Your Patient’s GLP-1 Prescription Could Be Treating More Than Weight Loss

By Genni Burkhart, Editor

Addiction has important clinical implications in dentistry. Heavy drinking affects healing, soft tissue health, and how patients metabolize sedation. Smoking accelerates alveolar bone loss, masks gingival inflammation, and raises implant failure rates. As such, addiction in all forms impacts patient diagnosis, treatment planning, and surgical recommendations.

A landmark study published in March in The BMJ adds an interesting layer to that picture. The results of this study found that GLP-1 receptor agonists are associated with significantly reduced rates of new substance use disorders across every major addictive substance studied, including alcohol and nicotine. Published in internal medicine, the findings carry a thread to the dental chair.

A patient who started semaglutide for weight management may have also reduced their alcohol intake or stopped smoking as an additional result. However, that change might not be reflected in the patient's chart, making it an important occurrence worth further understanding.

One Mechanism, Every Craving

Researchers at Washington University School of Medicine in St. Louis analyzed health records from 606,434 U.S. veterans with type 2 diabetes, followed for up to three years. They compared patients taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs), most commonly semaglutide, liraglutide, or dulaglutide, to those on a different class of diabetes medication.

Prior research had examined GLP-1s and individual substances in isolation. However, this study tested whether the effect held across all of them simultaneously. The results showed the effects did, in fact, hold consistently across every substance in the analysis.

The reason for this comes down to where the GLP-1 receptors actually are. They’re present in the gut, but also in the brain’s reward-processing regions, the same pathways that govern cravings. This class of drugs targets the craving signal itself, meaning whatever variety that craving happens to be.

“It really works against all major substances, and it works uniformly, not because it acts against alcohol or opioids or nicotine specifically, but because it is likely acting against the craving itself. It blunts that craving that pulls people toward whatever they’re addicted to,” said senior study author Dr. Ziyad Al-Aly, a clinical epidemiologist at WashU Medicine and Chief of Research and Development Service at the VA Saint Louis Health Care System.

Patients on GLP-1 medications frequently describe the disappearance of what Al-Aly calls “food noise,” the persistent mental pull toward eating that drives overeating. However, this study suggests something even broader. GLP-1s may also quiet “drug noise,” the relentless craving that pulls people toward a substance regardless of what it is. The biology underlying both appears to be the same: a shared pathway, with one medication class affecting it.

Striking Outcomes

The study divided its 606,434 participants into two groups: those with no pre-existing substance use disorder (SUD) and those who already had one. The comparison in both cases was patients on an SGLT2 inhibitor, a different class of diabetes medication used as an active comparator.

For patients with no pre-existing SUD, GLP-1 use was associated with a 14% lower overall risk of developing any new substance use disorder. The reduction held across every substance studied.

• Opioids: 25% lower risk
• Cocaine: 20% lower risk
• Nicotine: 20% lower risk
• Alcohol: 18% lower risk
• Cannabis: 14% lower risk

For patients who already had a substance use disorder, the outcomes were even more striking. Addiction medicine currently treats substances individually, a nicotine patch for smoking, and naltrexone for alcohol, with limited crossover between approaches. In this analysis, a single medication class reduced serious harm events across the board over three years.

• 50% reduction in drug-related deaths
• 40% fewer overdoses
• 30% fewer emergency department visits
• 25% fewer hospitalizations

In practical terms, that translates to seven fewer new SUD diagnoses and 12 fewer serious harm events per 1,000 GLP-1 users. GLP-1s appear to stand alone in producing results like that across all substances at once.

Thinking Beyond Intake Forms

Standard patient intake forms traditionally ask about tobacco, drug, and alcohol use. They capture a static snapshot but may miss whether use has changed recently or why. That’s a meaningful intake gap, given that a widely prescribed medication, such as GLP-1s, may have a significant impact.

For example, a patient who’s been on semaglutide for six months or more may have significantly reduced alcohol consumption or stopped smoking spontaneously, outside any formal program, in a way that felt entirely unremarkable to them. The craving got quieter, and they were able to move on. However, the chart still reflects where that patient was at the start of the year.

Alcohol use specifically can have changes in consumption affect healing after extractions and periodontal procedures, sedation response, and overall soft tissue health. Nicotine reduction, in turn, has direct implications for periodontal treatment outcomes and implant candidacy. Both carry direct clinical weight and actively inform treatment recommendations.

Sedation providers are already familiar with how GLP-1 medications affect sedation and should be adjusting their protocols accordingly. What this research brings into focus is something different—a patient’s overall health picture may be shifting in ways that aren’t always reflected on their intake form. In particular, changes in alcohol and nicotine use (both directly affecting sedation and recovery) may be more common than expected but not always captured in routine documentation. This creates a potential gap between what’s recorded and what’s clinically relevant at the current time of care.

Where the Research Stands

It’s worth being clear about what this study can and can’t claim. This is observational research. Meaning, participants in this study were U.S. veterans with type 2 diabetes, a population that skews older and predominantly male. Furthermore, they were people already taking these diabetes medications, and researchers tracked outcomes over time.

Al-Aly is clear about what comes next: Randomized controlled trials specifically designed to measure GLP-1s’ effects on substance use disorder as a primary endpoint. That work is still in progress, but its implications are important. Until those trials are complete, this study serves as a signal, and the research community is treating it as such.

That being said, the signal is strong. A single drug class reducing risk across every major addictive substance, by acting on a shared craving mechanism rather than targeting individual substances, points toward a fundamentally different framework for understanding addiction. In fact, that’s the part Al-Aly says opens the door to a new SUD approach that targets the underlying biology shared by all of them, rather than managing each substance individually.

Keep Learning

DOCS Education offers continuing education on SUD in clinical practice. Examining Addiction is a strong starting point. Also worth exploring are Treating Patients with Substance Abuse Disorder and You Are What You Eat.

The GLP-1 story started with blood sugar and expanded to weight loss. It may now be opening a chapter that touches how medicine understands craving itself, and for dental clinicians, that’s a development worth following.

References

1. Cai M, Choi T, Xie Y, Al-Aly Z. (2026, March 4). GLP-1RA and risks of substance use disorders among US veterans with type 2 diabetes: A cohort study. The BMJ. https://www.bmj.com/content/392/bmj-2025-086886
2. Ballard S. (2026, March 4). GLP-1 medications get at the heart of addiction: Study. WashU Medicine. https://medicine.washu.edu/news/glp-1-medications-get-at-the-heart-of-a…
3. GLP-1s viable option to treat and prevent wide range of substance use. (2026). Medscape. https://www.medscape.com/viewarticle/glp-1s-viable-option-treat-prevent…
4. More data show GLP-1s may reduce addiction risk. (2026, March 9). Healio. https://www.healio.com/news/psychiatry/20260309/more-data-show-glp1s-ma…
5. GLP-1 receptor agonists tied to lower SUD risk: Study. (2026). Becker’s Hospital Review. https://www.beckershospitalreview.com/glp-1s/glp-1-receptor-agonists-ti…

Author: With over 16 years as a published, award-winning journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.