The wonder drug that helps us drink less may already exist ...Middle East

Have you ever wondered why, despite your best intentions for clean living, you sometimes give in to temptation and pour that glass of wine?

One theory is that alcohol and recreational drugs can “hijack” the brain’s pathways designed to make sure we carry out evolutionarily essential behaviours, such as eating food and having sex.

This idea has been strengthened by growing evidence that weight-loss injections, currently exploding in popularity, may also help people cut down on booze.

Doctors are fascinated because this dual effect is shedding light on the brain pathways involved in destructive behaviour patterns, such as excessive drinking and drug use, as well as overeating.

People on slimming jabs often report a reduction in the amount of time they spend thinking about eating and craving their favourite snacks – it reduces their “food noise”.

A study out this week suggests these medicines also reduce “drug noise” or “booze noise”.

“It is possible that craving – that intense desire to consume something, whether it’s food or alcohol – that these things share a common biologic mechanism,” said Dr Ziyad Al-Aly, chief of research at VA Saint Louis Health Care System in Missouri.

While they might seem new, the drugs used in weight loss injections have been in use for 20 years, initially for type 2 diabetes, and then for obesity.

The drugs mimic a gut hormone normally released after eating called GLP-1. The first signs that they may be doing something else came from people using them who said they had less desire to drink alcohol or take drugs.

These claims were supported by surveys comparing drinking and drug use in people either using or not using the jabs. But these could have been biased by the fact that people who are able to afford the medicines may be more likely to have healthier lifestyles.

Impact of jabs on addiction

Now, one of the largest studies yet has confirmed the effect, by comparing people using the GLP-1 mimics to treat type 2 diabetes with those using a different diabetes medication.

It provides some of the strongest evidence so far that people taking the jabs to treat diabetes or obesity may also experience stronger control over addictive behaviours.

The study, which was published this week in the British Medical Journal, covered more than 600,000 US veterans who had been using either GLP-1s or an alternative diabetes drug for up to three years.

There were two findings. People on the GLP-1s who were already problematic drug or alcohol users had about half the risk of death due to their addiction and lower risks of other related harms, such as hospital admissions.

And in people who did not already have an addiction problem, GLP-1s cut the odds of them developing such a problem by 14 to 25 per cent, depending on the substance.

As well as being the largest study looking at this question, it is also one of the most comprehensive, showing a fall in use of all the major addictive substances – including alcohol, cannabis, cocaine and opioids such as heroin. People even smoked less.

This strengthens the idea that the GLP-1s are having a broad effect on addictive behaviours, in a similar way to how they reduce overeating.

People with gambling problems have even reported the slimming jabs have helped there too.

While the exact biological pathways are still unclear, GLP-1 drugs are known to not just act on the gut, but also cross from the blood to the brain. And there are GLP-1 receptors in the brain’s reward pathways.

The jabs are not yet licensed for treating addictions or just reducing alcohol use. But people are getting to hear about the early results and some doctors who are prescribing the medicines for weight loss report that patients are also keen to see if it helps them reduce their drinking.

“When GLP-1s are clinically indicated for cardiometabolic reasons, potential benefits for substance-related outcomes may be an added consideration,” Dr Fares Qeadan, a biostatistician at Loyola University Chicago, said in a BMJ editorial on the latest study.

Dr William Shanahan, a psychiatrist in London, said many doctors in the UK were already prescribing GLP-1s for dual use. “I’m giving it to people who want to lose weight and also want to reduce their drinking,” he said.

Of course, cutting down on booze is likely to also help with weight loss too. “Alcohol is a source of calories,” said Dr Shanahan. “A lot of my patients have beer bellies.”

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The drugs should not be seen as a magic bullet for alcoholism or addiction. They only reduce drinking and drug use, rather than completely stamp it out. And it is still unclear how people will fare long-term.

Many people choose to use the jabs as a short-term aid to weight loss and unfortunately they often see most of their weight return. It is unclear if the same rebound effect would happen with use of alcohol, said Dr Al-Aly.

Still, with such limited medical options currently available for addiction, the arrival of GLP-1s is the first good news in this field for some time. The surprising thing is, the most promising advance in addiction medicine in decades was a lucky break.

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