” The New Yorker, February 9, 2026.

“What GLP-1s Know About Addiction,” The Brian Lehrer Show, WNYC, February 17, 2026.

Image Copyright: epidemiks.