A large observational study using electronic health records from 30 U.S. healthcare systems found that adults with alcohol use disorder who initiated newer GLP-1 drugs like semaglutide and tirzepatide had significantly fewer alcohol-related emergency visits and hospitalizations. The findings,…
A large-scale observational study based on U.S. electronic health records suggests that newer glucagon-like peptide-1 receptor agonists GLP-1 RAs , including semaglutide and tirzepatide, may be linked to a lower risk of alcohol-related emergency department visits or hospitalizations among adults with alcohol use disorder AUD . The research, published in the journal BMJ Open on July 24, 2026, used data from Truveta, a network of 30 U.S. healthcare systems representing more than 120 million patients.
The study was conducted by a team of researchers including P.J. Rodriguez, J.B. Lusk, H.B. Mehta, J.F. Levy, A.P. Kalogeropoulos, S. Soneji, D. Do, E. Holler, E. Webber, T. Gluckman, and N. Stucky. The analysis focused on adults diagnosed with AUD who also had either type 2 diabetes T2D or obesity. The cohort included patients who began treatment for diabetes or obesity between January 1, 2018, and December 31, 2024.
Excessive alcohol consumption remains one of the most significant preventable causes of disease and death in the United States. Millions of people are affected, and the financial costs for health care services are considerable. Although medications for AUD exist, their use is often limited by poor adherence and tolerability issues.
GLP-1 RAs are already approved for treating T2D and obesity. There has been growing interest in whether these drugs might also influence alcohol consumption. However, previous human research has produced mixed results, prompting the need for further investigation into whether these medications are linked to fewer alcohol-related health events.
The study aimed to evaluate whether newer GLP-1 RAs, specifically semaglutide and tirzepatide, could reduce the risk of alcohol-related acute-care visits, including emergency department visits and hospitalizations. The researchers emphasized that the findings are observational and do not prove causality.
The researchers employed a retrospective cohort study using a target trial emulation framework. They designed four separate target trials to reflect different clinical scenarios:
Participants in each trial were those starting treatment for diabetes or obesity who were also being actively treated for AUD. The researchers compared patients initiating new GLP-1 RAs with those starting appropriate active comparator drugs, such as sulfonylureas, other diabetes medications, other obesity medications, or approved AUD medications like naltrexone or acamprosate.
All participants were followed for up to one year to identify alcohol-related ED visits or hospitalizations. Non-alcohol-related hospitalizations served as a negative control outcome to help assess potential confounding. The researchers used advanced statistical techniques to reduce bias, including propensity score weighting and matching, inverse probability of treatment weighting, inverse probability of censoring weights, and Cox proportional hazards models. They also conducted several sensitivity analyses to test the robustness of the findings.
A total of 40,703 adults met the eligibility criteria across the four target trials. The breakdown was as follows: 18,676 participants in the ADM trial, 9,391 in the AOM trial, 8,942 in the MAUD-T2D trial, and 11,198 in the MAUD-obesity trial.
Participants with T2D tended to be older than those with obesity. Individuals enrolled in the medications for AUD trials showed indicators of more severe and more recent AUD. The newer GLP-1 RAs were initiated more recently in the study period compared with comparator therapies. Most alcohol-related ED visits or hospitalizations were identified using diagnostic codes, with the remainder detected through laboratory testing.
In the ADM trial, 11.9% of participants who received newer GLP-1 RAs had an alcohol-related ED visit or hospitalization within one year. By comparison, the rate was 14.6% among those treated with sulfonylureas and 14.0% among those treated with other diabetes medications. Treatment with newer GLP-1 RAs was associated with significantly lower hazards of alcohol-related events compared with sulfonylureas hazard ratio HR 0.74; 95% confidence interval CI 0.62-0.89 , which corresponds to about a 26% lower hazard. Compared with other ADMs, the hazard was about 22% lower HR 0.78; 95% CI 0.65-0.92 . However, no significant difference was found when comparing newer GLP-1 RAs with older GLP-1 RAs HR 1.09; 95% CI 0.87-1.37 . Sensitivity analyses using stricter outcome definitions produced similar findings.
In the AOM trial, which included adults with obesity but not T2D, alcohol-related events occurred in 10.1% of participants receiving newer GLP-1 RAs compared with 12.8% of those receiving other AOMs. Newer GLP-1 RAs were associated with a significantly lower risk of alcohol-related events compared with other AOMs, equivalent to about a 32% lower hazard HR 0.68; 95% CI 0.54-0.85 . Again, no significant difference was observed compared with older GLP-1 RAs. Sensitivity analysis using only alcohol-related diagnosis codes confirmed the results. An exploratory analysis indicated that use of newer therapies was associated with larger reductions in alanine aminotransferase and aspartate aminotransferase levels compared with other medications, although these liver enzymes are nonspecific markers and were only assessed in the ADM trial.
Among participants actively receiving treatment for AUD, the associations appeared numerically stronger but required more cautious interpretation due to potential confounding. In the MAUD-T2D trial, alcohol-related ED visits or hospitalizations occurred in 13.5% of participants treated with newer GLP-1 RAs compared with 31.4% of those receiving approved medications for AUD. This translated to about a 63% lower hazard, with the confidence interval suggesting the reduction could plausibly range from 54% to 71% HR 0.37; 95% CI 0.29-0.46 . In the MAUD-obesity trial, event rates were 8.0% for newer GLP-1 RAs and 20.4% for approved AUD therapies, representing about a 65% lower hazard, with a plausible reduction range of 53% to 74% HR 0.35; 95% CI 0.26-0.47 .
Further analyses based specifically on diagnosis codes showed similar reductions, supporting consistency across clinically distinct populations. However, negative control findings and high treatment discontinuation in comparator groups suggested possible residual confounding, meaning unmeasured factors could partly explain the results.
The study found that initiating newer GLP-1 RAs, including semaglutide and tirzepatide, was consistently associated with a lower observed risk of alcohol-related ED visits or hospitalizations among adults with AUD who also had T2D or obesity. These associations were evident across multiple clinically distinct populations and remained consistent in several sensitivity analyses.
Despite the encouraging findings, the researchers caution that the observational design cannot establish causality. The results suggest that newer GLP-1 RAs may be promising candidates for further evaluation through randomized controlled trials. Such trials would be needed to determine whether these drugs truly reduce alcohol consumption and alcohol-related harm in people with AUD.
The study was published in BMJ Open under the DOI 10.1136/bmjopen-2025-109259. The full citation is: Rodriguez, P. J., Lusk, J. B., Mehta, H. B., Levy, J. F., Kalogeropoulos, A. P., Soneji, S., Do, D., Holler, E., Webber, E., Gluckman, T., & Stucky, N. 2026 . Association between GLP-1 receptor agonists and alcohol-related hospitalisations among adults with alcohol use disorder: Multi-target trial emulation study. BMJ Open, 16. DOI: 10.1136/bmjopen-2025-109259.
The article was written by Vijay Kumar Malesu, who holds a Ph.D. in Biotechnology and has six years of scientific research experience at the Indian Council for Agricultural Research and KIIT University. It was reviewed by Susha Cheriyedath, M.Sc. The research adds to a growing body of evidence exploring the potential of GLP-1-based therapies beyond diabetes and weight management.
Peptides referenced: Semaglutide, Tirzepatide, Glucagon, GLP-1.
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