The Future of Addiction Treatment Starts Here: GLP-1s Explained With Dr. Ken Spielvogel

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• GLP-1 medications, particularly the dual agonist Tirzepatide (Zepbound), show significant promise in addiction treatment by dampening the brain's dopamine reward response to substances, leading to reduced cravings and relapse risk.  Copied to clipboard!
• The effectiveness and compliance of injectable GLP-1s far surpass early oral versions due to issues with absorption and the need for strict patient adherence, which is difficult for those in early recovery.  Copied to clipboard!
• The use of GLP-1s must be coupled with supervised medical guidance, exercise, and lifestyle changes, as medication alone is insufficient for long-term healing and preventing muscle loss associated with rapid weight reduction.  Copied to clipboard!

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GLP-1s and Medical Guidance

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(00:00:00)

• Key Takeaway: Using GLP-1 drugs without supervised guidance on exercise and fitness is a disservice to the patient.
• Summary: Using GLP-1 drugs without guidance from a medical professional regarding exercise and fitness metrics is detrimental. One Call Placement is affiliated with Carrera Treatment, Wellness, and Spa. Dr. Kenneth Spiel Vogel, Senior Medical Officer at Carrera, joins the discussion on GLP-1 medications.

Host’s Initial Skepticism Confession

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(00:01:49)

• Key Takeaway: The host publicly admitted being wrong about the efficacy of GLP-1s for addiction two years prior.
• Summary: The host confessed to initially laughing at the idea of GLP-1s limiting cravings two years ago when Carrera began exploring their use. The host noted that the medication drastically reduced his Cuban cigar consumption from 15 a day to struggling to smoke two. This personal anecdote illustrates the drug’s potent effect on compulsive behavior.

GLP-1s and Unsupervised Use

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(00:04:07)

• Key Takeaway: The current trend of obtaining GLP-1s over the internet without medical oversight mirrors the chaotic early adoption of Botox.
• Summary: The revolution of GLP-1s is likened to Botox, where medical oversight rapidly diminished as practitioners injected people without proper guidance. Receiving these medications over the internet constitutes piecemeal medicine, which Dr. Spiel Vogel strongly opposes. The conversation pivots to understanding why GLP-1s entered the addiction conversation.

Injectable vs. Oral Compliance

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(00:04:55)

• Key Takeaway: Injectable GLP-1s are superior to early oral versions because oral absorption was highly variable and required strict fasting protocols.
• Summary: Early oral versions of GLP-1s suffered from variable intestinal absorption, requiring patients to fast before and after dosing. For addiction treatment, where regimented schedules are difficult for many, less frequent dosing like a weekly injection improves compliance significantly. Patients using Ozempic reported not only feeling fuller but also experiencing less craving for food, alcohol, and nicotine.

Ozempic vs. Zepbound Mechanism

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(00:06:46)

• Key Takeaway: Zepbound (tirzepatide) is a dual GLP-1/GIP receptor agonist, making it more effective at appetite suppression and squashing addictive behavior than Ozempic (semaglutide), a single GLP-1 agonist.
• Summary: Zepbound (tirzepatide) works on two receptor sites (GLP and GIP), whereas Ozempic (semaglutide) works on one, suggesting two mechanisms are better than one for weight loss and appetite suppression. The host experienced a significant reduction in smoking consumption on Zepbound, which he did not on Ozempic. These drugs temper the dopamine response associated with pleasurable activities like drug use.

Dopamine Reward System Impact

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(00:08:17)

• Key Takeaway: GLP-1s act as a ‘dopamine traffic cop’ by tempering the massive dopamine surges caused by substances like methamphetamine, facilitating a faster reset of the addicted brain’s signaling pathways.
• Summary: Substances like meth cause an extreme dopamine surge (up to 10 times that of cocaine) in the VTA, hooking users immediately. GLP-1s (semaglutide, terzepatide) squash and temper this dopamine response, preventing the massive surge. This action helps reset the dopamine system in a more timely fashion compared to the long recovery period required for meth addicts.

Nicotine Replacement Therapy Interaction

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(00:10:36)

• Key Takeaway: Nicotine replacement therapies like the patch or gum still help clear the host’s morning brain fog, suggesting the GLP-1 does not negate the cognitive benefits of nicotine delivery without smoking.
• Summary: The host uses a nicotine patch and gum in the morning to combat brain fog, which he finds helpful for waking up. He does not experience a reward feeling from the patch or gum, only mental clarity. Nicotine itself receives a bad rap due to the harmful delivery system of smoking.

Obesity and Addiction Overlap

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(00:12:10)

• Key Takeaway: Obesity is viewed as an addiction, and GLP-1s are crucial for reducing ‘food noise’ and compulsion, which is described as torture for sufferers.
• Summary: Obesity remains a major public health crisis, with over 50% of Americans affected, despite the availability of these drugs. GLP-1s decrease the compulsion and ‘food noise’ associated with overeating. Decreasing this internal noise is a huge benefit for individuals struggling with compulsion related to food, nicotine, or alcohol.

Carrera’s Early Patient Success Story

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(00:13:36)

• Key Takeaway: A wealthy client with alcoholism, cocaine, and sex addiction experienced fantastic results after just two injections of a GLP-1, with the noise around alcohol disappearing.
• Summary: Carrera began using GLP-1s two years ago, starting with a client who was medically compromised with diabetic-range A1C. The client was started on a low dose (2.5mg) to avoid severe gastrointestinal side effects common with the standard 5mg starting dose. After increasing to 5mg, the client reported the noise surrounding alcohol use completely vanished.

Off-Label Drug Use Precedent

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(00:17:50)

• Key Takeaway: Using GLP-1s off-label for addiction is medically justifiable, similar to established off-label uses like baby aspirin for cardiovascular prevention or Indocin for preterm labor.
• Summary: The argument that GLP-1 use for addiction is ‘off-label’ ignores common medical practice where drugs are used for proven benefits outside their initial indication. Baby aspirin, originally not intended for clot prevention, is widely used for cardiovascular disease prevention. Indocin, an anti-inflammatory, is used off-label to relax uterine contractions during preterm labor.

GLP-1s as Best Addiction Intervention

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(00:19:46)

• Key Takeaway: Richard Taite declared GLP-1s the best drug he has ever seen for treating drug addiction and alcoholism, surpassing Naltrexone, Abuse, and Vivitrol.
• Summary: This medication is considered the best intervention for addiction, second only to Narcan for immediate life-saving effects. Clients are staying sober at much higher rates than previously observed with other treatments. The host believes this drug is superior to established medications like Naltrexone and Vivitrol.

GLP-1s Impact on Major Killers

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(00:20:57)

• Key Takeaway: GLP-1s may reduce the risk of the four leading causes of death: cardiovascular disease, cancer, Alzheimer’s/dementia, and metabolic diseases like diabetes.
• Summary: GLP-1s improve arterial health, lower blood pressure, and reduce weight, directly addressing cardiovascular disease, the number one killer. By controlling weight and improving insulin sensitivity, they lower inflammation, potentially reducing risks for cancers like breast and prostate cancer. Emerging data suggests GLP-1s may reduce plaque formation in the brain, mitigating Alzheimer’s risk.

Common Side Effects and Dosing

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(00:25:02)

• Key Takeaway: The most common side effects of GLP-1s are gastrointestinal (nausea, bloating, gas), but careful, slow dose titration prevents patients from discontinuing treatment.
• Summary: Gastrointestinal issues like nausea, bloating, and constipation are the primary side effects experienced when starting the medication. The host noted that starting at 2.5mg and slowly titrating up prevented him from becoming miserable, unlike clients who started at 5mg. The host now takes his dose every five days instead of weekly because he dislikes the needle.

Cost Reduction and Access Landscape

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(00:27:13)

• Key Takeaway: New pricing deals drastically lowering costs to $150-$250 monthly improve affordability, but accessibility remains an issue due to the need for provider consultation and self-injection.
• Summary: Cost reduction is positive, but the expense was less prohibitive for active addicts than for those seeking health maintenance. Lilly Direct is an excellent program allowing patients to receive medication directly via mail after enrollment. Compounding pharmacies offer cheaper, non-FDA-approved versions, but the official price drop may put them out of business.

Muscle Loss and Lifestyle Necessity

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(00:29:51)

• Key Takeaway: Rapid weight loss from GLP-1s necessitates weight-bearing exercise and high protein/supplement intake to prevent excessive muscle loss, which is the body’s largest endocrine organ.
• Summary: If patients do not exercise and supplement properly while losing weight, they lose muscle mass disproportionately to fat, leading to a detrimental yo-yo effect upon stopping the drug. Muscle mass is crucial as it manages sugar sensitivity and protects bones from fracture. Using these drugs without supervised guidance on fitness and diet is a disservice.

Future Delivery Systems and Hormones

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(00:38:22)

• Key Takeaway: The future of GLP-1s likely involves longer-acting injections (monthly) or patches, and optimizing patient health requires concurrent hormone replacement therapy and supplementation like creatine.
• Summary: Future delivery systems may include monthly injections or wearable meters, similar to advancements seen in HIV prevention (PrEP). For men, optimizing muscle mass requires high-dose creatine and, when appropriate, testosterone therapy. Women benefit from testosterone supplementation, which studies suggest can reduce breast cancer risk by up to 30%.