Impact on social media platforms from reduced compulsive use vs. AI-driven growth.
Projected 20-Year Change
-4.5%
-$35.7B annually
RethinkX | 2 June 2026
Addiction is one of the most devastating and least-solved public health crises in the United States. Roughly 50 million Americans struggle with substance use and addiction. Approximately 28 million people have alcohol use disorder, tobacco remains the leading cause of preventable death, and opioids alone kill tens of thousands of people every year.
The existing options for treatment are limited and imperfect:
On the behavioral side, abstinence-based programs and peer support groups like Alcoholics Anonymous and Narcotics Anonymous have helped many people, but they depend entirely on sustained willpower and social support, and the majority of participants relapse.
Residential treatment programs are expensive, inaccessible to most people, and show highly variable long-term outcomes.
On the pharmaceutical side, methadone and buprenorphine help manage opioid dependence but do not address the underlying craving architecture and are themselves controlled substances requiring tightly supervised dispensing.
Naltrexone blocks opioid receptors but requires sobriety to start and has poor long-term adherence.
For alcohol use disorder, naltrexone and acamprosate exist but produce modest results and most patients relapse.
For cocaine, methamphetamine, and gambling addiction, there are essentially no approved pharmaceutical treatments at all.
That is what makes the emerging evidence on GLP-1s so significant and potentially transformative.
GLP-1 receptor agonists act directly on the brain's dopamine reward pathways, the same neural circuits that drive addictive behavior across substances. The overlap between the circuits governing food craving and those governing substance craving was recognized early in GLP-1 research and has since been extensively documented. Users of semaglutide and tirzepatide consistently describe a quieting of food noise. The same quieting, it turns out, appears to apply to drug noise.
A large study published in The BMJ, analyzing records from over 600,000 US veterans, found that GLP-1 users were significantly less likely to develop a new substance use disorder across every substance category studied — including alcohol, cannabis, cocaine, nicotine, and opioids — with roughly 7 fewer new diagnoses per 1,000 people over three years compared to those taking a different diabetes medication. Among people who already had a substance use disorder, GLP-1 users also experienced substantially fewer overdoses, hospitalizations, and deaths related to substance use over the same period. A study published in the journal Addiction, analyzing data from over 1.3 million individuals, found that people with opioid use disorder who were prescribed GLP-1 drugs experienced opioid overdose events at roughly 60% of the rate of those who were not, and people with alcohol use disorder experienced alcohol intoxication events at roughly half the rate. The National Academies of Sciences, in a May 2025 review, concluded that preclinical and clinical evidence shows GLP-1 receptor agonists decrease drug use and seeking across alcohol, nicotine, and opioids. A randomized controlled trial showed that low-dose semaglutide reduced alcohol self-administration, drinks per day, and cravings in people with alcohol use disorder, with effect sizes reportedly larger than those seen with existing treatments like naltrexone or acamprosate.
Critically, these effects appear to extend well beyond alcohol and opioids. Users report reductions in gambling, compulsive shopping, and even doom-scrolling on social media, behaviors that share the same dopaminergic reward architecture as substance addiction. This suggests the mechanism may be genuinely broad, addressing a fundamental feature of how the brain assigns reward salience rather than targeting any one substance specifically.
Most addiction treatment today is reactive, intervening after dependence has already taken hold, but HOTs offer the game-changing possibility of population-level prevention. If tens of millions of adults are routinely taking GLP-1s for metabolic health optimization, and those drugs simultaneously reduce the rewarding properties of alcohol, nicotine, opioids, and other substances, the number of people who never develop addiction in the first place could dwarf the number who are treated after the fact. This would be an epidemiological shift analogous to what fluoridation did for tooth decay, or what statins did for cardiovascular events. The prevention potential of HOTs for addiction could actually be their most consequential contribution to public health.
The health implications of addressing addiction at the population level would be profound. Alcohol contributes to over $30 billion in annual healthcare costs through comorbidities including liver disease, cardiovascular damage, and cancer. Tobacco drives over $225 billion in comorbidity costs and remains the single largest cause of preventable death in the US. Opioids account for over $95 billion in comorbidity-related healthcare costs annually, and opioid overdose deaths have run at tens of thousands per year for over a decade. Across all substances, addiction-related illness creates an enormous burden on emergency departments, hospitals, mental health services, and long-term care.
Beyond health, the societal implications could be equally as large. According to the National Council on Alcohol and Drug Dependence, 80% of all criminal offenders abuse drugs or alcohol. Nearly 50% of jail and prison inmates are clinically addicted. About 60% of individuals arrested test positive for illegal drugs at the time of arrest. Alcohol is involved in roughly 40% of all violent crimes, 30% of all traffic fatalities, and a substantial fraction of domestic abuse and child abuse cases. The US criminal justice system costs nearly $300 billion annually at state and local levels alone, and as much as $110 billion of that is directly attributable to alcohol and drug abuse.
If HOTs meaningfully reduce the prevalence and severity of addiction across the population, through both treatment and prevention, the downstream effects on crime, incarceration, family stability, child welfare, and public finances would be extraordinary. Fewer addicted individuals could mean fewer crimes of desperation, fewer violent incidents, fewer overdose deaths, fewer children growing up in households destabilized by addiction. The criminal justice savings alone could reach into the tens of billions annually.
Formal clinical trials specifically powered to test GLP-1s as addiction treatments are still underway, and regulatory approval for substance use disorder indications requires the full phase 1 through 3 trial sequence. But the convergence of mechanistic plausibility, preclinical evidence, large-scale observational data, and early randomized trial results makes the addiction story one of the most compelling and under-appreciated dimensions of the entire HOTs disruption.
Projected 20-Year Market Impact from HOT Adoption
How quickly market change occurs.
Percentage of adults that adopt HOTs.
Decline in alcohol, tobacco, gambling, drugs, gaming, porn, and treatment per adopter.
Impact on social media platforms from reduced compulsive use vs. AI-driven growth.
When the most rapid phase of change begins.
Addictive Products & Treatment ($715B) includes alcoholic beverages ($260B), illicit drugs ($150B), tobacco/nicotine ($115B), gambling ($70B), digital gaming ($55B), addiction treatment ($55B), and pornography ($10B). Social Media ($85B) faces uncertain impact—compulsive "doom scrolling" may decrease, but AI advancements could drive continued growth. GLP-1s modulate dopamine signaling in the brain's reward pathways, appearing to moderate addictive and compulsive behaviors across categories.
We are entering a new era of healthcare based on a categorically different kind of medicine whose purpose is not just to save us from illness, but to help us be the best version of ourselves.
The next generation of HOTs will trigger a multi-trillion-dollar global disruption, affecting dozens of industries across multiple sectors, driving a radical global improvement in health and wellness encompassing at least 1 billion people worldwide before 2040.
Optimizing well with advanced HOTs will soon become as important as eating well with nutritious foods. Nations, industries, and individuals that recognize this early and act decisively will be best positioned to capture the extraordinary benefits of this transformation.
Learn more about the HOT disruption and its implications for health, society, and the economy.
Disclaimer
The information provided in this FAQ is for general informational and educational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. This content does not establish a doctor-patient relationship. The content regarding GLP-1 receptor agonists (or any other medical treatments) should not be used as a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read here. The authors and publishers of this FAQ and related report make no representation or warranty, express or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any information presented. Reliance on any information provided here is solely at your own risk.
