Study Review
A large body of evidence has been accumulating supporting the utility of the GLP-1 agents, originally developed for the treatment if type 2 diabetes and obesity, in treatment if Alcohol and possibly other Substance Use Disorders. A level 2 clinical trial has been published along with smaller human clinical trials. There are larger controlled clinical trials currently underway in alcohol, nicotine, and opiate use disorders.
This post reviews a study published in the British Medical Journal in May 2026.
The study was a review of electronic medical records (EMR) of 696,434 VA Medical Center patients undergoing treatment for type 2 diabetes with either a GLP-1 agonist or an SGLT2 agonist used as a control population.
Two groups of patients were identified. Those with no prior history of Substance Use Disorder (DSM-5) were followed for a period of 3 years. Outcomes were development of a SUD, alcohol, cannabis, opiods, nicotine, cocaine, or other during the study period.
A second group with prior history of SUD was studied by EMR for incidence of a major complication related to SUD. Complications consisted of ED visit, overdose, suicide attempt or ideation, hospital admission, or death related to SUD.
Outcomes were compared for relative risk in the GLP-1 vs control groups.
Group 1 risk comparison for development of an individual SUD with composite for all SUDs on the far right. The top represents decreased risk per 1000 patients in the GLP-1 groups. The bottom represents net risk per 1000 patients for the two groups.
Results show a decreased risk across all substances studied indicating a protective effect. This has not been evaluated in previous published studies.
Summary results for both groups shown as net risk difference over 1000 people and a hazard ratio plot.
Hazard ratios represent the risk of an occurrence at any point during the study time. Hazard ratio less than one is the decreased risk in the GLP-1 group for that event.
For example HR of 0.8 for cocaine represents 20% less chance of developing Cocaine use disorder in the GLP-1 treated group.
Notable is a preventative effect across all substances. Most studies to this point have focused on alcohol or nicotine use. The effects were incidental as patients were taking the medications for diabetes and retrospectively evaluated for SUD related outcomes. This indicates a more purely pharmacological driven effect and net protective benefit from GLP-1 treatment.
This post is a summary of a recently published report showing novel findings related to Substance Use Disorders in patients undergoing GLP-1 agonist treatment for other conditions, It compliments a growing body of evidence for benefits related to SUDs from this class of medications.
Additional information further describing GLP-1s in SUD can be found in previous posts here
Thank you for your time and interest in reviewing this post. Images and data obtained from sources freely available on the World Wide Web. For information and educational purposes only. No commercial or institutional interests. Comments and suggestions are always welcome.
References
New GLP
https://pmc.ncbi.nlm.nih.gov/articles/PMC12958796/
Cai M, Choi T, Xie Y, Al-Aly Z. Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: cohort study. BMJ. 2026 Mar 4;392:e086886. doi: 10.1136/bmj-2025-086886. PMID: 41781010; PMCID: PMC12958796.
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