Semaglutide treatment associated with high reduction in Alcohol Use Disorder | Hacker News Reader

Semaglutide treatment associated with high reduction in Alcohol Use Disorder

eurekalert.org

51 pointsbelltaco57 comments

This is pretty interesting, but for anyone who is on semaglutide maybe not a huge surprise? At least in my experience with semaglutide, everything I consume I need less of and I feel way less desire for things.

I am not a big sweet eater, but usually enjoy a decent sized chunk of dark chocolate about every other day. I still have roughly the same cadence of wanting a piece, but the difference now a single square is enough and I don't feel the need for more. It isn't like the desire for things like sugar, fat, etc is gone, it is more like I am just wayyy better at knowing how much of that I need.

I have been on semaglutide for ~2 months and it has honestly been wonderful for me. I have described it as being the drug that helps my brain stop acting like we live in times of famine and has massively improved my relationship with food.

It really is just a shame that it is so cost prohibitive as I genuinely think that it probably could do a ton to reduce healthcare and impact of food overproduction (I eat so much less meat and I have heard some from others), but I don't think that will happen unless insurance starts covering it

I've never tried it. Can I ask a follow up question?

Do you feel less need of other "wants" as well? money, ambition, power, sex drive? Things in this vein.

Sorry if I'm being awkward but I'm genuinely curious.

No, it’s only food-related. Basically you feel hunger less. It’s easier to implement good diet. Obviously you need to eat healthy to get benefits from semiglutide.

Obviously you dont. Just the reduction of caloric intake and as a result, a reduction in body fat, is gonna lead to health benefits.

I’m taking it, and it’s still trivial to overeat with calorie-dense food. It’s just easier to control impulse to do so.

My point is you only need to eat LESS to be healthier if you are overweight. Ofcourse the best results are achieved when actually eating healthy... But still

Can confirm what the other poster said - it only affects the desire for food and food-related items.

It is absolutely amazing. Before I was basically always hungry, even right after a big meal that left the stomach physically full, the thought of "eh, maybe more food?" was in the back of my mind. Now it's not there and even a small portion makes me feel full.

If anything, the weight loss has made me feel so much better that I have more energy to work on other goals, it definitely hasn't stopped desire for sex or money or success.

I had the same question. Because it could have been that it reduces desires in general, like invoking a slight depression where you just don't care about things, including addictions. Then again, things like depression are likely to increase the desire for dopamine triggers.

Nope, not found that. It's been entirely food-related for me, although I did recently kick my nicotine gum habit without too much issue.

Compound itself is not that expensive. US prices are crazy as usual. In other countries it’s $300 for the month. In US you can buy off-brand semiglutide online for $300-$400 for the month as well.

"off brand" and "online" for something that I'm going to consume (or inject?) sounds pretty scary to me! I don't buy even simple recipe ingredients on Amazon.

Over here doctors are required to write the prescription for generic (off-brand) versions of medication if available. This was introduced to counter promotions to the medical professionals by pharmaceutical companies.

The generics have the exact same active compounds and are regulated exactly the same.

I do not think Amazon or any other non-Pharmacy can legally fill prescriptions for medicines here, brand or generic.

Semiglutide is patented by Novo Nordisk, so in this case it’s not even clear where this online off-brand semiglutide comes from. I.e. it’s not legally produced as generic yet.

Is semaglutide itself patented, or is it the pen/delivery mechanism? The online sellers provide vials of semaglutide that need to be reconstituted and then drawn up / injected like insulin or other vial-based peptides. I assumed this is legal and possible because the patent is actually on the pen and not the peptide itself. But I haven't been able to confirm that one way or another. Even if that is the case, the ease of use is no doubt to me a huge part of the reason it has been so successful. I don't think it would have seen such widespread use if it were only available in vials.

Novo Nordisk is buying sacks of API from Chinese and Indian factories like everybody else.

It's on the FDA drug shortage list, that allows compounding pharmacies to sell it off brand.

This is illustration of real vs US healthcare prices, not call to action to buy off-brand online medicine.

To save money realistic options in US: if paying with insurance Novo Novordisk has some rebate system. And if paying out of pocket - buy in Canada.

In EU we consider 300$ a month for a drug expensive.

What are the drawbacks of taking this? I saw the point about price, but if it was cheap enough to not be a factor, is there a reason why everybody wouldn't be on it?

Availability, price, some people get unpleasant side-effects. There are newer and better versions available, and more coming out soon. The whole field is relatively new.

It can affect other medications and anesthesia due to how it slows your body's intake of... everything? For example, my wife who takes wegovy and ADHD medication had to switch from an extended release stimulant to a regular immediate release one, which now acts like an extended release due to the interaction.

Anesthesiologists need to know about semaglutide usage because it makes the period you need to fast before going under a lot longer

There are apparently 40 million prescriptions in the US alone. There'd be more if not for the shortages and price.

I’ve been having a very similar experience with chromium supplementation (which supposedly improves insulin resistance), but likely not as strong an effect.

> Recently, attention has turned to the possibility that semaglutide may have broader applications, including its potential impact on addictive behaviors such as reducing drug craving and alcohol consumption.

Makes sense when your consider over-eating as addictive behavior. Considering there is a strong correlation between psychological trauma and addictive behavior as a coping mechanism, I wonder what happens to such people on Semaglutide.

Will they find alternative coping mechanisms? Or does the physiological effect of of Semaglutide somehow soften the impact of the trauma underlying addictive behaviors? If these drugs cure trauma-derived addictive behaviors, that's just so extremely interesting, mechanistically. Really curious to know if this is true, and if we'll ever find out in which direction the causality goes.

They're modified hormones. Normal glutide made by the body has a 5 minute half life and makes you feel full. Semaglutide has a 1 week half life.

It's amazing how much hormones control our minds.

If we're measuring the duration of effect of hormones, shouldn't we measure the duration of whatever it signals/triggers the action of or release of, rather than the molecule/peptide itself?

If whatever it signals has a shorter half-life, then yeah, the duration of effect is going to depend on the hormone's half life, but not if whatever it signals has a longer half-life of effect.

> If these drugs cure trauma-derived addictive behaviors, that's just so extremely interesting, mechanistically.

So much this. I think going off semaglutide makes the weight come back, so it would seem that semaglutide doesn't change the circuits of trauma and addiction permanently, but it does something to them. The theory that obesity is a result of food addiction is pretty revolutionary, and now having alcoholism confirmed to respond to the same drug really supports the theory. Additionaly, if both are caused by childhood or development traumas, that opens other treatment options, and maybe some forms of change in how we as a society look at addictions. But maybe I'm going too far.

Statistically going off makes some of the weight to come back on average. I.e. some people can keep the weight off when they are thin, and others need to take maintenance dose of semiglutide forever.

I was forced off of dulaglutide after the supply ran out in my country and have put back on all the weight I lost, but slower than expected.

I think there is also a simpler explanation: “I’m paying for this expensive drug to get better, and I’m getting better, so I’m eating and drinking healthier”. Basically reduced alcohol consumption could be a by-product of adherence to the healthier food diet.

It definitely is a more mechanistic effect, from experience and from a large sample of people I know addictive behaviors that were rooted for years and were unknown to be even addressed by the drug are dramatically nerfed, nearly universally. Just doesn't happen by wishful thinking.

Also it's not just food related - gambling, smoking, nail biting even.

I’m taking it, and while I definitely feel it for food, I would say it does nothing for compulsive video watching or doom scrolling (as proved by this late comment).

That would have shown up in trials vs placebo

Doesn't surprise me that much. I'm on tirzepatide, and I still enjoy the occasional drink, but it hits harder, the hangovers are worse, and I no longer get the sugar rush I used to.

Same as candy, in a way -- I still like to have an occasional frozen yogurt, but I no longer crave a second one immediately after I finish the first, and it doesn't sit that well, so it's become a sometimes treat rather than something I have to make a real effort to stop myself ordering at the end of the day.

I have a friend who works on reservations in Canada, who says they hand it out like candy there -- the health outcomes for people who are obese are like magic, and I have to imagine a reduction in AUD is a massive side-benefit for a population notably at risk.

Lost ~20lbs in 10 weeks.

Are these a magic pill or are there bad side effects?

Basically a magic pill (well, injection). Some mild nausea and indigestion at first, but nothing ginger tea and some over-the-counter antacids couldn't handle. Some people get severe nausea, and have to stop taking them. Only real issue at the moment is the high cost: $1k/month in the US, $500 rest-of-the-world, or cheaper in countries that subsidise them.

> well, injection

While I haven't any evidence about Tirzepatide in oral form, the results for semaglutide oral is pretty good. Haven't seen any oral vs injectable head-to-head studies of the same molecule though (funny how that is).

Sure, but it’s a PITA to take because absorption is bad. Take it on an empty stomach with exactly the right amount of liquid, and then nothing else in your stomach for 40m, and the gastrointestinal side effects are worse. I’m looking into using this for maintenance as I’ll be travelling a lot, but it’s much more of a hassle than the self-injecting needles

> Sure, but it’s a PITA to take because absorption is bad.

That’s a dosing problem :)

Unsure if the GI effects will actually worse. Depends if it’s a direct effect or not.

I had to stop taking it because it increased my resting heart rate by about 25 bpm.

They're modified hormones. Normal glutide made by the body has a 5 minute half life and makes you feel full. Semaglutide has a 1 week half life.

5-10% of those taking GLP-1 agonists discontinue treatment citing nausea, diarrhea, indigestion, vomiting, and abdominal pain. Patients often must change not just how much they eat but what they eat, especially, reducing fat intake, eating smaller meals, and staying active right after eating.

"What are the gastrointestinal adverse effects of the glucagon-like peptide 1 receptor agonists, and how should they be managed?"

https://illinoisadvance.com/what-are-gastrointestinal-advers...

"Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss"

https://jamanetwork.com/journals/jama/fullarticle/2810542

The main bad side effect is that you need to be really conscious about food. It’s easy to eat not enough or not to eat at all. Then unavoidably you feel really weak and metabolism slows down. You need to be really conscious to eat enough healthy foods, especially if you want to exercise.

If you’ve ever had pancreatitis you can’t take this (me) because it increases overall risk of having an episode. If you’re unlucky like me and have a predisposition for pancreatitis or gallbladder issues, this can push you over the edge into the worst pain of your life and possible life threatening complications. But the percentage of folks at risk is relatively low so this is not a concern for most. Heavy alcohol consumption is a leading cause of pancreatitis so for folks with AUD and diabetes, if this cuts down both diabetes and the causal factor (drinking), maybe it’s a net positive if they’ve never had pancreatitis before. Unfortunately severe pancreatitis increases the risk of Type 2 and 3 diabetes and unfortunately this great treatment won’t be available.

Just hit the mega baader-meinhof occurrence.

I just learned about this peptide this morning. Clicked the link and it's a paper from my alma mater. Lead author and I share a first name. I'm 4 years sober.

Fun coincidences!

I've long suspected that some excess alcohol consumption is a disguised form of overeating. It's socially acceptable for men to have a few beers in a way that it's not acceptable for them to have a few icecreams. I can well see semaglutide having a similar affect on that kind of use. But I wonder does it have the same effect on people drinking mainly to change their mental space.

> Semaglutide has made headlines recently as an FDA-approved drug for the treatment of diabetes under the name Ozempic, and weight loss under the name Wegovy.

Given the only commonality between these two conditions, it almost seems like semaglutide is a synthetic version of the “you’ve had enough” protein.

I think we know that it’s exactly that. I have no source to cite but I’m pretty sure I read this somewhere.

Absolutely. I recommend the references linked under “Mechanism of Action” of the wikipedia page: https://en.m.wikipedia.org/wiki/Semaglutide

Yes, that is exactly what it is. It is designed to mimick the action of the naturally occuring GLP-1 hormone. It is one part of the “you have just eaten” molecular signaling chain.

man, I wish I could afford this. Insurance (in Canada) caps out at like $800/y for reimbursement and the cost is something like $1k/month :(

Looks like Rybelsus (semiglutide in pill form) is $300 in Canada.

oh interesting, thanks! I'll look into this

sorry, can't edit this: but that's my (quite bad) insurance. not all insurance :)

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