Semaglutide (sold as Ozempic, Wegovy and Rybelsus) was initially developed to treat diabetes. It works by stimulating the production of insulin to keep blood sugar levels in check.

This type of drug is increasingly being prescribed for weight loss, despite the fact it was initially approved for another purpose. Recently, there has been growing interest in another possible use: to treat addiction.

Anecdotal reports from patients taking semaglutide for weight loss suggest it reduces their appetite and craving for food, but surprisingly, it also may reduce their desire to drink alcohol, smoke cigarettes or take other drugs.

But does the research evidence back this up?

Animal studies show positive results

Semaglutide works on glucagon-like peptide-1 receptors and is known as a “GLP-1 agonist”.

Animal studies in rodents and monkeys have been overwhelmingly positive. Studies suggest GLP-1 agonists can reduce drug consumption and the rewarding value of drugs, including alcohol, nicotine, cocaine and opioids.

Out team has reviewed the evidence and found more than 30 different pre-clinical studies have been conducted. The majority show positive results in reducing drug and alcohol consumption or cravings. More than half of these studies focus specifically on alcohol use.

However, translating research evidence from animal models to people living with addiction is challenging. Although these results are promising, it’s still too early to tell if it will be safe and effective in humans with alcohol use disorder, nicotine addiction or another drug dependence.

What about research in humans?

Research findings are mixed in human studies.

Only one large randomised controlled trial has been conducted so far on alcohol. This study of 127 people found no difference between exenatide (a GLP-1 agonist) and placebo (a sham treatment) in reducing alcohol use or heavy drinking over 26 weeks.

In fact, everyone in the study reduced their drinking, both people on active medication and in the placebo group.

However, the authors conducted further analyses to examine changes in drinking in relation to weight. They found there was a reduction in drinking for people who had both alcohol use problems and obesity.

For people who started at a normal weight (BMI less than 30), despite initial reductions in drinking, they observed a rebound increase in levels of heavy drinking after four weeks of medication, with an overall increase in heavy drinking days relative to those who took the placebo.

There were no differences between groups for other measures of drinking, such as cravings.

In another 12-week trial, researchers found the GLP-1 agonist dulaglutide did not help to reduce smoking.

However, people receiving GLP-1 agonist dulaglutide drank 29% less alcohol than those on the placebo. Over 90% of people in this study also had obesity.

Smaller studies have looked at GLP-1 agonists short-term for cocaine and opioids, with mixed results.

There are currently many other clinical studies of GLP-1 agonists and alcohol and other addictive disorders underway.

While we await findings from bigger studies, it’s difficult to interpret the conflicting results. These differences in treatment response may come from individual differences that affect addiction, including physical and mental health problems.

Larger studies in broader populations of people will tell us more about whether GLP-1 agonists will work for addiction, and if so, for whom.

How might these drugs work for addiction?

The exact way GLP-1 agonists act are not yet well understood, however in addition to reducing consumption (of food or drugs), they also may reduce cravings.

Animal studies show GLP-1 agonists reduce craving for cocaine and opioids.

This may involve a key are of the brain reward circuit, the ventral striatum, with experimenters showing if they directly administer GLP-1 agonists into this region, rats show reduced “craving” for oxycodone or cocaine, possibly through reducing drug-induced dopamine release.

Using human brain imaging, experimenters can elicit craving by showing images (cues) associated with alcohol. The GLP-1 agonist exenatide reduced brain activity in response to an alcohol cue. Researchers saw reduced brain activity in the ventral striatum and septal areas of the brain, which connect to regions that regulate emotion, like the amygdala.

In studies in humans, it remains unclear whether GLP-1 agonists act directly to reduce cravings for alcohol or other drugs. This needs to be directly assessed in future research, alongside any reductions in use.

Are these drugs safe to use for addiction?

Overall, GLP-1 agonists have been shown to be relatively safe in healthy adults, and in people with diabetes or obesity. However side effects do include nausea, digestive troubles and headaches.

And while some people are OK with losing weight as a side effect, others aren’t. If someone is already underweight, for example, this drug might not be suitable for them.

In addition, very few studies have been conducted in people with addictive disorders. Yet some side effects may be more of an issue in people with addiction. Recent research, for instance, points to a rare risk of pancreatitis associated with GLP-1 agonists, and people with alcohol use problems already have a higher risk of this disorder.

Other drugs treatments are currently available

Although emerging research on GLP-1 agonists for addiction is an exciting development, much more research needs to be done to know the risks and benefits of these GLP-1 agonists for people living with addiction.

In the meantime, existing effective medications for addiction remain under-prescribed. Only about 3% of Australians with alcohol dependence, for example, are prescribed medication treatments such as like naltrexone, acamprosate or disulfiram. We need to ensure current medication treatments are accessible and health providers know how to prescribe them.

Continued innovation in addiction treatment is also essential. Our team is leading research towards other individualised and effective medications for alcohol dependence, while others are investigating treatments for nicotine addiction and other drug dependence.

Read the other articles in The Conversation’s Ozempic series here.

Shalini Arunogiri, Addiction Psychiatrist, Associate Professor, Monash University; Leigh Walker, , Florey Institute of Neuroscience and Mental Health, and Roberta Anversa, , The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

From “breathwork recipes” to breathing techniques, many social media and health websites are recommending breathwork to reduce stress.

But breathwork is not new. Rather it is the latest in a long history of breathing techniques such as Pranayama from India and qigong from China. Such practices have been used for thousands of years to promote a healthy mind and body.

The benefits can be immediate and obvious. Try taking a deep breath in through your nose and exhaling slowly. Do you feel a little calmer?

So, what’s the difference between the breathing we do to keep us alive and breathwork?

Breathwork is about control

Breathwork is not the same as other mindfulness practices. While the latter focus on observing the breath, breathwork is about controlling inhalation and exhalation.

Normally, breathing happens automatically via messages from the brain, outside our conscious control. But we can control our breath, by directing the movement of our diaphragm and mouth.

The diaphragm is a large muscle that separates our thoracic (chest) and abdominal (belly) cavities. When the diaphragm contracts, it expands the thoracic cavity and pulls air into the lungs.

Controlling how deep, how often, how fast and through what (nose or mouth) we inhale is the crux of breathwork, from fire breathing to the humming bee breath.

Breathwork can calm or excite

Even small bits of breathwork can have physical and mental health benefits and complete the stress cycle to avoid burnout.

Calming breathwork includes diaphragmatic (belly) breathing, slow breathing, pausing between breaths, and specifically slowing down the exhale.

In diaphragmatic breathing, you consciously contract your diaphragm down into your abdomen to inhale. This pushes your belly outwards and makes your breathing deeper and slower.

You can also slow the breath by doing:

• box breathing (count to four for each of four steps: breathe in, hold, breathe out, hold), or
• coherent breathing (controlled slow breathing of five or six breaths per minute), or
• alternate nostril breathing (close the left nostril and breathe in slowly through the right nostril, then close the right nostril and breathe out slowly through the left nostril, then repeat the opposite way).

You can slow down the exhalation specifically by counting, humming or pursing your lips as you breathe out.

In contrast to these calming breathing practices, energising fast-paced breathwork increases arousal. For example, fire breathing (breathe in and out quickly, but not deeply, through your nose in a consistent rhythm) and Lion’s breath (breathe out through your mouth, stick your tongue out and make a strong “haa” sound).

What is happening in the body?

Deep and slow breathing, especially with a long exhale, is the best way to stimulate the vagus nerves. The vagus nerves pass through the diaphragm and are the main nerves of the parasympathetic nervous system.

Simulating the vagus nerves calms our sympathetic nervous system (fight or flight) stress response. This improves mood, lowers the stress hormone cortisol and helps to regulate emotions and responses. It also promotes more coordinated brain activity, improves immune function and reduces inflammation.

Taking deep, diaphragmatic breaths also has physical benefits. This improves blood flow, lung function and exercise performance, increases oxygen in the body, and strengthens the diaphragm.

Slow breathing reduces heart rate and blood pressure and increases heart rate variability (normal variation in time between heart beats). These are linked to better heart health.

Taking shallow, quick, rhythmic breaths in and out through your nose stimulates the sympathetic nervous system. Short-term, controlled activation of the stress response is healthy and develops resilience to stress.

Breathing in through the nose

We are designed to inhale through our nose, not our mouth. Inside our nose are lots of blood vessels, mucous glands and tiny hairs called cilia. These warm and humidify the air we breathe and filter out germs and toxins.

We want the air that reaches our airways and lungs to be clean and moist. Cold and dry air is irritating to our nose and throat, and we don’t want germs to get into the body.

Nasal breathing increases parasympathetic activity and releases nitric oxide, which improves airway dilation and lowers blood pressure.

Consistently breathing through our mouth is not healthy. It can lead to pollutants and infections reaching the lungs, snoring, sleep apnoea, and dental issues including cavities and jaw joint problems.

A free workout

Slow breathing – even short sessions at home – can reduce stress, anxiety and depression in the general population and among those with clinical depression or anxiety. Research on breathwork in helping post-traumatic stress disorder (PTSD) is also promising.

Diaphragmatic breathing to improve lung function and strengthen the diaphragm can improve breathing and exercise intolerance in chronic heart failure, chronic obstructive pulmonary disease and asthma. It can also improve exercise performance and reduce oxidative stress (an imbalance of more free radicals and/or less antioxidants, which can damage cells) after exercise.

A mind-body connection you can access any time

If you feel stressed or anxious, you might subconsciously take shallow, quick breaths, but this can make you feel more anxious. Deep diaphragmatic breaths through your nose and focusing on strong exhalations can help break this cycle and bring calm and mental clarity.

Just a few minutes a day of breathwork can improve your physical and mental health and wellbeing. Daily deep breathing exercises in the workplace reduce blood pressure and stress, which is important since burnout rates are high.

Bottom line: any conscious control of your breath throughout the day is positive.

So, next time you are waiting in a line, at traffic lights or for the kettle to boil, take a moment to focus on your breath. Breathe deeply into your belly through your nose, exhale slowly, and enjoy the benefits.

Theresa Larkin, Associate professor of Medical Sciences, University of Wollongong and Judy Pickard, Senior Lecturer, Clinical Psychology, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.