Published Mar 19, 2026 | 7:00 AM ⚊ Updated Mar 19, 2026 | 7:00 AM
Representational image. Credit: iStock
Synopsis: A new BMJ study on US veterans with type 2 diabetes suggests GLP-1 drugs may lower risks of developing or worsening substance use disorders across alcohol, nicotine, opioids, and more. Indian doctors find the biology compelling but caution that evidence is observational, population-specific, and far from clinical use. Experts stress randomised trials are needed before considering GLP-1s for de-addiction.
After gaining prominence for weight loss and later for their potential benefits for the heart, gut, liver and kidneys, GLP-1 drugs are now being discussed for yet another possible role: reducing addiction. But for doctors in India, the key question is whether the evidence is strong enough for these drugs to be considered anywhere close to clinical use in de-addiction care.
A new study published in The BMJ has given this conversation fresh attention. Researchers looked at US veterans with type 2 diabetes and found that those taking GLP-1 drugs seemed less likely to develop substance use disorders.
Among those who already had addiction-related problems, the drugs were also linked to fewer serious complications. What stood out was that this pattern was seen across several substances, including alcohol, cannabis, cocaine, nicotine and opioids, making doctors and researchers take notice.
The researchers did not give people the drug in a fresh experiment. Instead, they used existing health records from U.S. veterans with type 2 diabetes and tried to make that data behave as much like a real clinical trial as possible. They took two groups of patients: one group had started GLP-1 drugs and the other had started SGLT-2 inhibitors which are also diabetes medicines used for somewhat similar metabolic reasons. This comparison is important because they were not comparing GLP-1 users to “no treatment” patients, but to people taking another proper diabetes drug. Then they looked at two broad situations.
In the first group, they looked at people who did not already have a substance use disorder at the beginning. They asked: over the next three years, were people starting GLP-1 drugs less likely to newly develop problems with alcohol, nicotine, opioids, cannabis, cocaine, or other substances?
In the second group, they looked at people who already had a substance use disorder. Here the question was different: if these patients started a GLP-1 drug, were they less likely over the next three years to have serious addiction-related problems such as emergency visits, hospital admissions, overdose, suicidal thoughts or attempts, or death?
The researchers also tried to reduce bias by adjusting for many differences between patients, such as health background and other factors that could affect who gets which drug. They found that people who started GLP-1 drugs seemed to have fewer substance-related problems than those who started the other diabetes drug class. This was seen both in people who had no addiction diagnosis to begin with and in people who already had one.
The study also warns that the findings may not apply equally to everyone, because the study population was mainly older male U.S. veterans, so we cannot assume the same results in women, younger people, Indians, or people without diabetes.
Speaking to South First, “This VA study is a notably strong real-world signal that GLP-1 drugs might be linked to lower risk of developing substance use disorders and fewer severe addiction-related outcomes among people who already have them,” said Dr Alok Kulkarni, Senior Consultant Psychiatrist and De-addiction Expert, Manas Institute of Mental Health, Hubballi.
“What stands out is signals across alcohol, nicotine, opioids and other substances which fits with a plausible biology: GLP-1 receptors are present in brain circuits involved in reward and craving,” he added.
But, Dr Kulakarni cautioned, “It’s crucial not to over-interpret this as proof that these medications ‘treat addiction.’ The analysis is observational, based on electronic health records, so unmeasured differences between patients, who gets prescribed what, how closely they’re followed, what’s documented can still drive part of the association.”
Because the study population consisted of U.S. veterans with type 2 diabetes, “largely older and male,” Kulkarni said doctors should also be careful about generalising the findings to younger people, women, or those without diabetes.
That caution is echoed by endocrinologists watching the GLP-1 boom unfold in India.
“Some people are even claiming that they might help in certain forms of dementia. But it is too early to comment on that because we do not have concrete evidence yet,” said Dr E Ravi Shaker, Consultant Endocrinologist, Apollo Hospitals, Jubilee Hills.
Meanwhile “There are also reports suggesting they may help reduce addiction in some patients. But I would not like to comment much on that right now, because these drugs are not licensed for such indications yet and we should avoid sending the wrong signals to people. What is clear today is that awareness about these drugs has increased significantly and more people are now looking at them in one way or another,”
That last point may be especially relevant in India, where public curiosity around semaglutide and tirzepatide has far outpaced scientific literacy around what these drugs are actually approved to do. As awareness grows, so does the risk of indication creep, a situation in which medicines meant for diabetes or obesity begin to be seen as answers for a widening list of problems long before evidence is strong enough.
At the clinic level, some doctors say they are nowhere near ready to use GLP-1s as part of de-addiction care.
“I have not been using it yet in my clinic. It is still in the research stage and we need more data and evidence that it will work for de-addiction,” said Dr Mahesh Gowda, Psychiatrist, owner of Spandana Hospitals. “I only insist on lifestyle changes and psychiatric medicines if need be,”
What makes the GLP-1-addiction link scientifically compelling is not just the statistics, but the biology behind them. Researchers say GLP-1 receptors are found in the brain’s mesolimbic reward system, which is involved in motivation, reinforcement and craving.
That has led to a theory that these medicines may help quiet the “noise” in the brain that drives compulsive reward-seeking–whether that reward comes from food, alcohol, nicotine or other substances.
Still, even researchers leading this work have stopped far short of calling GLP-1s addiction treatment. The BMJ paper was observational, meaning it can only show association, not causation.
There is some early trial evidence, but it is still limited. A 2025 randomised clinical trial published in JAMA Psychiatry found that semaglutide reduced alcohol craving and some drinking outcomes in adults with alcohol use disorder, supporting the idea that the addiction signal may be real. But that trial was small, focused on alcohol, and its authors themselves said larger clinical trials are needed before GLP-1 drugs can be considered for routine use in addiction care.
That is why Indian experts say the real story is not that Ozempic-like drugs have become de-addiction medicines overnight. It is that they may be revealing something deeper about addiction itself– that very different substances might share parts of a common biological pathway linked to reward and craving.
For now, though, the clinical message remains conservative. If a patient already has clear metabolic indications for a GLP-1 drug, any possible benefit on substance-related outcomes may be an added point of interest. But that is a very different proposition from prescribing the drugs specifically for alcohol dependence, nicotine addiction or opioid use disorder.
Dr Kulkarni added, “For now, I’d frame this as hypothesis-generating evidence, not a reason to replace established addiction care.”
He said the next step should be randomised trials in specific disorders. Until then, Indian doctors say GLP-1 drugs should be viewed not as a magic bullet for addiction, but as an intriguing lead that needs far more testing before it reaches everyday practice.
