This important research letter explored the potential use of antiobesity medications (AOM), such as metformin, bupropion and naltrexone, and particularly the GLP-1 receptor agonists (i.e., first-generation liraglutide and dulaglutide; or second-generation tirzepatide and semaglutide), for the treatment of alcohol use disorder (AUD). GLP-1 receptor agonists have demonstrated efficacy in weight reduction and are believed to also influence alcohol consumption.

The authors employed a retrospective cohort design, enrolling 14,053 participants from the WeightWatchers (WW) Clinic telehealth program between January 2022 and August 2023. Inclusion criteria required initiation of AOMs and completion of follow-up surveys assessing alcohol use. Participants with prior AOM use or bariatric surgery were excluded to isolate the effects of new pharmacological intervention. Alcohol consumption was stratified into four categories (none, low, moderate, and high) based on frequency and volume, aligning with established thresholds for risk. The study did not explicitly address clinical criteria for AUD, such as loss of control or adverse consequences. Instead, it focused on changes in self-reported alcohol consumption among individuals participating in a weight management program after initiating AOMs.

Medications like naltrexone, included in the bupropion/naltrexone combination, are commonly used to treat AUD, suggesting that some participants might have had problematic drinking patterns. However, the primary focus remained on alcohol consumption as a secondary outcome of weight management, not on AUD-specific treatment or prevalence. Participants with a history of bariatric surgery, who were at higher risk for AUD, were excluded, further narrowing the focus to general alcohol use patterns.

Multivariate logistic regression was employed to examine predictors of reduced alcohol use, controlling for demographic variables, obesity class, baseline alcohol use, and percentage weight loss. Approximately 45.3% of participants with baseline alcohol use reported reductions in consumption after AOM initiation. The likelihood of reduction in alcohol use was higher in individuals with greater baseline alcohol consumption and higher obesity classes. Notably, participants prescribed bupropion/naltrexone were more likely to reduce alcohol use compared to those on metformin, though this association diminished after adjusting for weight loss. Second-generation GLP-1 receptor agonists, the most frequently prescribed class (86.2%), were also associated with reduced alcohol consumption, potentially due to their effects on reward pathways linked to food and alcohol. The findings suggested dual utility for GLP-1 receptor agonists and naltrexone-containing treatments, in addressing both obesity and alcohol use.

GLP-1 receptor agonists may exert their effects by attenuating reward sensitivity in the mesolimbic pathway, a mechanism shared with food intake. Similarly, naltrexone reduces alcohol cravings through opioid receptor antagonism. Behavioral components of the weight management program, including caloric awareness and reinforcement of health-oriented goals, likely contributed to reductions in alcohol use even among metformin users. These results aligned with existing literature suggesting that integrated pharmacological and behavioral strategies can modulate addictive behaviors, reinforcing the potential for AOMs in multidisciplinary psychiatric care and warrant further investigation with a focus on elucidating neurobiological mechanisms and optimizing treatment protocols for individuals with co-occurring obesity and substance use disorders.

This study is highly relevant to C-L psychiatrists as it highlights the intersection of obesity, alcohol use, and mental health, offering novel insights into dual-purpose pharmacological treatments. The findings also emphasize the importance of integrating psychosocial and behavioral strategies within interdisciplinary care plans, as observed reductions in alcohol use were partly attributable to structured weight management programs. C-L psychiatrists can leverage these insights to guide holistic, patient-centered care for individuals with coexisting obesity and substance use issues while exploring innovative treatment approaches and research opportunities that overlap metabolic and psychiatric conditions, including addiction.