A major new study out of the Department of Veterans Affairs’ St. Louis Health Care System found that GLP-1 medications, the class of drugs that includes Ozempic, Wegovy, Mounjaro and Zepbound, are associated with a reduced risk of developing substance use disorders across every major addictive substance studied; and with reduced hospitalization, overdose and death in veterans who already have an addiction.
The results appeared March 4 in the BMJ article “[GLP-1 drugs] and risks of substance use disorders among US veterans with type 2 diabetes: A cohort study,” the largest study to date on GLP-1 drugs and addiction.
For a veteran population disproportionately affected by substance use disorders, post-traumatic stress and chronic pain conditions that frequently overlap with addiction, the findings could eventually reshape how the VA approaches treatment.
What the Study Found
Researchers analyzed electronic health records of 606,434 U.S. veterans with type 2 diabetes in the VA system, splitting them into two groups: those without a pre-existing substance use disorder and those who already had one. Veterans on GLP-1 medications were compared with those taking SGLT2 inhibitors, another class of diabetes drug.
Among veterans without a prior addiction, GLP-1 use was tied to a lower risk of developing substance use disorders involving alcohol, opioids, nicotine, cocaine, cannabis and other substances. Among veterans who already had a substance use disorder, GLP-1 use was associated with lower rates of hospitalization, overdose and death. The study also found a 25% reduction in suicidal ideation among GLP-1 users, a significant finding given earlier concerns that the drugs might increase suicide risk. Both the European Medicines Agency and the FDA have since found no causal link between GLP-1s and suicidal thoughts.
Overall, the researchers estimated that GLP-1 drugs prevented roughly seven cases of substance use disorder and 12 incidents of serious harm for every 1,000 users over three years.
Read More: The Cost of Skipping Sick Call: How Active-Duty Service Members Can Protect Future VA Claims
Why It Matters
The study’s senior author, Dr. Ziyad Al-Aly, a clinical epidemiologist and chief of the Research and Development Service at the VA St. Louis Health Care System, described the findings as a potential shift in how addiction medicine works. Current treatments tend to target one substance at a time: a nicotine patch for smoking, naltrexone for alcohol, methadone for opioids. No approved medication works across multiple addictive substances. For some substances, such as methamphetamine, no medicinal treatment exists at all.
GLP-1 drugs appear to work differently. They act on receptors in the brain’s mesolimbic system, the region responsible for reward signaling, motivation and stress. That is the same circuitry that addiction hijacks. Rather than targeting any single substance, GLP-1s appear to reduce the underlying craving mechanism itself. Al-Aly has described this as moving from “food noise” to “drug noise,” suggesting the same biological pathway that helps patients lose interest in overeating may also quiet the pull of alcohol, nicotine, opioids and other substances.
What It Doesn’t Prove
The researchers and outside experts have been careful to note the study’s limitations. It is observational, meaning it shows an association between GLP-1 use and reduced addiction risk, not that the drugs directly caused the reduction. Veterans who start GLP-1 medications may also be more engaged with their health care overall, which could influence outcomes. The study population is predominantly older, white and male, reflecting the VA patient population, though results were consistent in a separate analysis of more than 35,000 women. The study also includes only veterans with type 2 diabetes, not the general population.
Dr. Anna Lembke, a Stanford University addiction medicine specialist, told The Associated Press that while some clinicians are already prescribing GLP-1s off-label for addiction, the drugs don’t work the same way for everyone and carry risks, including gastrointestinal side effects, pancreatitis and kidney conditions, that must be weighed. Several randomized controlled trials are now under way, including one at the National Institute on Drug Abuse evaluating semaglutide for alcohol reduction, that should provide more definitive answers.
Read More: Veterans Often Overlook These VA Disability Claims: Secondary Conditions Explained
The Bigger Picture at VA St. Louis
This study is the latest in a series of large-scale GLP-1 investigations led by Al-Aly’s team at the VA St. Louis Clinical Epidemiology Center. An earlier study published in Nature Medicine in January 2025 mapped the benefits and risks of GLP-1 drugs across 175 health outcomes in more than 2 million veterans, finding reduced risks for dementia, Alzheimer’s disease, psychotic disorders and seizures alongside known risks for pancreatitis and kidney problems. The VA St. Louis research program has approximately 125 active studies and has positioned itself as one of the leading centers in the country for real-world evidence on medications affecting the veteran population.
For the more than 48 million Americans with substance use disorders, including a disproportionate share of veterans, GLP-1 drugs are not yet an approved addiction treatment. But the evidence base is growing, and it is coming from the VA.
Stay on Top of Your Military Benefits
Military benefits are always changing. Keep up with everything from pay to health care by subscribing to Military.com, and get access to up-to-date pay charts and more with all latest benefits delivered straight to your inbox.
