Off-Label Use of GLP-1s for Addiction

Hunger quiets, cravings fade, and the conversation around recovery shifts when biology finally meets behavior. We unpack GLP-1 receptor agonists—how they signal fullness early, slow gastric emptying, and may unexpectedly lower alcohol intake and even smoking—through personal experience and fresh science. 

Ryan shares how a weekly injection moved his A1C from prediabetic to optimal without losing strength or ditching the gym, while also softening the pull of old addictive patterns. Dr. Daryl Shorter explains why these drugs, approved for type 2 diabetes and obesity, are generating buzz well beyond weight loss, and how they challenge the willpower-only model that has long fueled shame around food and substance use.

We break down a recent phase 2, placebo-controlled trial of low-dose semaglutide that showed reduced alcohol self-administration, lower cravings, and fewer drinks per drinking day, with a bonus signal on smoking. Then we get practical: what responsible, off-label consideration looks like; why first-line treatments and therapy still matter; and how to weigh lawsuits, side effects, and costs against the reality of stalled recovery. The goal isn’t hype—it’s clarity. For some, GLP-1s may be a bridge to consistent habits, social meals without overeating, and a quieter mind around alcohol. For others, the risks or lack of indication mean they’re not the right fit.

We also look ahead to oral formulations in development and a care model where metabolic health, psychiatry, and recovery intersect. If you’re curious whether biology-informed tools can make change stick, this conversation offers nuance, guardrails, and hope. Listen, reflect, and share with someone who’s weighing their options. If this resonated, follow the show, leave a review, and tell us: could GLP-1s be a game changer in your recovery toolkit?

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Recovery Playbook episodes with Ryan Leaf and Daryl Shorter, M.D.  To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.

Transcript

Welcome And Topic Setup

Dr. Daryl Shorter 0:07

Welcome to the Recovery Playbook, brought to you by the Menninger Clinic, a national leader in addictions and mental health treatment. I'm one of your hosts, Dr.

Ryan Leaf 0:16

Daryl Shorter. And I'm your other host, Ryan Leaf, and we are going to take you through some of the more exciting addictions treatment talk that we have. Hopefully, not only to entertain, but also to educate you and those that need to be educated.

What GLP-1 Meds Are

Dr. Daryl Shorter 0:30

Yeah. And today we are going to be talking about GLP1 receptor agonists. What are GLP1s? I'm glad you asked. So glucagon-like peptide-1 receptor agonists, also known as GLP1 RAs, are a class of medications that if you haven't heard about them, I don't know how. I mean, everybody is talking about some names that are semaglutide, also known as Ozempic or Zep Bound. Tirzepatide also known as Manjaro. These medications are FDA approved for treatment of type 2 diabetes as well as obesity, and people are using them either whether or not they have those conditions to control and manage their weight.

Ryan Leaf 1:22

Recently we've heard of a civil lawsuit out there against Ozempic, a very large number. That's right. You talked about individuals using this drug the right way or not, of abusing it because of the weight loss attributes that come from them. Talk about why this was thought of by pharmaceutical companies and why doctors prescribed them.

Dr. Daryl Shorter 1:53

Yeah, so coincidentally, I mean, from a from the addiction standpoint, I don't think that they ever intended to use these medications for treating alcohol use disorder or tobacco use disorder. And to be clear, there's no indication from the FDA or anybody else, there are no clear guidelines that these medications should be used just to treat addictive disorders. However, what has been found anecdotally among people that might have had diabetes is when they were started on a medication like an Ozempic or a semaglutide, they found that their desire to drink alcohol, as well as, even if they had had a day where they were drinking, the amount that they were consuming went down significantly.

Lawsuits, Use, And Misuse

Ryan Leaf 2:35

The idea around the drug is that it informs the brain when it's full. Right. Much earlier than the body used to before the drug was there. So those of us who love to eat, we would absolutely destroy the plate before we felt full. Yeah. And then we have over eight in terms of caloric intake, where now this drug hits the receptors and lets you it it really sends a signal from your

How GLP-1 Signals Fullness

Ryan Leaf 3:05

stomach to your brain saying we're full.

Dr. Daryl Shorter 3:07

That's exactly right. So not only are people experiencing early satiety, they're feel full more quickly. They also have delayed gastric emptying, which means it's a fancy way of saying that your stomach feels full faster and empties much slower. So that that feeling of fullness, you get a sense that you're like, well, I don't want to eat anymore because I already feel full, both physically, and your brain is telling you that you're full.

Ryan’s GLP-1 Experience

Ryan Leaf 3:32

So full disclosure, about four years ago I went on a GLP1. You know, mainly for I was pre-diabetic. My number was my hemoglobin A1C. Yeah, A1C was right on that pre-diabetic number. And so I went on the drug. I take a shot once, I would take a shot once a week. And I noticed pretty quickly the difference in my appetite. Okay. I never felt hungry. I never felt weak because I would still go to the gym and I would still do all the things I needed to do. I wasn't just absolving myself from any sort of exercise and just rather you know doing that. I think the the lowest I got down to was 209, which was too low for me, I think. Okay. I have documentation. You and I did a podcast in September of 23 here, and I see myself on the picture and I'm wearing like almost the same shirt, and it looks I'm really thin. Oh for me, that's like my wife pointed out, like I was really thin. I was like 209 pounds, which was absurd. I'm 2 28 right now and feel really good and really healthy. But I will say this too there is I have been sober for a long time. But whatever cognitive effects that it has on the limitation of or the obsession to want to drink or to use, I just on a daily basis I understand what and who I am. I just didn't think about it. And I do think that my substance use disorder was incredibly symptomatic of being the symptom to my mental health diagnosis and old behavior. And so, but those old behaviors weren't cropping themselves up either. Like there was an addict behavior around what I was doing, which would then in turn me to you know drug seek in single way. So if that was a benefit to the health, now my A1C or my A1C level absolutely like 5.1 now.

Dr. Daryl Shorter 5:46

Wow.

Ryan Leaf 5:47

Like it's just it's non-existent. But that goes into all the food that we're eating, and we talked about earlier in an earlier episode where we started doing all non-processed foods. You know, that that and who knows if you know which one came first, if that applied to that or not. I think that the drug has been a godsend. I've recommended it to my father-in-law, who I think has needed it for some time later in life, and it's really affected him in a positive way, which has been

Food Culture And Less Shame

Ryan Leaf 6:15

great to see. We're having him move out to be near our family now. That's nice. To be around he's in his late 70s, so I mean there's always this conversation around pharmaceuticals and the pharmaceutical companies and the amount of money that they're making off these and that and other drugs, but there's the inventions of these pharmaceuticals that have been lifesavers in in our lifetime. And who knows? Because I think one of the biggest and most devastating causes of death in our country is obesity. Absolutely. I mean heart disease. Those are the silent killers that are the ones that are doing it, and this may be, you know, this generation's penicillin. Who knows?

Dr. Daryl Shorter 6:57

So, what's interesting about what you're what you're saying right now is that it completely changes and challenges the way that we have historically thought about our relationship to food. Right. We typically think about our relationship to food as being emotional, as being psychological, and as being social, right? I go out to dinner with people on a Friday night to celebrate the end of the week and to the development of a sense of camaraderie with people that I love and care about. And now I can do that on a GLP1RA and say, all right, well, instead of having an appetizer, two entrees, and three desserts, I can have a little bit of an appetizer and kind of my meal, and then maybe take the dessert home with me if I decide to order one at all.

Ryan Leaf 7:39

Or go no dessert, be a piece of an entree and stick with the three desserts. Yeah. I'm with you on it. Like uh food, and there's a reason why my wife and I get along so well. We're both kind of foodies. We love to like our date night, does not have to be this over exaggeration of uh romance. It has it can revolve really around a new restaurant with a new menu and her and I spending time with one another. Absolutely. And so I'm with you on that. Like the idea of and the understanding of your body just telling you you're full when you are. Yeah. I don't think it's trying to fool you.

Dr. Daryl Shorter 8:14

No, not at all. And the interesting thing is like it can really reduce our sense of shame and guilt that people experience as a result of feeling like, well, my weight is my is because of my weak will, my weight problems are because like I'm just not a good enough person, I'm not disciplined enough, I don't exercise enough or hard enough or whatever those things. And then you have this class of medications that comes in and really shakes up our conversation about obesity in a major, major way. And then you find out on top of that that people drink less on this medication.

Ryan Leaf 8:51

I think once you if you've done the research, like if you've done the things that we talked about in previous episodes of going through the medical process, getting a blood test, understanding kind of where you're at. The only reason you know you're close to diabetes or prediabetic is the blood test because you find out what your A1C level looks like. You have an understanding of what that is. And so the less sugar you're putting in your body, the better you're going to be. And, you know, the drinking aspect of things is you're you're full sooner, and alcohol just becomes this thing that that doesn't seem relevant anymore, maybe.

Drinking Less On GLP-1

Dr. Daryl Shorter 9:33

Well, I think what I want to make sure that we talk to the audience today about a study that was recently published in JAMA psychiatry.

The JAMA Psychiatry Trial

Dr. Daryl Shorter 9:41

This was in February of 2025. It's really the only study where they've looked at semaglutide, also known as Ozempic, in humans. It's a phase two randomized controlled placebo controlled trial. And they found that low-dose semaglutide, it was a nine-week study, uh, and they gave it at three different doses, reduced alcohol consumption during a laboratory self-administration. So they allow people to kind of go around and give themselves alcohol as much as they might would have liked. It also decreased alcohol craving. People reported that they were drinking less per drinking day. And in a smaller group of people that also smoked cigarettes, it reduced their smoking too.

Ryan Leaf 10:21

I mean, those types of that type of data, which is one that the tobacco and alcohol lobby isn't gonna like very much. I'm sure they're gonna love it. But the people around the pharmaceutical conversation should be applauded for it because what you're doing is like anything, you're extending life.

Dr. Daryl Shorter 10:48

But think of it this way, also, right? Like, so you're also saying that biologically there is something about our brains and our bodies where you can give someone a medication and they are now drinking less and smoking less.

Biology, Cravings, And Comparisons

Ryan Leaf 11:02

I mean, I've had these conversations around the opioid blockers. Yeah you know, when we talked about vivitrol and it being a non-narcotic alternative to help block those receptors, where it literally, if you were to choose to take some sort of opiate or anything, you would not receive any of the endorphin rush that euphoria from it that you would normally do. And how is that not a beneficial thing to make it more available to those people that are going through something like this? This is also a really good way to allow people to do things on their own terms, I think, too, where it's not like you some of the hardest parts of getting clean or getting a recovery is admitting you have a problem. Like that's the hardest part in a lot of it. Like, no, I don't have a problem. This is this is being heaped onto me by other people and everything like that. But I'd like to be thinner, you know, I'd I'd like to, I'd like to look better in my jeans.

Dr. Daryl Shorter 11:58

Yeah.

Ryan Leaf 11:59

So if it's an excuse-riddled way you want to go about something, by all means. Yeah. I mean, to have this side effect, if you want to call it that, to a health and recovery aspect of things that could benefit something that you may have co-occurring, yeah, touchdown.

Dr. Daryl Shorter 12:19

It's interesting. I was having a dinner meeting with some folks. This was a couple months ago, and one of the questions that they asked me was, would I feel comfortable prescribing something like a semaglutide for someone who has problems with alcohol?

Off-Label Use And Ethics

Dr. Daryl Shorter 12:36

And what I offered was that while it wouldn't necessarily be the first, second, or maybe even third medication that I might prescribe for someone in the context of like severe alcohol use disorder, I would try the things that are sort of FDA approved and indicated. If that individual really still was struggling with establishing abstinence and they still wanted to have abstinence as their goal, would I consider it? I absolutely would. Now, this is off label. I recognize that it's not FDA approved. And I also think that the desperation that many people experience as a result of their substance use disorder can be so great that to withhold that medication from somebody that's really, really suffering and really, really struggling, but hasn't responded to traditional treatment, that this could be an option for them as well.

Ryan Leaf 13:18

And I applaud you for that. The desperation part is I is I know really well. So like I think a lot of the time we just want some sort of hope. We want it once I got diagnosed with the mental health stuff and understood that like the substance use disorder was just you know revolving around the co-occurring mental health diagnosis, like that's huge.

Dr. Daryl Shorter 13:47

Yeah.

Ryan Leaf 13:48

The why, and this generation is just just buried in the why. We they want to know about why of everything. Absolutely. And so if you can give them something that can help with that why in some way, shape, or form, I think you would, if you didn't, you would be doing that client, that patient a disservice and trying to help them have a healthy and full-fledged life.

Monitoring, Safety, And Pills

Dr. Daryl Shorter 14:10

Absolutely. And there are ways to do it in a healthy way, also. Like you would want to check the hemoglobin A1C. You would want to make sure that you're following this person medically and making sure that it's not an unsafe option for them. But again, if what we're trying to do is really help people to establish some sobriety and some recovery, and this is the way that you can jumpstart that for someone, I think it is important to at least consider it as an obvious.

Ryan Leaf 14:32

I hear I hear uh Eli Lilly is close to making this in pill form.

Dr. Daryl Shorter 14:38

Oh, yeah, absolutely. So there are a couple of oral versions of semaglutide that are already actually being studied in clinical trials. We're still waiting to hear about that. I mean, and listen.

Ryan Leaf 14:47

But that's crazy though.

Dr. Daryl Shorter 14:48

That's amazing. And a lot of the data we have right now is anecdotal. Like I said, this one trial is like one of the most robust trials that we've seen. And even then they didn't have a ton of people in that trial. But we sort of know and hear people talking about it, and I think Well, is there anything anything new that needs to be data driven?

Risk, Benefit, And Individual Fit

Ryan Leaf 15:05

Absolutely. And so, you know, I hate to use like, you know, when you when you say something like this to something new, our generation's penicillin, like the reason we know that about penicillin is because of the work it did for so long and the data that's behind it. If you look at this a hundred years from now and go, how many lives were saved because of obesity deaths, you know, high blood pressure, heart disease deaths, like we don't have the data to back that up yet.

Dr. Daryl Shorter 15:34

Not yet.

Ryan Leaf 15:35

You know, in this day and age, too, you have to circumvent all the things that are come with it because Ozempic is getting sued for, I think, a hundred million, hundreds of millions of dollars because of side effects that come from that.

Dr. Daryl Shorter 15:47

It's just so it's about risk and benefit ultimately, right? Like if someone were to say to me that they had really no risks as a result of, you know, that they're they're not obese, they don't have diabetes, they don't have an alcohol use disorder or a tobacco use disorder, then maybe that medication has more risks for them than it would perceive benefits. But for somebody who's really super desperate and trying to get sober and they find that they can't do it, then maybe in some cases the risk from that medication is outweighed by the potential benefits from it.

Ryan Leaf 16:17

You know, I can just speak to its benefits. So, you know, that's uh it's weird, of course, like anything else. Like some individuals who took opiates, the opiates that I took, they were sick from them, they couldn't like, they didn't like them, it affected them negatively. Not that it didn't ultimately affect me negatively, but I loved it.

Dr. Daryl Shorter 16:37

Yeah.

Ryan Leaf 16:37

Right? I loved that it it worked for me exactly

Takeaways And Closing

Ryan Leaf 16:40

how it worked for me. Whatever the combination of opiate and acetaminophen that was chemically mixed in those pills worked for me. And and like anything, it can be that simple that it it works for you. And a GLP1, it worked for me. Yeah, and you know, I'm gonna be 14 years sober here coming up in April. I've kind of got the life of my dreams. So I can't speak negatively to it.

Dr. Daryl Shorter 17:07

Yeah.

Ryan Leaf 17:07

I've had no side effects from it. And so, you know, this isn't an ad, but you know, I could be the the spokesperson for it in that sense. And so, and what this show does, and we hope it does, is that it educates those people who are asking the questions around okay, so what is this product? How has it had an effect on I had not heard of that study. I love being on this show with you because you always come up with new and you make me smarter because then I go off into the world then, and when I talk with people, it kind of sounds like I know what the hell I'm talking about. And I'm like, no, I have a doctor on staff. So it's very nice.

Dr. Daryl Shorter 17:46

Well, we thank you for being here. And if you have questions about whether or not GLP ones could be helpful for you, talk to your doctor. Thanks, everybody. We'll see you next time.