I hate alcohol. I'm just gonna say it out loud, I've never liked it, conceptually. I've never had a full “drink” in my life. I've had a couple of sips of wine and beer in my early childhood, another sip of potato sake because somebody tricked me into it when I was 21, and a sip of this or that over the years from girlfriends or my wife.
Alcohol has not been kind to my family. My father was an alcoholic for the majority of his life. By alcoholic, I'm using the colloquial term for alcohol use disorder. You know disease is bad—and pervasive— if you need a colloquial term for it.
Not drinking when you're a teenager means you're not cool. It means either you don't get invited to the cool parties, or you're just actively hostile to the cool kids, and their drinking, and their drugs. At the Taft school, between 1994 and 1997, there was a lot of drugs, and there was a lot of drinking. There's more of that at college all over again. I went to Amherst College, where we worked hard and played hard. And by played hard? Almost everybody means drank hard— except for me. I either didn't go to those sorts of parties, or I did, gritted my teeth, and couldn't help but notice this whole thing was a terrible idea.
Owen Muir, M.D., at 46, is still not drinking.
I remember in my junior year of college, my friends and I put together a bunch of signs before a major party on campus, and those signs were actively hostile to the alcohol soaked rape culture around us.
“An intoxicated person can't consent, try waiting till she's sober.”
I know, I'm so punk rock. I'm also such a huge asshole. I get it. Now, at least, I get it. A lot of the classmates had a real problem, and they couldn't do much about it. It was pervasive, it was socially sanctioned, and nobody, but nobody, was gonna not be drinking. I mean, I guess you could be me, but nobody really liked what I was doing. Some would bother with peer pressure, but most of the time, they were just kind of like generically disappointed.
The frontier psychiatrists is a daily health-themed newsletter. The plural is currently an anachronism. It’s written by Owen Scott Muir, M.D., a child and adult Psychiatrist and Healthcare muckety-muck. Please subscribe to support this absurd endeavor. Today, I'm writing about a question people ask all the time, but probably shouldn't.
Well, after that exciting data, I'm bringing up the fact that many more women, after they get out of childhood, become victims of sexual assault thereafter:
Conservative estimates of sexual assault prevalence suggest that 25 percent of American women have experienced sexual assault, including rape. Approximately one-half of those cases involve alcohol consumption by the perpetrator, victim, or both. Alcohol contributes to sexual assault through multiple pathways, often exacerbating existing risk factors.1
Although most of the women who report a sexual assault to the authorities were assaulted by a stranger, the overwhelming majority, 80% of sexual assaults, are perpetrated by someone the woman already knows.2 Further, approximately 90 percent of rapes perpetrated by an acquaintance of the victim involve alcohol. The horrifying out-of-the-blue sexual assaults by a stranger? That's also alcohol for you:
For example, sexual assaults involving alcohol consumption are more likely than other sexual assaults to occur between men and women who do not know each other well (e.g., strangers, acquaintances, or casual dates as opposed to steady dates or spouses). Furthermore, alcohol-involved sexual assaults tend to occur at parties or in bars, rather than in either person’s home3
Research has been done, with some modeling to understand why alcohol makes sexual assault more likely, and the leading theory is that alcohol is great at making people mutually “not get it:”
During a date or other social interaction, many points occur at which a man evaluates the potential sexual meaning of a female companion’s verbal or non-verbal cues. Alcohol can contribute to the misperception of the woman’s cues in such a way that the man perceives her as being more encouraging than she really is because of alcohol’s effects on his cognitive functioning. The woman experiences the same cognitive deficits as the man does if the woman also consumes alcohol. Thus, if she feels that she has made it clear that she is not interested in sex at this point, alcohol consumption will make her less likely to process the man’s cues indicating that he has misread her intentions.4
As if all that wasn't bad enough, alcohol also increases the risk of intimate partner violence (I'm gonna miss the CDC when these kinds of numbers are deemed inconvenient by the men in power who find their sexual assaulting impinged upon by such data):
About 41% of women and 26% of men experienced contact sexual violence, physical violence, or stalking by an intimate partner during their lifetime and reported a related impact.
Over 61 million women and 53 million men have experienced psychological aggression by an intimate partner in their lifetime.5
Dealing with women who have been raped is also traumatic for the psychological professionals and physicians who care for them, as one study of vicarious trauma from South Africa, with perhaps the best name of any study I've ever seen, points out:
“I found that I was actually avoiding certain wards in the hospital. I would turn on my heels and not go into particular wards. Some days when I drive into work, I feel a deep sense of dread; there’s part of me that wants to run for the hills. I started noticing that I was cutting [patient] interviews short.”
…
One clinician disclosed that she had developed vaginismus, which she ascribed to the psychological impact of her work on her body: “I had developed vaginismus. Intercourse was very painful, and that was also because I would think about the [patient’s] abuse just before we have sexual relations, or I would get a flashback and that would be extremely difficult for me.”6
As a health professional, I've heard quite enough in my life about the sexual violence against women, physical violence against women, and the crime and physical violence against everybody else. I'm not into it. And a major contributor, as I hope I've demonstrated, is alcohol. So I hope you can all now join me as we celebrate the fall of alcohol, which I am depositing is in part due to the rise of GLP-1s.
There was a big spike in drinking during the pandemic, but now, it's coming down:
When asked in April 2023, 54% of Gen Z … adults in the US say they have not consumed an alcoholic beverage in the past six months, compared to 37% of the total [legal drinking age] population.
Also, mocktails and non-alcoholic drinks are booming (which, as a consumer and friend of a mocktail company founder, I’m excited to hear):
Between 2018 and 2022, volumes of both no- and low-alcohol products in the US more than doubled, and IWSR expects strong growth to continue in the years ahead, forecasting a volume CAGR gain of +17% for no-alcohol between 2022 and 2027.
Here is a discount link. They are better than drinking alcohol and soda.
Now, part of the slowdown in very expensive alcohol may be economic, and part of it may be cultural. Still, I'm also gonna argue that I think GLP-1s ones are doing a thing that the economy was never capable of doing on its own, which was slowing the actual craving for alcohol.
Heavy drinkers are responsible for a massive amount of the revenue of the alcohol industry:
Those drinking above guideline levels are estimated to account for 68% of total alcohol sales revenue in 2013/14: 81% of off-trade revenue and 60% of on-trade revenue. This represents 77% of beer, 70% of cider, 66% of wine and 50% of spirits sales value. The heaviest drinking 4% of the population account for 30% of all consumption and 23% of all industry revenue. If all consumers reduced their drinking to within guideline levels, alcohol sales revenue could decline by 38% (£13 billion).7
At least in that UK data set…
When you drill down into the data, only a few people are drinking most of the alcohol. Those are often the same people who were getting blasted drunk. Blasted-level drunk people tend to be the ones causing the problems when it comes to intoxication-related issues. There's also a plausible mechanism of the relationship between weight gain and alcohol, in that alcohol is very energy-dense:
Finally, other recent studies have shown that heavy drinking may be more of a risk factor for weight gain than light-to-moderate drinking… Sayon-Orea et al. [46] found that drinking more than seven times per week was associated with increased risk of weight gain and development of overweight and obesity.8
GLP-1s are Taken By Those More Likely to Drink Too Much Already
Which is, of course, part of my argument, suggesting that the cohort most likely to be already taking GLP-1s are those who are already overweight, obese, or have diabetes, and those individuals have alcohol overuse over-represented.
About 1 in 8 US adults aged 18 years or older report having ever used a glucagon-like peptide 1 (GLP-1) agonist medication, according to results from a KFF (formerly Kaiser Family Foundation) poll involving about 1500 respondents. This includes the 6% of people currently using a GLP-1 agonist such as semaglutide, marketed as Ozempic or Wegovy.
Alcoholic-ish rats have been benefiting from semaglutide since 2023, in a hilariously titled “drinking-in-the-dark” paradigm, which I suspect is not entirely dissimilar from human Biobehavioral models, if college taught me anything:
A drinking-in-the-dark procedure was used to test the effects of semaglutide on binge-like drinking in male and female mice. We also tested the effects of semaglutide on binge-like and dependence-induced alcohol drinking in male and female rats.10
And we now have RCT evidence that drinking is reduced by GLP-1s in humans, too:
In this randomized clinical trial, relative to placebo, low-dose semaglutide reduced the amount of alcohol consumed during a posttreatment laboratory self-administration procedure. Over 9 weeks of treatment, semaglutide led to reductions in some but not all measures of weekly consumption, significantly reduced weekly alcohol craving relative to placebo, and led to greater relative reductions in cigarettes per day in a subgroup of participants with current cigarette use.11
That's only one Study, with only 24 people randomized to the semaglutide. However, 12% of the US population is now being treated with “open-label” and often higher-dose GLP-1 drugs already. It might be enough to drive alcohol use off a cliff! This hunch of mine? Well, astute authors are already on top of it, and confirming my suspicion is large-scale samples:
In this retrospective cohort study of electronic health records of 83,825 patients with obesity, we show that semaglutide compared with other anti-obesity medications is associated with a 50%-56% lower risk for both the incidence and recurrence of alcohol use disorder for a 12-month follow-up period….Similar findings are replicated in the study population with 598,803 patients with type 2 diabetes.12
Remember, alcohol use disorder individuals are the ones who buy the majority of the alcohol. If it wasn't for alcohol, used disorder, we wouldn't have a profitable, alcohol industry at the current prices of booze. Alcoholics are subsidizing the drinks for those who drink moderately, after a fashion. And we are all subsidizing the illness of those alcohol-use-disorder-stricken individuals with our insurance premiums and criminal justice system tax funding. Functionally, we're also sacrificing our daughters, sisters, wives, and, for women, themselves, at the very fickle altar of high-dose drinking, particularly in youth, being the norm.
Ending Rape Culture By Ending Drinking Culture, with GLP-1s
Semaglutide may be the best alcohol used to serve treatment we've ever created, and it was entirely by accident. Quoting Nora Volkow, M.D., one of the most important substance use disorder academics ever, “Compared to naltrexone or topiramate, semaglutide was associated with a significantly lower risk of recurrent AUD diagnosis.”
Yes, that's the same medicines that have been the cornerstone of alcohol use disorder treatment for years—and they work less well than semaglutide, probably. But you know what is even better about GLP-1s? You don't have to use them because you have an alcohol used disorder. You want to use them anyway. Do you wanna be less obese? Do you wanna have diabetes go away? Then you're gonna take a GLP-1. These drugs are not just treatments for obesity and diabetes, but they are also primary prevention for alcohol use disorder. This is awesome, in and of itself, for everybody, except those involved in the alcohol industry for a living. But it's especially awesome for young people, and young women. Because it means men are less likely to drink as much, and that means they're less likely to rape women and assault women physically.
And yes, it’s overwhelminglymen who commit these crimes. Ninety percent of people who commit violent physical assault are men. Males perpetrate 95% of all serious domestic violence.13
Alcohol is rape sauce. I'm sorry, it's a lot of other things, but it's also definitely rape sauce. Slapping it out of the hands of men is not an option, but having them all clamor for a drug that reduces their desire to drink it in the first place? That's a huge win for human health, and it's a huge win for women. It's also a massive win for men, who want untraumatized women in their lives, and who would rather not be violent offenders themselves.
Viva la sobriety, viva la GLP-1s. I'm excited for a world where we don't have to worry about alcohol increasing the already pervasive risk of sexual assault among women. Complaining about it doesn't do any good, but encouraging men everywhere to pursue GLP-1 treatment just might.
Abbey A, Zawacki T, Buck PO, Clinton AM, McAuslan P. Alcohol and sexual assault. Alcohol Res Health. 2001;25(1):43-51. PMID: 11496965; PMCID: PMC4484576.
Abbey A, Ross LT, McDuffie D, McAuslan P. Alcohol, misperception, and sexual assault: How and why are they linked? In: Buss DM, Malamuth N, editors. Sex, Power, Conflict: Evolutionary and Feminist Perspectives. New York: Oxford University Press; 1996b. pp. 138–161
Abbey A, McAuslan P, Ross LT. Sexual assault perpetration by college men: The role of alcohol, misperception of sexual intent, and sexual beliefs and experiences. Journal of Social and Clinical Psychology. 1998;17:167–195.
Gilbert, L. K., Zhang, X., Basile, K. C., Breiding, M., & Kresnow, M. (2022). Intimate Partner Violence and Health Conditions Among U.S. Adults—National Intimate Partner Violence Survey, 2010–2012. Journal of Interpersonal Violence, 38(1-2), 237-261. https://doi.org/10.1177/08862605221080147 (Original work published 2023)
Padmanabhanunni, A., & Gqomfa, N. (2022). “The Ugliness of It Seeps into Me”: Experiences of Vicarious Trauma among Female Psychologists Treating Survivors of Sexual Assault. International Journal of Environmental Research and Public Health, 19(7), 3925. https://doi.org/10.3390/ijerph19073925
Bhattacharya A, Angus C, Pryce R, Holmes J, Brennan A, Meier PS. How dependent is the alcohol industry on heavy drinking in England? Addiction. 2018 Dec;113(12):2225-2232. doi: 10.1111/add.14386. Epub 2018 Aug 22. PMID: 30136436.
Hendershot, C. S., Bremmer, M. P., Paladino, M. B., Kostantinis, G., Gilmore, T. A., Sullivan, N. R., ... & Klein, K. R. (2025). Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. JAMA psychiatry, 82(4), 395-405.
Wang, W., Volkow, N.D., Berger, N.A. et al. Author Correction: Associations of semaglutide with incidence and recurrence of alcohol use disorder in real-world population. Nat Commun15, 5177 (2024). https://doi.org/10.1038/s41467-024-49655-6
What you miss out is the personal benefits of moderate drinking... The "placebo effect" and the chemical influence.... From someone who enjoys the occasional drink, but more for the placebo effect than anything else... The other point is that the horrific figures about sexual violence are lifetime figures, if you look at assault rates in the past year they suddenly dwindle to minimal levels (I'm thinking of the domestic violence rate against women here, which is less than one percent in the past year but some ridiculous lifetime figure) which does make me think people deliberately choose the number that will inflate emotions...
Viva La Sobriety!! and may we revive curious self assessment for all those abusing it...Such a curious molecule. Almost always dulling the senses. Heightening something else for some of us, and so often something terrible...To escape, in my view, almost always to escape something. Whether it's the circumstances that surround us or to escape our own essence and the cloak of understanding created by our ego. May we each find a better molecule! There are so many others that it should be inevitable.
What you miss out is the personal benefits of moderate drinking... The "placebo effect" and the chemical influence.... From someone who enjoys the occasional drink, but more for the placebo effect than anything else... The other point is that the horrific figures about sexual violence are lifetime figures, if you look at assault rates in the past year they suddenly dwindle to minimal levels (I'm thinking of the domestic violence rate against women here, which is less than one percent in the past year but some ridiculous lifetime figure) which does make me think people deliberately choose the number that will inflate emotions...
Viva La Sobriety!! and may we revive curious self assessment for all those abusing it...Such a curious molecule. Almost always dulling the senses. Heightening something else for some of us, and so often something terrible...To escape, in my view, almost always to escape something. Whether it's the circumstances that surround us or to escape our own essence and the cloak of understanding created by our ego. May we each find a better molecule! There are so many others that it should be inevitable.