When you start continually using a substance such as alcohol, opioids or cocaine, your body not only builds up a tolerance, but it eventually starts to develop cravings for that substance. This isn’t all too dissimilar to cravings you will have for certain kinds of food.
When one’s hunger hormones are out of whack, the person is at risk of overeating and eventually obesity. Researchers have begun studying this phenomenon as it relates to drug and alcohol use. And in limited trials to this point, they have found quite positive results.
This article will break down the likely connection between hunger hormones and substance cravings, and then we will get into the latest advancements and what they could mean for treating addiction in the near future.
How Hunger Hormones May Be Related to Substance Use
As we learn more about overeating and obesity, the more important it is to focus on how hunger hormones (aka gut hormones) work. And as scientists study these hormones more and more, they are finding an increasingly stronger connection to the continued use of alcohol or drugs.
“Hormones from the gut act in the brain to modulate dopamine signaling, which controls decisions to seek out rewards,” said Dr. Mitchell Roitman, University of Illinois-Chicago neuroscientist, in a Society for the Study of Ingestive Behavior article.
It’s no secret that drugs and alcohol have a direct effect on the brain’s dopamine production. Dopamine is a chemical in the brain sent by neurons to other nerve cells. In most cases, drug and alcohol use temporarily speeds up the production of dopamine. It tempts people into repeating and reinforcing this perceived pleasurable activity.
Prolonged substance use changes the brain’s natural ability to produce dopamine, and the body physiologically wants more of the substance in order to feel “normal” again. There is a reward in the brain when substances are used to achieve a certain state, and after a while, that reward almost becomes expected, leaving the person on edge until it is met again.
So if gut hormones have an effect on dopamine, and drugs and alcohol do, too, it follows that the key to fighting substance abuse should be in figuring out how to regulate these hormones. We are starting to understand that gut hormones are responsible for our cravings for more than just food, but any substance we put into our bodies.
Which Hormones Play a Role in Cravings?
There are three main gut hormones in play when it comes to regulating cravings and how “full” someone is regarding food, liquids, substances and more. These hormones are:
- Ghrelin: The primary hunger hormone that increases appetite and food intake while promoting fat storage. It also plays a role in insulin release, and it can act on regions of the brain known for reward processing. A recent study found that ghrelin can influence the reward value of alcohol intake similar to the way it increases the reward value of food.
- GLP-1: A hormone that releases while eating to tell the brain when the person has eaten enough. GLP-1 originates in the small intestine, and it stimulates insulin secretion while inhibiting glucagen secretion. This lowers the blood sugar levels in the body.
- Amylin: Another hormone that tells the brain when to stop eating, and it also mitigates glucagen secretion. Diabetic patients are deficient in this peptide hormone.
Medications that Focus on These Hormones
If GLP-1 and amylin tell the person when to stop eating or drinking, then focusing on these hormones appears to be the key to regulating cravings and preventing overconsumption.
“Medications affecting GLP-1 and amylin are already FDA approved for Type II diabetes and obesity. These drugs could be repurposed for treating drug craving and relapse,” said Dr. Heath Schmidt of the University of Pennsylvania’s Perelman Medical School.
And at the University of Rhode Island, a group of researchers from the school’s College of Pharmacy have begun studying how a ghrelin-inhibiting drug affects alcohol cravings. Their studies have worked under the theory that higher concentrations of ghrelin are associated with higher alcohol cravings and consumption.
Professor Fatemeh Akhlaghi said that his team has found positive results when using a drug to block ghrelin in order to stave off alcohol cravings. So far, they have tested this medication in rats, as well as 12 volunteer patients. Their study was published in May in the journal Molecular Psychiatry.
Granted, scientists need to do further research in order to make a rock-solid conclusion about treating substance cravings by inhibiting ghrelin. But, the early results show much promise, at least.
Types of Diabetes Drugs – and Their Drawbacks
When focusing on hunger hormones in order to reduce alcohol cravings, the goal would be to:
- Mitigate ghrelin levels.
- Increase GLP-1 and amylin production.
The University of Rhode Island team used a drug originally developed by Pfizer to treat obesity and diabetes in their study. Elsewhere, scientists are focusing on GLP-1 analogs and agonists. In total, all aforementioned drugs have to do with diabetes and obesity, but scientists are now looking at them as a potential solution to alcohol and drug cravings.
If you’re not familiar with GLP-1 agonists, also called incretin mimetics, some common names to know are (generic name followed by brand name in parentheses):
- Dulaglutide (Trulicity)
- Exenatide (Bydureon)
- Exenatide (Byetta)
- Liraglutide (Victoza)
- Lixisenatide (Adlyxin)
- Semaglutide (Ozempic)
An agonist means it boost the production of, in this case, GLP-1. The drugs listed here are for type 2 diabetes patients and injectable, but they aren’t insulin. Instead, they improve blood sugar control and make you feel “full” more quickly – and for a longer period of time. This helps prevent overeating and, by extension, promotes weight loss.
However, you have to be careful when using GLP-1 agonist drugs and watch for side effects such as:
- Either diarrhea or constipation
- Nausea and vomiting
- Loss of appetite
- Heavy sweating
Managing Cravings in Rehabilitation and Recovery
Drug and alcohol addiction recovery programs typically place a major emphasis on managing cravings. This is often part of their relapse prevention education, in which clients learn about cravings and then practice a few strategies for keeping them in check. This is especially important as they graduate the program and return home to everyday life with no therapist or doctor to watch over them 24/7.
Cravings tend to last two to five years in most clients, although they can persist longer in some cases. They tend to lessen in intensity and frequency in time, but it’s important for people in recovery to know how to manage them and not let them draw them into relapse.
Although medications such as diabetes drugs may eventually become popular in order to help with substance cravings, they are not quite ready yet. In the meantime, learn some tried-and-true relapse prevention techniques, and find a rehab program that will teach these to you and give you sufficient time to practice these before you return home as a sober individual.