Quick Answer: Early clinical trials suggest GLP-1 medications may reduce cravings and use of alcohol and nicotine in some people, not just appetite for food, but this research is small, early, and not why the FDA approved these drugs. Semaglutide and tirzepatide are FDA-approved for weight management and type 2 diabetes, not for treating alcohol use disorder, nicotine addiction, or any other substance-use or behavioral-addiction diagnosis. Using a GLP-1 specifically to try to reduce a craving or addiction, rather than for an FDA-approved use, would be an off-label use that has not been evaluated or approved by the FDA.
Important: Compounded medications are not FDA-approved finished drug products. They are not equivalent to branded drugs like Wegovy, Ozempic, or Zepbound. Compounded GLP-1 medications differ in formulation, regulation, and approval status. Always consult a licensed healthcare provider.
The FDA has proposed excluding semaglutide, tirzepatide, and liraglutide from the 503B bulk compounding list, citing no identified clinical need. The public comment period, extended to July 30, 2026, has now closed. If finalized, this could affect the availability, pricing, and continuity of some compounded GLP-1 programs. We will update this page as the regulatory situation develops.
Why This Question Keeps Coming Up
People taking a GLP-1 for weight loss often report that more than their appetite for food changed. Some describe drinking less, losing interest in a nightly glass of wine, or finding cigarettes less appealing, without trying to change any of that. Researchers call the broader idea “food noise” reduction, or more precisely, reduced reward-driven wanting, and they have started testing directly whether it extends to alcohol and nicotine, not just food.
This is genuinely different from the food-and-cravings changes covered in how a GLP-1 changes food and inflammation. That page covers appetite, taste, and cooking habits. This one covers what the actual controlled trials say about alcohol, nicotine, and other substances, and where the evidence stops.
What Controlled Trials Have Actually Found
Two randomized controlled trials and one large observational study make up essentially all of the direct evidence, and they point the same direction without being large or definitive.
A Small Semaglutide Trial on Alcohol Use
Hendershot and colleagues published a phase 2 randomized controlled trial in JAMA Psychiatry (2025, volume 82, issue 4, pages 395 to 405) testing semaglutide, titrated from 0.25 mg to 1.0 mg over 9 weeks, in 48 adults with alcohol use disorder (71% female). Semaglutide significantly reduced lab-measured alcohol self-administration (beta -0.48, 95% CI -0.85 to -0.11, P=.01), peak breath alcohol concentration (P=.03), drinks per drinking day (P=.04), and weekly alcohol craving (P=.01), and predicted greater reductions in heavy drinking days over time relative to placebo (P=.04). Among participants who smoked, cigarettes per day also fell significantly (P=.005). Two measures did not reach statistical significance: average drinks per calendar day and total drinking days.
The authors describe this as a small proof-of-concept study, and the mixed results across endpoints, some significant, some not, are consistent with that framing. It is evidence that something is happening, not proof that semaglutide treats alcohol use disorder.
A Larger Semaglutide-Plus-Therapy Trial
A separate, larger randomized controlled trial published in The Lancet in 2026 (DOI 10.1016/S0140-6736(26)00305-3) tested semaglutide 2.4 mg combined with cognitive behavioral therapy against placebo plus the same therapy, over 26 weeks, in 108 participants (54 per arm) with alcohol use disorder. Heavy drinking days fell 41.1 percentage points in the semaglutide group versus 26.4 percentage points with placebo, a treatment difference of 13.7 percentage points (95% CI -22.0 to -5.4; P=.0015). Gastrointestinal side effects were reported as mild to moderate. This is a separate trial from the Hendershot study above and should not be confused with it; RangeYourself was unable to access the full primary paper directly (paywalled) and is reporting the numbers from a search-engine synthesis of the published abstract, which carries slightly lower confidence than a direct read of the paper itself.
A Large Observational Study Across Several Substances
Cai, Choi, Xie, and Al-Aly published a target-trial emulation in BMJ (2026, volume 392, article e086886) comparing roughly 606,434 veterans with type 2 diabetes who started either a GLP-1 or an SGLT2 inhibitor (a different diabetes drug class used as a comparison group). GLP-1 initiators had a lower rate of new alcohol use disorder diagnoses (hazard ratio 0.82), along with lower rates tied to cannabis (0.86), cocaine (0.80), nicotine (0.80), and opioid (0.75) diagnoses, and a lower composite substance-use-disorder rate (0.86). Among people with a pre-existing substance use disorder, the study found lower rates of overdose (0.61) and substance-use-disorder-related death (0.50).
This is an observational study, not a randomized trial: people were not randomly assigned to take a GLP-1, so the comparison groups could differ in ways the analysis did not fully capture, and it cannot prove the drug caused the difference the way a randomized trial can. It is also paywalled, so the confidence intervals behind these hazard ratios have not been independently confirmed by RangeYourself and should be treated as unconfirmed pending a direct read of the paper.
What Has Not Been Shown
Gambling and Shopping
Claims that GLP-1s reduce compulsive gambling or shopping circulate widely online, but no clinical trial or cohort study was found testing this. The most-cited source behind these claims, a piece by Playford and Deahl in QJM (2024, volume 117, issue 10, pages 693 to 694), is a commentary describing individuals who informally reported behavior changes, not a peer-reviewed case report or a study of patients. Treat this as an anecdote circulating in commentary and on social media, not as clinical evidence.
The Hedge-Fund Rumor
A version of this story claims investment funds are restricting exposure to junk-food and vice stocks because of GLP-1 drugs. No reputable reporting was found describing an actual fund policy change, across two independent searches. What does exist is ordinary sell-side stock analysis unrelated to any fund's actual holdings: a 2023 Barclays note on packaged-food and consumer-credit stocks (reported by Fortune) and 2026 Bernstein downgrades of packaged-food companies. If you see this claim stated as fact, it is an unconfirmed rumor with no reporting behind it.
Why This Might Be Happening
GLP-1 receptors are not limited to the gut and pancreas; they are also present in brain regions involved in reward processing. The leading hypothesis among the researchers behind these trials is that GLP-1 medications may reduce the rewarding or reinforcing pull of a substance the same general way they reduce food's pull, by acting on shared reward circuitry rather than through a mechanism specific to food. That is a hypothesis grounded in the trial results above, not an established mechanism, and it does not mean the drugs work identically across every substance or every person.
What This Means If You Are Already Taking a GLP-1
If you notice reduced interest in alcohol, nicotine, or another substance while on a GLP-1, that lines up with what these early trials describe, and it is not something to be alarmed by. It is not evidence that the medication is treating a diagnosed substance use disorder on its own, and it is not a reason to stop other treatment, counseling, or support you are already receiving for that purpose. If you have an alcohol, nicotine, or other substance use concern and are curious whether a GLP-1 could help as part of a treatment plan, that is a conversation for a prescriber or an addiction specialist, not something to pursue by adjusting a weight-loss prescription on your own.
Do not stop, start, split, or change a GLP-1 dose to try to produce or test this effect. Dosing decisions belong with your prescriber.
Frequently Asked Questions
Are GLP-1 medications FDA-approved to treat alcohol or nicotine addiction?
No. Semaglutide and tirzepatide are FDA-approved for chronic weight management and, in some formulations, type 2 diabetes. Using one specifically to address a craving or addiction would be an off-label use that has not been evaluated or approved by the FDA for that purpose.
Is there real research on GLP-1s and alcohol cravings?
Yes. A phase 2 randomized trial (Hendershot et al., JAMA Psychiatry 2025) and a separate, larger randomized trial (The Lancet, 2026) both found semaglutide reduced measures of alcohol use or heavy drinking days versus placebo. Both are described by their own authors as early-stage evidence, not proof the drug treats alcohol use disorder.
Do GLP-1s reduce gambling or shopping addiction?
There is no clinical trial or cohort study evidence for this. The claim traces back to a commentary describing informal reports, not a study of patients, and should be treated as anecdote rather than clinical evidence.
Is the research on GLP-1s and other substances like cocaine or opioids as strong as the alcohol research?
No, it is weaker. The main evidence there is one large observational study (BMJ, 2026) comparing outcomes in people who happened to be prescribed a GLP-1 versus a different diabetes drug. It found lower rates of several substance-use diagnoses, but because it is not a randomized trial, it cannot prove the GLP-1 caused the difference.
Should I ask my doctor about a GLP-1 for a craving or addiction issue?
If you have a genuine alcohol, nicotine, or other substance use concern, that is worth raising with a prescriber or an addiction specialist as part of an honest conversation about your options, including established addiction treatments. It is not a reason to start, stop, or adjust a GLP-1 on your own, and no program can guarantee this effect for any individual.
Will my cravings for alcohol or nicotine stay reduced if I stop the GLP-1?
This has not been studied directly in the trials above, which measured effects while participants were still on treatment. Based on how these medications behave with food-related appetite, it is plausible that some effect fades once the medication stops, but this is inference from a different, more heavily studied effect, not a direct finding about substance cravings specifically.
Sources: Hendershot CS, et al. Effects of Semaglutide on Alcohol Consumption and Craving. JAMA Psychiatry. 2025;82(4):395-405. The Lancet, 2026, DOI 10.1016/S0140-6736(26)00305-3 (abstract synthesis, primary paper paywalled). Cai Z, Choi C, Xie Y, Al-Aly Z. BMJ. 2026;392:e086886 (paywalled; hazard ratios from secondary sources, confidence intervals unconfirmed). Playford C, Deahl M. QJM. 2024;117(10):693-694 (commentary, not a case report). Accessed 2026-09-05 and 2026-09-15.
This article is for informational purposes only and is not medical advice. It does not describe an FDA-approved use of any medication. GLP-1 medications require medical evaluation and may not be appropriate for everyone. Always consult a licensed clinician before starting, stopping, or changing any medication, and before making decisions about alcohol, nicotine, or substance use.
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