86. Semaglutide and Smoking86. Semaglutide and Smoking
Addiction Medicine Journal Club
Does semaglutide cause people to cut down on smoking?
31:48•2 Nov 2026
Semaglutide, Smoking, and BORGs: What GLP-1s Might Mean for Addiction Care
Episode Overview
- Semaglutide did not significantly change delay to first cigarette or number of cigarettes smoked, though it modestly reduced cravings.
- Participants on semaglutide experienced meaningful weight loss and improved A1c, which may help address fears of post-quit weight gain.
- The trial’s small sample size and restrictive inclusion criteria limit how widely the findings can be applied in everyday practice.
- BORGs (blackout rage gallons) carry a high risk of alcohol poisoning and give a false sense of safety despite containing around 17 standard drinks.
- GLP-1s are increasingly discussed for mental health indications, with emerging data suggesting anxiety and depression may improve in some patients.
“First of all, it sounds horrifying… that’s an incredibly dangerous amount of alcohol, like 17 standard drinks.”
What drives someone to seek a life without alcohol? For clinicians working in addiction and recovery, this episode offers a different angle: how modern metabolic drugs might also shape smoking and drinking behaviours. Addiction Medicine Journal Club looks at a phase 2 trial on once-weekly semaglutide for adults who smoke daily but aren’t actively trying to quit.
The hosts break down a tightly designed study where 24 participants were randomised to semaglutide or placebo and then put through a lab set-up to see how long they could delay smoking and how many cigarettes they’d choose to have in an hour. The headline? Semaglutide didn’t dramatically change "delay to first cigarette" or number of cigarettes smoked, although it did reduce cravings and led to meaningful weight loss and better A1c.
You’ll hear clear, practical commentary on what these results might mean for frontline addiction care. The hosts point out that many patients fear post-quit weight gain, and that GLP-1 drugs could potentially ease that concern, even if they don’t magically stop smoking on their own.
There’s also a candid discussion about trial limitations, from the very narrow inclusion criteria to the small sample size and the difficulty of truly blinding GLP-1 studies when "approximately 73% of recipients have at least one GI adverse effect." Away from semaglutide, they tackle the college trend of BORGs (blackout rage gallons), highlighting how the supposed safety benefits mask "an incredibly dangerous amount of alcohol, like 17 standard drinks" and a high rate of blackout and vomiting.
GLP-1s for mental health, recent regulatory changes around suicidality warnings, and the sheer volume of clinic visits now focused on these drugs also get airtime. If you look after people with addiction – or you’re just curious how smoking, alcohol, weight, and mood all intersect – this episode might leave you asking: how could these findings shape the conversations you’re having about risk, treatment options, and realistic expectations?
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