GLP-1s in Addiction Medicine: An Update Since Our Last Conversation

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor welcomes back Dr. Stephanie Weiss and is joined by Dr. Anna Lembke to explore an update on GLP-1 receptor agonists for alcohol use disorder (AUD), discussing current research, how things have evolved since the last discussion, and the challenges and implications of integrating these innovative treatments into addiction care. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Stephanie Weiss, MD, PhD Dr. Stephanie Weiss is a Research Physician with the Translational Addiction Medicine Branch (TAMB) of the NIDA Intramural Research Program. She holds a PhD in pharmaceutical chemistry and a medical degree from the Cleveland Clinic Lerner College of Medicine. Board-certified in emergency medicine, addiction medicine, and medical toxicology, Dr. Weiss focuses on caring for patients with poisonings, overdoses, and medication misuse. Her research interests include novel psychoactive substances, medication misuse, and improving urine drug testing interpretation. Expert Anna Lembke, MD, FASAM Dr. Anna Lembke received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University. She is currently Professor and Medical Director of Addiction Medicine, Stanford University School of Medicine. She is also Program Director of the Stanford Addiction Medicine Fellowship, Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and a diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. 📖 Show Segments 00:05 - Introduction  04:15 - Latest Developments in Research 05:34 - Prescribing GLP-1's Off Label 06:28 - Challenges With Prescribing 07:36 - Who Benefits From GLP-1's and Who Doesn't 09:52 - Potential for Other SUD Treatment Beyond AUD 11:18 - Side Effects, Tolerability Concerns, and Adherence Challenges 15:11 - Where GLP-1's Fit into the Treatment Toolbox 16:19 - Unanswered Questions about GLP-1 Treatment 19:14 - GLP-1's Possible Impact on Mood 25:11 - Dosing Strategy and Titration Approach 26:36 - Life After GLP-1s: Rebound Risk and "Chipping" 28:52 - Biggest Surprise from the Research So Far 31:05 - Practice Pearls 32:34 - Conclusion and Additional Learning Opportunities 📋 Key Takeaways Emerging evidence continues to build for GLP-1s in AUD: Multiple recent clinical trials of semaglutide for AUD have reported positive findings, with additional studies expected to be published in the coming year. While the evidence base is growing, GLP-1s are not yet FDA-approved for the treatment of substance use disorders. Continue to prioritize FDA-approved medications for AUD first: Clinicians should start with established treatments such as naltrexone, acamprosate, and disulfiram before considering off-label GLP-1 therapy. Consider GLP-1s for patients with AUD and relevant co-occurring conditions: Patients with refractory AUD who have not responded well to evidence-based treatments and also have obesity, diabetes, binge eating disorder, food addiction, or treatment-resistant depression may be good candidates for a GLP-1 trial. Start low and titrate based on efficacy and tolerability: There is currently no established optimal GLP-1 dose for AUD. Clinicians prescribing GLP-1s off-label should begin with low doses and gradually titrate while monitoring symptom improvement and adverse effects