Semaglutide in pill form shows promise for alcohol use disorder
STUDY: Schacht JP et al, American Journal of Psychiatry 2026
STUDY TYPE: Randomized, double-blind, placebo-controlled trial
FUNDING: National Institute on Alcohol Abuse and Alcoholism, National Center for Advancing Translational Sciences, Hewit Family Foundation, anonymous donor
Background
GLP-1 drugs like semaglutide (Ozempic) have a mix of positive and negative data in alcohol use disorder, but most of the research has involved non-treatment seeking populations, which often differ in their responses. This small trial delivers mixed results for an oral version of semaglutide in treatment-seeking patients.
The Study
- 50 adults with moderate to severe alcohol use disorder who were actively seeking treatment
- Randomized to oral semaglutide (3 mg for 4 weeks, then 7 mg for 4 weeks) or placebo for 8 weeks
- Primary outcome was craving after exposure to alcohol cues in the lab
Results
The primary outcome – craving measures in the labs – was negative:
However, most secondary outcomes were positive, and many of these reflect more important real-world variables.
Semaglutide cut heavy drinking days by more than half a day per week, and reduced drinks per drinking day, naturalistic craving (Penn Alcohol Craving Scale), and alcohol-related problems (PROMIS); but not drinking days per week.
More patients on semaglutide dropped down at least one World Health Organization drinking risk level (81% vs 54%). Effect sizes for drinking outcomes were medium to large, similar to what’s been seen with injectable semaglutide.
As a side finding, semaglutide also cut cannabis use days among the minority of patients who used cannabis.
Side Effects
Semaglutide was well tolerated.
Limitations
Only 50 patients randomized of 347 screened, suggesting the sample doesn’t represent reality. Nearly all overweight or obese, White. Sshort term, no lab-markers to test drinking levels. Placebo patients guessed their assignment more often than semaglutide patients did, suggesting partial unblinding.
Practice Implications
- A small study, negative on primary measures, is unlikely to convince skeptics, particularly as past trials have inconsistent results.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
