Who benefits most from GLP-1 drugs?
The clearest benefits are for people with metabolically unhealthy obesity (MUHO) — obesity combined with conditions like high blood pressure, high cholesterol, or diabetes. A 2025 study of nearly 3 million patients found that GLP-1 users with MUHO had a 42% lower risk of death and a 7-9% lower risk of stroke, atrial fibrillation, and heart failure hospitalization compared to non-users [5]. For people with metabolically healthy obesity (MHO) — obesity without those risk factors — the trend was similar but not statistically significant, meaning the benefit is less certain [5]. This suggests GLP-1s are most powerful when metabolic health is already compromised.
For people with type 2 diabetes, a massive 2025 analysis of over 215,000 GLP-1 users compared to over 1.2 million people on standard diabetes drugs found reduced risks of substance use disorders, psychotic disorders, seizures, neurocognitive decline (including Alzheimer's), and several heart and lung conditions [2]. The same study also found increased risks of gastrointestinal disorders, hypotension, fainting, arthritis, kidney stones, and pancreatitis [2]. So the net benefit is real but comes with a clear side-effect profile that patients and doctors need to weigh.
Can GLP-1 drugs help with addiction, fatty liver, and other conditions?
Yes, but the evidence is at different stages for each condition. For alcohol use disorder (AUD), early clinical trials show mixed results: a 26-week trial of exenatide found no significant reduction in drinking compared to placebo, while a 9-week trial of semaglutide found significant reductions in alcohol self-administration and craving in a controlled lab setting [1]. The same review notes that large real-world studies have linked GLP-1 use to lower rates of AUD, tobacco use, and cannabis use, but rigorous long-term trials are still needed [1]. A key unknown is whether patients would need to stay on the drug indefinitely — stopping GLP-1s in obesity often leads to weight regain, and the same may apply to addiction [1].
For metabolic fatty liver disease (MASH), newer dual-agonist drugs like tirzepatide (which targets both GLP-1 and GIP receptors) and survodutide (which targets GLP-1 and glucagon receptors) are showing more promise than older GLP-1s alone. A 2024 review found that while liraglutide and semaglutide improved MASH, they had limited effect on liver fibrosis [3]. The dual agonists achieved higher rates of MASH resolution and fibrosis improvement, though gastrointestinal side effects remain a major concern [3]. This suggests that the next generation of drugs may be more effective for liver disease, but tolerability will be a key factor in real-world use.
What are the risks and what don't we know yet?
The most consistent risk across studies is gastrointestinal side effects. The large 2025 analysis found increased risks of nausea, vomiting, diarrhea, and more serious conditions like pancreatitis and kidney inflammation [2]. A 2026 review also flags gastrointestinal tolerability as a major concern, especially for newer dual agonists [4]. For cardiovascular health, the picture is more nuanced: GLP-1s clearly reduce heart attack and stroke risk in people with diabetes, but a 2026 review notes that the largest trials showing this benefit were done with injectable forms (liraglutide, semaglutide, dulaglutide), and it's not yet clear if oral versions or dual agonists like tirzepatide will have the same effect on hard cardiovascular endpoints [6].
Several critical unknowns remain. For addiction, there are no published data on how many patients sustain GLP-1 therapy after achieving abstinence, whether benefits persist after stopping the drug, or what role psychotherapy should play alongside medication [1]. For obesity, stopping GLP-1s often leads to substantial weight regain, suggesting these may need to be lifelong treatments for many people [1]. And for liver disease, while dual agonists look promising, the 2024 review emphasizes that future research needs to identify which patients benefit most and how to balance efficacy with tolerability [3]. Across all conditions, the evidence base is growing fast — but for many potential uses, we're still in the early stages.
About These Sources
This answer is built on 6 peer-reviewed studies — published from 2024 to 2026, 6 from 2024 or later, 5 in Q1 journals, collectively cited 222 times — selected as the most relevant from 6 studies that passed quality screening, drawn from 80 papers retrieved from a database of over 500 million.
Sources used in this answer
Glucagon‐like peptide‐1 receptor agonists in alcohol use disorder: Multi‐system effects, early clinical promise and uncertain long‐term use
A 2026 review of GLP-1RAs for alcohol use disorder finds early clinical promise from a 9-week semaglutide trial (reduced craving and drinking in lab) but no significant effect in a 26-week exenatide trial, and highlights major unknowns about long-term efficacy, discontinuation effects, and optimal dosing for addiction populations.
Mapping the effectiveness and risks of GLP-1 receptor agonists
A 2025 cohort study of over 215,000 GLP-1 users (vs. over 1.2 million on standard diabetes drugs) found reduced risks of substance use disorders, seizures, neurocognitive disorders, and several heart/lung conditions, but increased risks of gastrointestinal disorders, pancreatitis, and kidney stones.
GLP-1, GIP/GLP-1, and GCGR/GLP-1 receptor agonists: Novel therapeutic agents for metabolic dysfunction-associated steatohepatitis
A 2024 review finds that older GLP-1s (liraglutide, semaglutide) improve MASH but have limited effect on liver fibrosis, while newer dual agonists (tirzepatide, survodutide) show higher rates of MASH resolution and fibrosis improvement, though gastrointestinal side effects remain a major concern.
The expanding landscape of GLP-1 medicines
A 2026 review highlights that new GLP-1 medicines with optimized pharmacokinetics and dual agonism produce greater weight loss and are being explored for neurodegenerative diseases, substance use disorders, and liver disease, but notes areas of uncertainty requiring further investigation.
GLP-1 receptor agonists and cardiovascular events in metabolically healthy or unhealthy obesity.
A 2025 study of nearly 3 million patients found that GLP-1 use in metabolically unhealthy obesity was associated with a 42% lower risk of death and 7-9% lower risks of stroke, atrial fibrillation, and heart failure hospitalization; similar trends in metabolically healthy obesity were not statistically significant.
GLP-1 and the cardiovascular system
A 2026 review confirms that injectable GLP-1RAs (liraglutide, semaglutide, dulaglutide) reduce cardiovascular outcomes in large trials, but notes that ongoing trials will determine whether oral versions and dual agonists like tirzepatide have similar effects on hard cardiovascular endpoints.