MedPage Today‘s enterprise and investigative team in July 2025. A 25-year journalism veteran, he has covered everything from misinformation to public health data in roles at USA Today, The Associated Press, and CBS 17 News in North Carolina, where he lives with his family. He holds a bacheloru2019s degree in journalism from West Virginia University and a masteru2019s from Northwestern Universityu2019s Medill School of Journalism. On Sundays, you can often find him on a baseball diamond, playing the sport competitively. Email him at j.mccreary@medpagetoday.com with story ideas and tips.”,”affiliation”:””,”credential”:””,”url_identifier”:”jm7987″,”avatar_url”:”https://assets.medpagetoday.net/media/images/author/BETTER_JOEDY_MUG_188.jpg”,”avatar_alt_text”:”Joedy McCreary”,”twitter”:”https://x.com/joedymccreary”,”links”:{“signal”:””,”bluesky”:”https://bsky.app/profile/joedymccreary.bsky.social”,”website”:””,”linkedin”:””,”muckrack”:”https://www.medpagetoday.com/people/gb5181/gillian-booth”},”has_author_page”:1,”byline”:”Enterprise & Investigative Writer, MedPage Today”,”full_name”:”Joedy McCreary”,”title”:”Enterprise & Investigative Writer, MedPage Today, “,”url”:”https://www.medpagetoday.com/people/jm7987/joedy-mccreary”,”bluesky”:”https://bsky.app/profile/joedymccreary.bsky.social”}]” reviewedby date=”December 24, 2025″ updatedate=”December 24, 2025″ timetoread=”3 min read” articlehasdatawrapper breaking=”3″>
Gastroenterology
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General Gastroenterology
— Findings add to evidence that GLP-1s may influence reward, addiction pathways beyond weight loss
by Joedy McCreary, Enterprise & Investigative Writer, MedPage Today
December 24, 2025 • 3 min read
- Studies have shown that bariatric surgery can raise the risk of alcohol use disorder (AUD) and other addictive behaviors, a phenomenon often described as “addiction transfer.”
- Treatment with incretin-based therapies after bariatric surgery was associated with lower risks of new-onset AUD and initiation of medications for AUD compared with non-incretin anti-obesity drugs.
- The findings add to mounting evidence that GLP-1 drugs and dual incretins may influence reward and addiction pathways beyond weight loss.
Treatment with incretin-based weight-loss medications, like GLP-1 receptor agonists, after bariatric surgery was associated with significantly lower risks of alcohol use disorder (AUD) and initiation of medications for AUD compared with other anti-obesity drugs, a large U.S. retrospective cohort study found.
In a propensity score-matched analysis of nearly 8,000 patients, treatment with GLP-1 receptor agonists or dual incretin therapies was linked to a 55% lower risk of new-onset AUD (HR 0.45, 95% CI 0.25-0.81, P=0.006) and a 41% lower risk of initiating AUD medications (HR 0.59, 95% CI 0.46-0.75, P<0.001) compared with non-incretin-based weight-loss drugs, reported Juan Pablo Arab, MD, of Virginia Commonwealth University in Richmond, and colleagues in JAMA Network Open.
The findings add to growing evidence that incretin-based therapies may influence behavior and reward pathways beyond their established effects on weight and glycemic control — a potentially important consideration for bariatric surgery patients, who face a well-documented increased risk of alcohol misuse.
Prior studies have shown bariatric surgery can raise the risk of developing AUD and other addictive behaviors, a phenomenon often described as “addiction transfer” in which alterations in eating behavior are accompanied by increased vulnerability to substance use. Altered alcohol absorption, shifts in gut hormones, and neurobiological changes in reward processing are thought to contribute.
“Incretin-based therapies may counteract these effects by blunting the reinforcing properties of alcohol and potentially diminishing the substitution of alcohol for food, a behavioral mechanism frequently reported after bariatric surgery,” the investigators wrote.
In an accompanying editorial, Robert O. Cotes, MD, of Emory University School of Medicine in Atlanta, and colleagues noted the study “opens an important conversation” but cautioned against drawing causal conclusions from observational data.
“We are only just beginning to understand how these medications influence the neurobiological circuits that govern both appetite and reward,” they wrote. “Future prospective and mechanistic studies will help clarify whether these medications truly modify risk of AUD or simply identify patients who are more engaged with their care. Either way, this work challenges us to think more broadly about how metabolic and addiction medicine intersect.”
The association remained consistent across multiple sensitivity analyses. Among patients who initiated anti-obesity medications within 5 years of bariatric surgery, incretin-based therapies were associated with a significantly lower risk of both AUD (HR 0.43, 95% CI 0.22-0.86, P=0.01) and initiation of medication for AUD (HR 0.64, 95% CI 0.49-0.83, P<0.001).
In a 6-month landmark analysis designed to minimize bias from early events, incretin-based therapies were again linked to lower risks of AUD (HR 0.36, 95% CI 0.18-0.72, P<0.001) and AUD medication initiation (HR 0.63, 95% CI 0.48-0.82, P<0.001). With extended follow-up to 3 years, the reduced risks persisted for both AUD (HR 0.44, 95% CI 0.25-0.74, P<0.001) and AUD medication initiation (HR 0.71, 95% CI 0.57-0.88, P=0.002).
If confirmed, the findings raise the possibility that incretin-based therapy could offer dual benefits in post-bariatric patients by supporting weight management while potentially reducing the risk of problematic alcohol use, and they suggest a rationale for studying incretins as preventive or adjunctive treatments for substance use disorders.
Arab and team analyzed TriNetX electronic health record data from 15,382 adults who underwent bariatric surgery and subsequently initiated pharmacologic treatment for weight management between 2020 and 2024. Patients were grouped according to treatment with incretin-based therapies — including semaglutide (Ozempic, Wegovy, Rybelsus), liraglutide (Victoza, Saxenda), or tirzepatide (Mounjaro, Zepbound) — or non-incretin anti-obesity medications.
After propensity score matching to balance demographics, comorbidities, psychiatric history, and substance use risk factors, 3,990 patients were included in each group and followed for incident AUD or initiation of medications for AUD for up to 3 years. Mean age in the matched cohorts was 46, 85% were women, 56-57% were white, 24% were Black or African American, and 14% were Hispanic or Latino.
The investigators acknowledged several limitations, including reliance on diagnostic and procedure billing codes that may be subject to misclassification. AUD-specific psychotherapy was poorly captured, likely reflecting underuse of AUD-specific coding. Additionally, behavioral data such as alcohol consumption patterns, binge drinking, and quantity of intake were unavailable, raising the possibility of unmeasured confounding.
