Trial finds daily oral semaglutide lowered heavy drinking but missed craving goal

Daily oral semaglutide lowered heavy drinking and several related measures in adults with alcohol use disorder, according to a phase 2 randomized trial that did not meet its main craving endpoint ^[1][2]. The findings appeared in the American Journal of Psychiatry and were announced by the American Psychiatric Association on July 29, 2026 ^[1].

The double-blind study randomized 50 people with moderate to severe alcohol use disorder who were seeking treatment ^[1][2]. One group received semaglutide by mouth for eight weeks, starting at 3 milligrams a day for four weeks and then moving to 7 milligrams a day for the final four weeks; the other group received placebo ^[1][2].

When they enrolled, participants reported drinking about six drinks a day on average and roughly five heavy drinking days each week. Almost all fell into the high or very high tiers of the World Health Organization's risk drinking scale ^[1].

The primary outcome was alcohol cue-elicited craving measured in a laboratory at week six. On that measure, semaglutide produced no statistically significant advantage over placebo, and neither did it significantly reduce drinks per day ^[1][2].

Preregistered secondary outcomes moved in the other direction. Across the last four weeks of treatment, the semaglutide group had significantly fewer heavy drinking days (b=-0.580, 95% CI=-1.012, -0.148) and fewer drinks on the days they drank (b=-1.177, 95% CI=-2.307, -0.047) ^[2]. They also reported greater declines in day-to-day craving as scored on the Penn Alcohol Craving Scale (b=-2.195, 95% CI=-4.174, -0.216), and their alcohol-related negative consequences fell at a significantly faster rate than placebo (b=-4.618, 95% CI=-8.651, -0.585) ^[2].

At the end of treatment, 81 percent of the semaglutide group had moved down at least one category on the WHO risk drinking scale, compared with about 54 percent of those on placebo, a difference reported as significant (Wald χ2=4.01) ^[1][2].

Eleven participants said they had used cannabis before the study began. In that subgroup, cannabis use days dropped more with semaglutide (b=-1.434, 95% CI=-2.568, -0.301), a result the researchers called exploratory ^[1][2].

"It could represent a new treatment option for alcohol use disorder, particularly for those who have not benefited from existing medications," said Joseph Schacht, Ph.D., professor of psychiatry at the University of Colorado Anschutz School of Medicine ^[1]. He also said that even cutting back on heavy drinking can lead to meaningful improvements for patients and families ^[1].

Schacht disclosed serving on a scientific advisory board for Apollo Therapeutics and as a consultant for SOURCE Bio, receiving funding as a site principal investigator for a study by Altimmune, receiving study medication from Bausch Health, and belonging to the Alcohol Clinical Trials Initiative, which is currently supported by Eli Lilly and Imbrium Therapeutics. The other authors reported no financial relationships with commercial interests ^[2].

The National Institute on Alcohol Abuse and Alcoholism, the National Center for Advancing Translational Sciences, the Hewit Family Foundation and an anonymous family donor funded the work ^[1].

Semaglutide is the molecule in Ozempic, Wegovy and Rybelsus. GLP-1 receptor agonists in this class are FDA-approved for type 2 diabetes and for weight loss, not for alcohol use disorder ^[1].

Why it matters for patients

Alcohol use disorder is treated with counseling and with medication, but the study authors note that some patients do not get enough benefit from the drugs already available ^[1]. A treatment that lowers heavy drinking without requiring complete abstinence could be relevant for people who are not trying to quit altogether, Schacht said ^[1].

The evidence here is early. Fifty people were enrolled and treatment lasted eight weeks, so the results cannot show how the drug would perform in a larger or longer study ^[1][2]. Whether any reduction in drinking lasted after the medication stopped has not been reported, and the cannabis signal rests on 11 participants ^[1][2]. Nothing in this trial changes the approved uses of semaglutide, and no dose for alcohol use disorder has been established.

What happens next

The investigators wrote that larger clinical trials are warranted and that semaglutide and other GLP-1 receptor agonists hold potential for broader use in alcohol use disorder ^[1]. The published abstract states that continued development of semaglutide for this condition is warranted ^[2]. No sizes, locations or start dates for further trials have been disclosed, and no timeline for regulatory review of semaglutide for alcohol use disorder has been announced.