Clinical Summary: Significant Decrease in Alcohol Use Disorder Symptoms Secondary to Semaglutide Therapy for Weight Loss: A Case Series
Alcohol use disorder remains common, morbid, and undertreated, with currently less than 2% of people with AUD in the United States receiving pharmacotherapy using one of these drugs. In this obesity clinic case series, patients started semaglutide for weight loss and all 6 showed marked improvement in alcohol-related symptoms, raising a clinically relevant signal for patients who have both excess weight and hazardous drinking.
Key Findings
- The mean AUDIT score at intake was 14.0 ± 3.9, with a mean follow-up AUDIT of 4.5 ± 2.0; the mean [SD] change = 9.5 [2.7] (paired t5 = 8.50, P < .001).
- At follow-up, all 6 patients (100%) had AUDIT scores consistent with “low-risk” drinking.
- Individual AUDIT scores fell in every case, with decreases of 8 points, 14 points, 10 points, 7 points, 11 points, and 7 points.
- Improvement was seen across follow-up intervals ranging from 1 month to 9 months, including a 7-point decrease after 1 month and an 11-point decrease after 9 months.
- Patients were predominantly (83.3%) female and had a mean ± SD age of 43.5 ± 12.3 years; semaglutide exposure included 0.25 mg weekly in 2 (33.3%), 0.5 mg weekly in 3 (50%), and 1 mg weekly in 1 (16.7%).
In this small case series, semaglutide prescribed for weight loss was associated with a large drop in Alcohol Use Disorder Identification Test scores, and every patient reached low-risk drinking at follow-up. For patients with obesity or overweight and co-occurring hazardous alcohol use, semaglutide creates a notable signal worth monitoring, but current AUD care should still rely on validated psychological and pharmacologic treatments.
Practice Implications
- When prescribing semaglutide for weight loss in patients with overweight or obesity, consider tracking alcohol use with the AUDIT at baseline and follow-up, as scores fell from 14.0 ± 3.9 to 4.5 ± 2.0 in this series.
- Do not assume alcohol improvement depends on major weight loss; one patient lost only 1% of her total body weight but had a 77% (7-point) reduction in AUDIT score in a 1-month period.
- Interpret large individual responses cautiously when other agents with AUD activity are on board, as 1 patient was also prescribed topiramate 100 mg and had the largest AUDIT decrease, from 20 to 6.
- Continue to direct patients toward established AUD treatment, because the article states that until randomized, placebo-controlled clinical trial data are available, evidence-based practice requires that providers point patients toward the psychological and pharmacologic interventions that have already been validated.
