Could GLP-1 drugs help curb addiction? Large veteran study points to potential benefit

By Pooja Toshniwal PahariaReviewed by Susha Cheriyedath, M.Sc.Mar 8 2026

A major study of US veterans suggests that GLP-1 diabetes medications may influence addiction-related outcomes, revealing a surprising connection between metabolic treatments and substance use risk.

Study: Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: cohort study. Image Credit: Kotcha K / Shutterstock

A recent study published in the British Medical Journal suggests that medications commonly prescribed for type 2 diabetes (T2D) may also be associated with a reduced risk of substance use disorders (SUDs). These findings point to an unexpected link between diabetes treatment and addiction risk.

Researchers examined the effects of initiating glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) among United States (US) veterans with T2D. They found that people starting these drugs had a lower risk of incident SUDs. Among those already living with such conditions, the medications were also linked to fewer adverse outcomes, including SUD-related hospitalizations, overdose, and suicidal ideation or attempt.

The findings highlight a potential new role for these diabetes treatments. However, further research is needed to confirm their broader clinical impact. SUDs remain a major health challenge among veterans.

Background: GLP-1 Receptor Agonists and Brain Reward Pathways

GLP-1 RA medications are widely prescribed to treat T2D. Growing evidence suggests that these drugs may also affect brain pathways linked to addiction. Preclinical research suggests that these medications may cross the blood-brain barrier (BBB) and act on regions involved in reward, motivation, and impulse control. These actions may influence dopamine signaling in the reward circuitry of the brain.

Preclinical studies indicate that GLP-1 RAs may reduce the reinforcing effects of substances such as nicotine, alcohol, opioids, and cocaine. Observational human studies have also reported lower risks of certain SUDs following treatment initiation. However, evidence for broader benefits remains limited. Large-scale studies evaluating the GLP-1 receptor agonist drug class’s potential role in preventing or improving SUD outcomes are scarce.

Study Design and Veteran Cohort

In this cohort study, researchers examined the association between GLP-1 RAs and SUD among T2D patients receiving care through the US Department of Veterans Affairs (VA) healthcare system, including over 1,000 outpatient clinics and 170 medical centers.

The study population included veterans with and without a prior history of SUDs. All participants were actively using VA healthcare services, defined as having at least two clinical encounters and one pharmacy record in the year before enrollment. The researchers excluded individuals who previously used GLP-1 RAs, and those with drug contraindications, such as gastroparesis, diabetic ketoacidosis, thyroid cancer, pancreatitis, severe hypoglycemia, or severe renal impairment.

Data Sources and Target Trial Emulation

The investigators emulated eight parallel target trials within an active-comparator framework. Seven of these analyses assessed the development of incident SUDs among 524,817 participants. One analysis focused on outcomes among 81,617 individuals with a prior history of SUD. In total, the team analyzed electronic health record data obtained from 606,434 participants.

The dataset included information on outpatient visits, hospitalizations, pharmacy records, vital signs, laboratory results, and Medicare data. The researchers also estimated the Area Deprivation Index (ADI) derived from participants’ residential addresses to assess socioeconomic status.

Study Outcomes and Statistical Analysis

The primary study outcomes included the initiation of alcohol, cocaine, cannabis, opioid, and nicotine use disorders. Among participants living with SUD, researchers evaluated adverse outcomes such as SUD-related hospitalizations, emergency department (ED) visits, overdose, suicidal ideation, and SUD-related mortality. They compared these outcomes with those observed after initiating sodium-glucose cotransporter 2 (SGLT-2) inhibitors.

The team followed the participants for up to three years. They used inverse probability-weighted Cox survival models to estimate the hazard ratios (HRs) and three-year net risk differences (NRD) per 1,000 individuals for statistical analysis.

Results: Reduced Risk of Substance Use Disorders

In comparison with SGLT-2 inhibitor use, initiating GLP-1 RAs was linked to a decreased risk of alcohol use disorder (HR, 0.82; NRD, −5.57). GLP-1 RA initiation was also linked to lower risks of cannabis use disorder (0.86; −2.25), cocaine use disorder (0.80; −0.97), nicotine use disorder (0.80; −1.64), opioid use disorder (0.75; −0.86), and other substance use disorders (0.87; −1.12). The composite study outcome, including all new-onset SUDs, showed similar results (0.86; −6.61).

Outcomes Among Individuals With Existing SUD

Among individuals living with SUD, GLP-1 RA initiation was linked to reduced SUD-associated ED visits (0.69; −8.92), hospitalizations (0.74; −6.23), overdose events (0.61; −1.49), suicidal ideation (0.75; −9.95), and SUD-related mortality (0.50; −1.52). Findings on treatment adherence aligned with those observed for treatment initiation in new-onset SUDs and related adverse events among individuals with SUD.

Sensitivity analyses using sulfonylurea initiators as controls, multiple lookback periods, overlap weighting, average treatment effects on controls, truncation cut-offs, and trimmed propensity score thresholds yielded similar results, supporting the robustness of the findings.

Conclusions: Potential Role of GLP-1 Drugs in Addiction Prevention

The findings suggest that initiating GLP-1 RAs may offer benefits beyond glucose control for T2D patients. The medications were associated with a lower risk of new-onset SUDs and with fewer related adverse outcomes, including overdose, hospitalizations, and suicidal ideation, among those living with SUDs. The results highlight the potential role of GLP-1 RAs in SUD prevention and management.

Clinically, the findings may inform treatment considerations, particularly for diabetic individuals who are also at risk for or experiencing SUDs. However, clinicians must weigh potential benefits against known adverse effects, underscoring the need for further research and individualized clinical decision-making. Because this was an observational study conducted in a predominantly older male veteran population, the findings cannot establish causation, may not fully generalize beyond the VA healthcare system, and residual confounding cannot be excluded despite statistical adjustment.