Newer GLP-1 Therapies Linked to Fewer Alcohol-Related Hospitalizations in Adults With AUD

Adults with alcohol use disorder (AUD) who initiated semaglutide or tirzepatide for type 2 diabetes or obesity experienced fewer alcohol-related emergency department visits and hospitalizations than patients initiating several comparator medications, according to findings published in BMJ Open.¹

The retrospective study included 40 703 adults with documented AUD and either type 2 diabetes or obesity. Researchers used electronic health record data to emulate 4 target trials comparing newer glucagon-like peptide-1 (GLP-1)–based therapies with medications for diabetes, obesity, or AUD.

Although the findings add to growing interest in incretin-based therapies for addictive disorders, the investigators emphasized that the observational results do not establish that semaglutide or tirzepatide treats AUD.

Limited pharmacologic options for AUD

Pharmacologic treatment for AUD has changed relatively little during the past several decades. Disulfiram became the first medication used for the condition in 1949, followed by oral naltrexone in 1994 and acamprosate in 2004. These remain the 3 medications approved by the US Food and Drug Administration for AUD.²

The need for additional treatment options remains substantial. The average annual number of US deaths attributable to excessive alcohol use increased 29.3%, from 137,927 during 2016-2017 to 178,307 during 2020-2021, according to the Centers for Disease Control and Prevention.³

Interest in GLP-1 receptor agonists emerged initially from preclinical findings and patient reports of reduced alcohol consumption. More recently, a small randomized phase 2 trial found that once-weekly semaglutide reduced alcohol craving and some measures of alcohol consumption among adults with AUD.⁴ A nationwide Swedish cohort study also associated semaglutide use with fewer AUD-related hospitalizations (adjusted hazard ratio [HR], 0.64; 95% CI, 0.50-0.83).⁵

Study design and findings

For the current analysis, investigators used data from 30 US health systems to identify adults with AUD who initiated treatment between January 1, 2018, and December 31, 2024. Semaglutide and tirzepatide were classified as newer GLP-1–based therapies.¹

The primary outcome was time to a first alcohol-related emergency department visit or hospitalization during the year after treatment initiation. Propensity-score methods and inverse-probability censoring weights were used to balance measured differences between treatment groups.¹

Among participants with type 2 diabetes, the estimated 1-year alcohol-related event rate was 11.9% with a newer GLP-1 therapy, compared with 14.6% with a sulfonylurea and 14.0% with another diabetes medication. Newer GLP-1 therapy was associated with a lower event hazard compared with sulfonylureas (HR, 0.74; 95% CI, 0.62-0.89) and other diabetes medications (HR, 0.78; 95% CI, 0.65-0.92).¹

Among adults receiving pharmacotherapy for obesity, the corresponding event rate was 10.1% with semaglutide or tirzepatide and 12.8% with another antiobesity medication (HR, 0.68; 95% CI, 0.54-0.85).¹

The investigators did not observe significant differences when newer therapies were compared with older GLP-1 receptor agonists in either the diabetes cohort (HR, 1.09; 95% CI, 0.87-1.37) or obesity cohort (HR, 1.12; 95% CI, 0.76-1.66).¹

Larger associations were observed in analyses comparing semaglutide or tirzepatide with acamprosate, disulfiram, or naltrexone. Among matched adults with type 2 diabetes, the estimated event rates were 13.5% with a newer GLP-1 therapy and 31.4% with an AUD medication (HR, 0.37; 95% CI, 0.29-0.46). Among matched adults with obesity, the rates were 8.0% and 20.4%, respectively (HR, 0.35; 95% CI, 0.26-0.47).¹

Findings require cautious interpretation

Residual confounding was most evident in the comparisons with AUD medications. In those analyses, semaglutide and tirzepatide were also associated with fewer hospitalizations unrelated to alcohol, suggesting that differences in socioeconomic status, baseline clinical stability, AUD severity, medication access, or engagement with health care may have influenced the results.¹

AUD and alcohol-related outcomes may also have been underdocumented because of stigma, inconsistent diagnostic coding, and incomplete laboratory testing. Treatment discontinuation was common, particularly among patients receiving established AUD medications, further increasing the potential for selection bias.¹

The study was funded by Truveta, and several authors disclosed current or former employment with the company. One author reported current employment with Eli Lilly, although the research was conducted before that employment began.¹

The authors stated that the findings “may suggest a potential role for GLP-1 receptor agonists in the context of alcohol-use disorder.” Randomized clinical trials will be needed before semaglutide or tirzepatide can be considered treatments for AUD.¹

References:

1. Rodriguez PJ, Lusk JB, Mehta HB, et al. Association between GLP-1 receptor agonists and alcohol-related hospitalisations among adults with alcohol use disorder: multi-target trial emulation study. BMJ Open. 2026;16:e109259. doi:10.1136/bmjopen-2025-109259
2. National Institute on Alcohol Abuse and Alcoholism. Medications Development Program. Accessed July 21, 2026. https://www.niaaa.nih.gov/medications-development-program
3. Esser MB, Sherk A, Liu Y, et al. Deaths from excessive alcohol use—United States, 2016-2021. MMWR Morb Mortal Wkly Rep. 2024;73(8):154-161. doi:10.15585/mmwr.mm7308a1
4. Hendershot CS, Bremmer MP, Paladino MB, et al. Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry. 2025;82(4):395-405. doi:10.1001/jamapsychiatry.2024.4789
5. Lähteenvuo M, Tiihonen J, Solismaa A, et al. Repurposing semaglutide and liraglutide for alcohol use disorder. JAMA Psychiatry. 2025;82(1):94-98. doi:10.1001/jamapsychiatry.2024.3599