Ricky Carioti/The Washington Post/Getty Images For Sydney S., there is no way to describe rock bottom. She was her addition and her addiction was her. Even from a young age, she says her memories contained one throughline: “Always wanting more.”
Before 2024, Sydney, now 27, responded to every minor upset, irritant, or disappointment with drug use. (She requested her full last name not be shared to protect her privacy.) What started as a marijuana dependency at 12 moved to alcohol use at 14. During college, she joined in on the binge drinking culture, adding drugs like cocaine, Percocet, Xanax, and eventually ketamine to an already overwhelming alcohol consumption. It interrupted friendships, cut through studio time for her art degree, and took up so much time that she eventually shut down her small art business. Even when she wanted to sit down and paint, the drugs came first. By the time Sydney was 21, the solution to every problem was drug use. “My life just became so unmanageable. There was a downward spiral,” Sydney says. “I was taking so much in a day that I cannot believe I’m alive.”
At the threat of losing her friends, family, and possibly her life, Sydney agreed to go to inpatient treatment in 2024. She spent months at Caron Treatment Centers, a facility in Delray Beach, Florida that combines medical treatment with psychiatric counseling. Sydney is one of the 48 million Americans each year who struggle with substance use disorder. But when she walked through the doors of Caron, she joined a much more exclusive group — a select number of patients including GLP-1 medications in their addiction treatments.
GLP-1 medications like Ozempic have dominated public attention since 2021 for their ease with aiding weight loss. But a growing body of research over the last few years suggests that GLP-1s can significantly help people suffering from substance abuse disorders get clean fast and stay clean longer. GLP-1s aren’t the first potential meds targeting these issues. But the new research about their link comes at a time when the medical community is facing a historically devastating overdose epidemic — one that’s killed more than 450,000 Americans in the past five years. Aside from GLP-1s, a small number of therapeutic options already exist and are approved by the FDA. But experts tell Rolling Stone their social stigma often drive patients away from the help they need. Prescribers also have to contend with a lack of information about the long term effects of GLP-1 usage, which becomes especially dangerous when a return to form doesn’t just include weight loss but a possible relapse to life-threatening substance abuse. GLP-1s have fought a winning battle in the public consciousness, a transformation that’s taken them from unknown “miracle drugs” to routine treatments in just a few years. Can they have the same impact on the opioid crisis?
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HERE’S HOW IT WORKS: GLP-1s TICKLE a set of receptors in the body that signal the pancreas to release more insulin. That delays emptying of the stomach. And in so doing, it controls peoples’ appetites, leaving them feeling fuller longer. Taken for an extended period of time, these medications can directly lead to weight loss. First developed and approved in 2017 as a treatment for type 2 diabetes symptoms, Ozempic became especially popular online on apps like X (formerly Twitter) and TikTok in 2021, where it was referred to as a “secret weight loss drug” for the biggest names in Hollywood. After interest in the drugs sparked a national shortage in the U.S., the FDA approved several versions specifically for weight loss, including Zepbound and Wegovy’s pill form.
But GLP-1s also have an unexpected impact on the brain. Dr. Christian Hendershot, the director of Clinical Research at the USC Institute for Addiction Science, tells Rolling Stone that GLP-1s interact with a person’s neural reward network, structures stored in the brain that impact what we do to feel good and how often we do it. “There’s a kind of a satiety effect that is generated by these medications that is brain mediated,” Hendershot says. “Reward-related centers of the brain are what we think leads to reduced cravings.” This aligns with reporting from 2023 and 2024, which found that patients who used GLP-1s for weight loss reported less “food noise,” a term for how much brain power is spent thinking strictly about food.
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One of the most hopeful areas of application, therefore, is substance abuse disorders. There were a record number of drug-related deaths in 2023, with an average of 110,000 Americans dying annually from opiate overdoses. But the years since have seen decreases in the number of overdose deaths. T. John Winhusen, professor and vice chair of addiction sciences at the University of Cincinnati, attributes that progress in part to a coordinated set of harm reduction measures, such as access to both Narcan and doctors who could prescribe medications to forestall opioid use. But public health experts are concerned those trends might not stick, given recent actions by the Trump administration. Take, for instance, $350 million in funding cuts, and layoffs that have gutted nearly half of the Substance Abuse and Mental Health Services Agency’s (SAMHSA) workforce, according to reporting by STAT News.
“If people can’t access treatment,” Winhusen says, “we’re definitely going to see an increase in overdose deaths.”
Medication development for addiction has been a slow process. Before 1956, addiction to drugs and alcohol were considered failings in morality or personal will. Today, there are still only three major medicines used for addiction treatment and approved by the FDA: buprenorphine, methadone, and naltrexone, along with a handful more that treat specific withdrawal symptoms. But Hendershot says that many of these medications are historically underutilized because of stigma. In 2024, a CDC study found that of the estimated 10 million American adults who needed treatment for opiate use disorder, only 25 percent were prescribed buprenorphine. A part of accepting the prescription, might mean the difficult task of accepting the addiction as a problem that needs medical treatment.
In contrast, with a GLP-1, people might be more inclined to take them because of their burnished reputation. “One of the appealing aspects about GLP-1 therapies is that they’re widely accepted,” Hendershot says. “They’re actually very much in demand, and [an] increasing proportion of physicians and clinicians are familiar with these medications. We think that this will allow us to circumvent some of the barriers related to the uptake of traditional [substance] use disorder treatments.”
Winhusen envisions a future where GLP-1 drugs help with one of the most difficult barriers to successful medical treatment — keeping people in treatment. There’s a limit to what the current medications on the market can address. For a person struggling with substance abuse disorder, one strong craving can be the catalyst for a patient to completely abandon sobriety. Studies show that, in the month after patients stop therapies like buprenorphine, they are six times more likely to die than while they were in treatment.
“One of the biggest challenges in treating opioid use disorder is actually keeping people in treatment long enough for them to benefit from it,” Winhusen says.
That’s why Winhusen has kicked off one of the largest trials in the country using GLP-1’s in tandem with buprenorphine, the synthetic opioid used in substance abuse treatment. He’s aiming to enroll more than 300 patients across 10 sites to see if GLP-1’s can stop patients from having that one bad day, and keep them in treatment for longer: studies show that only about half of patients who start treatment stay in treatment for more than six months.
AT CARON TREATMENT CENTERS, WHERE Sydney was treated, Dr. Adam Scioli works as the chief medical officer and program director, where he supervises the center’s staff, and treatment protocols. In 2023, the center worked with Penn State University School of Medicine to start one of the first studies on the effect of a GLP-1 on addiction patients. “What we found was a pretty significant reduction in cravings at a much lower dose than the general population tends to be on, particularly for weight loss,” he says.
After the study was over, Scioli and the doctors at Caron began to offer GLP-1s as supplemental medication for those at the center for addiction treatment. Since then, they’ve treated 150 patients with GLP-1s for their substance abuse disorders, with a large majority reporting significant reductions in cravings.
“This medication gets patients feeling more normal earlier,” he says. Instead of seeing themselves as addicts, he adds, they seem themselves as members of a community, “just like anyone else who is sick — someone who has the potential to get well, contribute in a meaningful way, and be treated as an equal.”
That was Sydney’s experience. When she added a GLP-1 five months into treatment, she found that the mental space she had dedicated to drugs and alcohol began to shrink. Sydney continued to speak with her doctor, and attend counseling both solo and with her family, a combination that aided her recovery. But she says the most shocking moment came after she left treatment. Eventually, inevitably, she was confronted with drugs again. But things went differently this time.
“I found it pretty unique to see how it worked in my brain,” she says. “When I went to move out of my home in Miami, there [were] enough drugs in the house for months of relapsing. And I didn’t touch one thing. That was a pretty spiritual moment where I was able to be around drugs and not pick up anything.”
Despite the potential for the medications — and their positive effects for people like Sydney — the FDA has not currently approved any GLP-1s for specific use in substance abuse disorder treatment. That means doctors have to prescribe GLP-1’s “off-label,” which is fairly common across medicine — especially in psychiatry, where many popular medications for sleep disorders, anxiety, and depression were originally approved for other conditions, like seizures. But GLP-1 prescriptions for off-label uses are much less likely to be approved by insurance companies, studies show.
Those trends make the kinds of trials that researchers like Scioli and Winhusen are doing — to prove the therapies work for many patients, not just a few — all the more urgent. They’ll also have to mitigate concerns about potential long-term effects of taking a GLP-1. The FDA already notes that common long term side effects of GLP-1s could include bone density loss and gastrointestinal issues. (A 2025 study created by researchers at Washington University at St. Louis found links between long-term GLP-1 usage and pancreatitis and kidney conditions.)
But only way to truly know the long-term effects of GLP-1 usage is to monitor patients who go through the trials for months and years. But if the drugs aren’t approved, that means the patients who can’t get the drug off-label (either because doctors won’t prescribe, or because insurers won’t cover it) will have to wait, too. And that’s the very thing that people with substance use disorder might not have: time.
“I’m a researcher, so I’m excited when there are opportunities for developing new therapies,” says Dr. Carolina Haass-Koffler, an associate professor of Psychiatry and Human Behavior at Brown. “But,” Haass-Koffler adds, ”there are only two real clinical trials that show the use of GLP-1s–and the majority of [available] information is anecdotal. We need to be careful.”
