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The Future of Addiction Treatment Starts Here: GLP-1s Explained With Dr. Ken Spielvogel
20 Jan 2026
Chapter 1: What are GLP-1 medications and their original purpose?
You know, using these drugs without a, to me, a supervised medical professional that's guiding you in terms of what you should be taking on top, how you should be exercising, how you should be, you know, looking at metrics of fitness and longevity, then you're doing yourself a disservice. And so as a person that's just given it to you.
If someone has a problem with substance use disorder, please call One Call Placement. That's 888-831-1581. And if we can't help you, we'll make a referral to someone who can. One Call Placement is affiliated with Carrera Treatment Wellness and Spa and One Method Treatment Centers.
Today I'm with Dr. Kenneth Spielvogel, Senior Medical Officer at Carrera Treatment Wellness and Spa, to talk about something a lot of people in addiction and mental health are watching closely, GLP-1 medications. These drugs were created for diabetes and weight loss, but early research shows they may also reduce cravings and relapse risk.
With major new deals dramatically lowering their cost and expanding access, this could become one of the most interesting developments in addiction treatment. Dr. Spielvogel is here to help break down what's real, what's emerging, and what still needs to be proven.
Chapter 2: How do GLP-1s impact cravings and relapse risk in addiction?
Dr. Spielvogel, how are you? How are you, Richard? How are you doing, buddy? I'm really happy to be here. So the first thing I want to say is two years ago, when Carrera started, you told me about the GLP-1s and how it worked for addiction and limited cravings. And I laughed in your face. Yes, you did. You weren't the only one. Right. And today I want to say that I was wrong.
Chapter 3: What are the advantages of injectable GLP-1s over oral medications?
You were right. And I was wrong. And I apologize. This is recorded, right? It is. Sweet. I mean, look, people looked at me with a third eye. You know, when I... said there's a medication that we can use that absolutely reduces craving. There's not great data to support it right now, but there's plenty of things that we do in medicine.
Chapter 4: How do GLP-1s affect dopamine signaling in the brain?
But it doesn't matter what the data is because I was smoking 15 Cuban cigars a day, and now I got to struggle to smoke two. Poor Bobby. I know. I just can't. I mean, you took the last thing I had, right? That and food. And you took that too. You took everything from me. Thank God it's only those two. It could be worse.
Chapter 5: What are the potential side effects associated with GLP-1 medications?
Actually, you're dating the mother of my children. So you took her too. There we go. Well, you brought it up. What was that? Was that 48 seconds in? Hey, dude, you're a better man than me, clearly. Stop. All right. So go on.
Chapter 6: How do GLP-1s contribute to reducing the risk of major health issues?
uh go on where where would we like to go i mean look this is the the the glp ones are right now i'm using it right uh you you had me using it for my cholesterol and my blood pressure right okay and because you want to look sexy you wanted to lose weight and okay but and i do and i look very sexy here's the problem it works so good that i'm on an ice cream diet
Literally, I've got a six pack and all I've been doing for the last week is eating ice cream. That craving for sugar. Yeah. Well, I mean, does it? So it clearly doesn't. But I'm looking great and I'm happy as a clam. But I know it's hurting me. I know it's going to end up harming me long term. So that I mean, look, that's one of the biggest concerns.
Chapter 7: What role does lifestyle change play in addiction recovery with GLP-1s?
I liken this revolution to Botox a little bit in that Botox came out, you know, wrinkle reduction, all the facial rejuvenation stuff. And all of a sudden it went from MDs to nurse practitioners to guys with their baseball hats backwards injecting people.
So the same thing right now is going on with these medications and people getting them over the internet and just getting a drug and injecting it. It's literally, it's, it's piecemeal medicine and I'm totally not cool with it. How did GLP one medications even end up in the addiction conversation in the first place? It's a good question. So there, you know,
ozempic which was really the first first let's answer this question you know why are we injecting a drug once a week versus just taking a pill right okay i mean why wouldn't we just take a pill the problem was with the early versions the oral versions is that the absorption in the intestine was really variable so if you ate anything you had to be fasting
You couldn't eat for at least 30 minutes afterwards. You had to take it at the same time every day.
Chapter 8: What does the future hold for GLP-1s in addiction treatment?
How many people can do that? Plus, if you're going to think about the idea of using it in addiction and recovery, people being on a regimented schedule of taking medications when they're really just starting to piece their life together, unless they have an assistant that's giving them the medication on time. It's never happened. It's not happening.
And most people are super non-compliant when it comes to oral medications. So the idea with compliance, with getting people to take a medication, to have it be reliable, the less frequent you have to use it, the better. Okay, so an injection once a week, a good start.
And what they saw was with people using Ozempic was they reported that they just had not only like feeling fuller, all metabolic numbers looking better, improved insulin resistance, lowering their hemoglobin A1C, improving their cholesterol panel, maybe even a secondary effect of lowering blood pressure is that they had less craving for food.
And then when you looked at obese alcoholics, opioid addicts in particular, you saw that they reported less desire to use, less desire to drink, less desire to smoke. So that just- That's what's happening to me. But on the Zepound, because the Ozempic made me nauseous. What's the difference between Ozempic and Zepound And why was I having such a hard time with the Ozempic?
But the Zepound is not a problem at all. That's a great question. I mean, I think that it's a... It's a complex answer. First of all, the Zepbound, which is terzepatide, is a GLP-GIP receptor agonist, where Ozempic, which is semaglutide, is just a GLP agonist. Man, can you dumb that down for my audience? Or how about dumbing it down for me? So it works in two different places with terzepatide.
And semaglutide works in one place. So two is better than one, if we really want to say it. You're probably going to lose more weight. You're probably going to have more appetite suppression. On the Z-bound. On Z-bound. And you're going to have an increased sensation of being full sooner. Right. And then probably the...
uh crave addiction type behavior is you know is squashed let's talk about it wasn't it wasn't squashed with the ozempic i could smoke all i wanted with ozempic right on zep bound i'm literally about one-tenth of my smoking consumption Because there's receptors. And I'm not enjoying it. I'm doing it as habit and holding on. I am not enjoying it.
And the reason for that is that what happens when we do pleasurable things? Well, we have a dopamine reward center in the brain.
okay you have the uh it's called the vta i'm not going to even get into the scientific name for you vta produces dopamine you smoke a cigar richard's brain says god damn that's good dopamine surge goes to the nucleus accumbens nucleus accumbens says wow that really feels good let me tell the frontal cortex Tell us to smoke another cigar. That feels good.
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