Many veterans across the nation experience alcohol use disorder (AUD), and researchers are evaluating additional treatment options. The U.S. Department of Veterans Affairs has launched a clinical trial to assess the safety and effectiveness of semaglutide, a GLP-1 receptor agonist, for treating AUD. A pharmacologist with Baylor College of Medicine and the Michael E. DeBakey VA Medical Center explains why these medications show promise and what researchers hope to learn from the trial.

“The nucleus accumbens is a key part of the brain’s reward circuitry. GLP-1 medications may influence these circuits, which provides a rationale for studying whether they can reduce alcohol craving and drinking,” said Dr. Christopher Verrico, associate professor of psychiatry research at Baylor and local site investigator of the study in Houston.

The study, known as the Cessation or Reduction of Alcohol Consumption in Veterans trial, is a randomized controlled trial that is actively recruiting veterans from VA medical centers nationwide. Half of the participants will receive semaglutide injections while the other half will receive a placebo. If the trial demonstrates that semaglutide is effective and has an acceptable safety profile, the results could support a future application for FDA approval to treat AUD. In addition to the Michael E. DeBakey VA Medical Center, the study is being conducted at other VA medical centers:

Ann Arbor VA Health Care System, Ann Arbor, Mich.

Charles George VA Medical Center, Asheville, N.C.

Durham VA Medical Center, Durham, N.C.

Edward Hines Jr. VA Hospital, Hines, Ill.

George E. Wahlen VA Medical Center, Salt Lake City, Utah

Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Ga.

Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio

Minneapolis VA Medical Center, Minneapolis, Minn.

Orlando VA Medical Center, Orlando, Fla.

Palo Alto VA Medical Center, Palo Alto, Calif.

Philadelphia VA Healthcare System, Philadelphia, Pa.

Portland VA Medical Center, Portland, Ore.

Tibor Rubin VA Medical Center, Long Beach, Calif.

VA Greater Los Angeles Health Care System, Los Angeles

VA North Texas Health Care System, Dallas, Texas

VA Puget Sound Health Care System, Seattle, Wash.

William S. Middleton Memorial Veterans Hospital, Madison, Wisc.

Some veterans use alcohol to cope with stress, anxiety or trauma-related symptoms. However, AUD also can develop without combat exposure to PTSD.

“Among substances of abuse, alcohol is one of the biggest problems among active military and our veterans, and part of that is because alcohol is so widely available. They have ready access to alcohol through military stores on base, including exchanges and some commissaries, whereas illicit drugs are less accessible,” Verrico said. “For active-duty service members, illicit drug use is prohibited and can lead to disciplinary action. Alcohol use is permitted within military rules, but alcohol-related misconduct can also have serious consequences.”

While other drugs are FDA-approved to treat AUD, they are not widely used. Verrico hopes semaglutide is effective to pair with other drugs for AUD to see if there is synergy for those struggling to quit drinking.

“Ideally the GLP-1s will work well and a lot of veterans will start using it,” he said. “If semaglutide demonstrates benefit and an acceptable safety profile, future studies could explore whether combining it with existing AUD treatments, such as naltrexone, improves outcomes. The current trial compares semaglutide with placebo.”

The VA is actively recruiting veterans with AUD and hopes to recruit women in particular. The FDA requires at least 20% female enrollment to approve the semaglutide as a treatment for AUD. Veterans can learn more by contacting their local VA medical center.

“Our research group at the Houston VA was among the first to actually show in a randomized controlled trial that GLP-1 agonists might potentially be useful for substance use disorders, so we’re really excited to be part of this,” Verrico said.

By Homa Warren