GLP-1 Medications and Alcohol Use Disorder: What I'm Seeing in the Field
- Cindy Feinberg, CPC, CAI
- May 14
- 4 min read
By Cindy Feinberg, Founder of The Recovery Coach NY
GLP-1 medications have moved into the substance use field over the last year. Most people know them as Ozempic, Wegovy, and Mounjaro. They were brought to market for diabetes, then for weight loss, and then a quieter pattern began to emerge in the data. Patients on these medications were also reporting that their drinking had quieted down.
Not stopped. Quieted.
The mechanism, as it's been explained to me by addiction psychiatrists I trust, is that GLP-1 medications act on the same brain receptor that drives what people on these drugs call "food noise." That constant background hum of wanting to eat, wanting to snack, wanting to think about the next meal. The medication turns that volume down. And it turns out the same receptor is involved in the noise around alcohol.
When I went to a dinner last year hosted by the AAAP, the American Academy of Addiction Psychiatry, the entire evening was on GLP-1s and alcohol use disorder. The studies coming out of that group are astounding. So I want to share what I'm watching happen in my own practice, with the appropriate caveats.
The client who barely drinks anymore
I had a client for many, many years. She drank a bottle or two of wine a day for a long time. She smoked heavily. She lost a child as a consequence of her alcohol use. We did a lot of work together over those years.
About 18 months ago, her addiction psychiatrist put her on a GLP-1 medication. I was surprised because she's a very thin woman. The intent wasn't weight loss. The intent was the alcohol.
In a relatively short period, she was down to one margarita a day. Her appetite was barely affected. The thing the medication seemed to be doing for her was quieting the noise around alcohol the way it does for some people around food.
She is no longer my client. She doesn't need my services anymore. She's in a relationship she wasn't able to maintain when she was drinking the way she was drinking. She still hardly drinks today.
I am not a doctor. I'm not here to report on the pharmacology. I can only tell you what I watched happen in front of me, with one person, after years of trying many other things.
Why is this peptide connection meaningful, given what came before?
Until recently, the medication options for alcohol use disorder were limited, and most of them addressed the consequences rather than the desire.
Antabuse (disulfiram) makes someone violently ill if they drink on it. It doesn't quiet the wanting. It just makes the drinking miserable enough to stop. Some people respond to that. Many don't.
Naltrexone, used off-label, is more useful in this category. It's primarily approved for opioid use disorder, but the data and my own client experience suggest it does lower the desire to drink for some patients. Some people find that helpful.
What's different about GLP-1s is that the medication appears to be operating on the same neural circuitry that drives the wanting itself. Not making the person sick. Not blocking the reward after the fact. Just turning down the volume on the impulse before it gets loud. That is a very different mechanism, and it seems to apply beyond alcohol. There are studies looking at GLP-1s for gambling and other compulsive behaviors. We are early in the research, but the early signal is real.
The caveat I always give
I'm careful when I talk about this, because I don't want anyone to mishear me.
GLP-1 medications are not a substitute for the work.
When someone tells me they're starting one, I tell them: "This can help quiet the noise enough that you can finally do the work. But the work still has to happen."
Nobody started drinking the way you were drinking for no reason.
There was something underneath.
Trauma. Childhood. Loss. Anxiety.
Something the alcohol was managing for you.
The medication doesn't address any of that.
If a person uses a GLP-1 to stop the wanting, and never does therapy, never does the deeper work, never builds a sober community, what happens the day they're not on the medication? What happens if their insurance changes? What happens if their body adjusts and the noise comes back? They are right back where they started, with nothing built underneath.
Active addiction makes the work nearly impossible. You can't do trauma work with a brain that is preoccupied with its next drink. So the way I think about GLP-1s in this context is that they create a window. They quiet the addiction enough that the real work of recovery becomes accessible. Therapy. Coaching. Community. Medication for co-occurring conditions when appropriate. Whatever recovery looks like for that particular person, whether that's complete abstinence or harm reduction.
The medication gets them to a place where they can finally hear the message. Then they have to actually do something with it.
What this means for families and clinicians
If you're a family member watching someone you love struggle with alcohol use disorder and you've heard about GLP-1s, the right next conversation is with an addiction psychiatrist, not a general practitioner phoning in a prescription. The reason is not that the medication is dangerous. The reason is that the medication is one piece of a treatment plan that has to include the rest.
If you're a clinician already working with substance use, the AAAP and other professional bodies are publishing on this regularly. The data is moving fast. It's worth keeping up.
And if you are the person considering this for yourself, here's the honest version: the medication may give you the easiest first weeks or months of sobriety you've ever had.
Don't waste them.
Use that quiet to build the structure underneath you so that when the medication is no longer the thing that's holding you up, something else is. Something that you built; that is yours forever.
That's the conversation I have with every client.
Cindy Feinberg is the founder of The Recovery Coach NY. She has been continuously sober since 1986, founded her firm in 2009, and works closely with addiction psychiatrists in New York and nationally on team-based treatment for substance use and co-occurring mental health.
