Key Points

  • A review published in JAMA on August 4, 2026, reports that US deaths from alcohol-related liver disease rose from 6.7 to 12.5 per 100,000 people between 1999 and 2022, a near-doubling over 23 years.
  • The disease often develops with long-term daily consumption above 20 grams of alcohol for women and 30 grams for men (roughly 1.5 and just over 2 standard drinks per day), and about 90% of people have no clear symptoms until the damage is advanced.
  • A routine blood test called the Fibrosis-4 score, which uses common lab values, can screen for early liver damage before symptoms appear and is worth asking a primary care clinician about.
  • The VA opened enrollment on July 28, 2026, in the CRAVE trial, testing semaglutide against a placebo in more than 600 veterans with moderate or severe alcohol use disorder at 18 medical centers; results are years away, and semaglutide is not approved for this use.
  • Dr. Sylvie Stacy notes that three FDA-approved medications for alcohol use disorder (naltrexone, acamprosate, and disulfiram) are already available and underutilized, and therapy can also help.
  • A four-year evaluation of six mobile addiction programs in Massachusetts found the model served 4,645 people and started 1,227 on buprenorphine; 15% remained in treatment at 180 days, a figure the authors attribute to a population largely disconnected from conventional care.

Addiction News Weekly Episode 1.12

In This Episode:

Episode Transcript

Welcome to Addiction News Weekly by Rehab.com, where we break down the biggest stories in addiction, recovery, and public health. Last week we told you that alcohol use disorder is declining in federal survey data. This week a JAMA review complicates that, because deaths from alcohol-related liver disease have nearly doubled since 1999. Then the VA has started a trial testing semaglutide, the drug sold as Ozempic, as a treatment for alcohol use disorder, and a four-year evaluation of mobile addiction treatment in Massachusetts shows what happens when care goes to people instead of waiting for them to arrive. Let’s get into it.

We start with a number that sits uneasily next to last week’s episode. A review published in JAMA reports that US deaths from alcohol-related liver disease rose from 6.7 per 100,000 people in 1999 to 12.5 per 100,000 in 2022.1 Alcohol-related liver disease is now the leading cause of liver-related illness and death, and the most common reason for liver transplant in both the United States and Europe. The review comes from researchers at Odense University Hospital in Denmark, with co-authors at Helsinki University Hospital, Henry Ford Health and Michigan State University, and the University of Southern California.

Two findings in it are worth knowing about even if you never read a word of the paper. The first is the drinking level involved. The review reports the disease develops with long-term daily consumption above 20 grams of alcohol for women and 30 grams for men. In practical terms, that is about one and a half standard drinks a day for women and just over two for men, where a standard drink means 12 ounces of beer, 5 ounces of wine, or one and a half ounces of spirits. Most people would not call that heavy drinking. The variable that matters is duration alongside quantity, which is how someone can drink at a steady, unremarkable level for years and still accumulate real damage.

The second finding is that symptoms alone are a poor warning system. About 90% of people with the disease have no clear symptoms, or only vague ones like fatigue. Symptoms tend to only show up once the disease has advanced, and the staging matters because early damage is reversible. Fat accumulation in the liver can be reversed. Scarring that has progressed to cirrhosis and liver failure cannot.

So the practical takeaway is about testing rather than waiting. The review points to a first-line screen called the Fibrosis-4 score, which combines two liver enzymes, platelet count, and age, and often uses routine blood work a person may already have on file. It’s worth asking a primary care clinician about. The review also recommends starting alcohol cessation treatment early rather than treating liver disease and alcohol use as separate, sequential problems. And it names specific approaches such as motivational enhancement therapy, cognitive behavioral therapy, and medication, including naltrexone and baclofen.

On outcomes, the review cites patients with alcohol-related cirrhosis followed for a median of three years, where sustained abstinence was associated with roughly half the risk of related liver and all-cause death compared with continued drinking. Those figures come from observational data adjusted for other factors rather than a randomized trial, so they may describe a strong association rather than proven cause.

The VA Is Testing Semaglutide for Alcohol Use Disorder in Veterans

And that brings us to medication and to a trial that got a lot of headlines with the wrong emphasis. The Department of Veterans Affairs has begun a randomized clinical trial testing whether semaglutide, the GLP-1 drug sold as Ozempic and Wegovy, helps people with alcohol use disorder.2 The study is called CRAVE, for Cessation or Reduction of Alcohol Consumption in Veterans. It will enroll more than 600 veterans between 18 and 80 with moderate or severe alcohol use disorder across 18 VA medical centers, with participants receiving weekly injections of either semaglutide or a placebo over 24 weeks. Recruitment began July 28. The VA reports more than 400,000 veterans in its system carry an alcohol use disorder diagnosis and cites estimates that the condition affects close to 11% of US adults.

For the clinical read on what this does and does not mean, here is Rehab.com Chief Medical Officer Dr. Sylvie Stacy.

First off, why does this trial exist at all? Well, the interest in GLP-1 medications for addictions comes from a plausible mechanism. These drugs appear to act on brain regions that are involved in how the body processes rewards, which is the same circuitry involved in substance use. And an analysis published earlier this year found that patients taking GLP-1 medications have lower rates of alcohol use disorder and other substance use disorders than comparable patients on other diabetes drugs, with fewer emergency visits and fewer hospitalizations.3 So that is really interesting. But it’s not enough evidence, and there are potentially confounding variables here.

People who get prescribed and stay on a GLP-1 medication are simply different from people who do not, in ways that can be hard to adjust for statistically in a study. Most importantly, people who stay on GLP-1 medications tend to engage with medical care more consistently. And consistent engagement with medical care independently predicts better outcomes in almost everything that we measure. So when you see lower rates of alcohol use disorder in that group, you can’t tell how much is the drug and how much is the kind of patient who ends up on the drug. And that’s why a randomized placebo-controlled trial is the right next step, and one of the major reasons for the CRAVE trial.

Results from this trial are years away, though, and I know there are a lot of people struggling with problematic alcohol use who are interested in trying a GLP-1 to help them right now. But we don’t yet have sufficient evidence for these medications to be approved specifically for alcohol use disorder or any addictions. And because of that, they’re not currently covered by insurance companies for this. I do think that some patients who are candidates for GLP-1 medications for other reasons, like diabetes or obesity, who also have alcohol use disorder, are likely to experience some benefit related to their drinking in addition to their primary indication.

Of course, not everyone will be in that situation, so it’s also worth pointing out that we do have three other medications that are approved for alcohol addiction: naltrexone, acamprosate, and disulfiram, and a few other older medications that are available as generics and that are much less expensive than GLP-1s. And these medications are actually underutilized. Additionally, therapy can also be a huge help for alcohol addiction. So not being able to receive a GLP-1 should not dissuade someone from seeking help for their drinking right now. There’s definitely a lot we can do to assist with problematic drinking while we’re awaiting the results of this trial.

Mobile Addiction Clinics Are Reaching People Conventional Treatment Missed

Our last story is about the other half of that problem. Effective treatment does not help those who never reach it. A four-year evaluation co-led by Mass General Brigham looked at six mobile addiction programs across Massachusetts between July 2022 and June 2024, publishing in the International Journal of Environmental Research and Public Health.4 Over that period, the programs logged 16,117 clinical encounters serving 4,645 individuals, plus 17,887 encounters providing services aimed at reducing the health, social, and legal consequences of drug use. The programs focused specifically on people at high risk of drug-related illness and death who are unhoused or at risk of losing housing.

The central outcome was medication access. The programs started 1,227 people on buprenorphine, one of three FDA-approved medications for opioid use disorder. Of those, 15% were still in buprenorphine-based treatment at 180 days. That is a modest number against the usual six-month benchmark and worth stating plainly rather than dressing up. The authors are direct that it reflects a population largely disconnected from conventional care, people for whom the alternative was frequently no treatment at all. They also identified the model’s clearest limit in the same place: continuity between that first contact and ongoing care.

The model started in 2018 as a single Boston clinic under the Kraft Center for Community Health and has grown to six programs statewide. Senior author Elsie M. Taveras, Chief Community Health and Health Equity Officer at Mass General Brigham, said the approach proved adaptable across regions and can be run by different kinds of organizations, from academic medical systems to community health centers. Cynthia Tschampl, a senior research scientist at Brandeis, described the physical presence of units as a low-barrier entry point for adults with complex needs.

For anyone whose search for treatment has stalled because of transportation, housing instability, or a bad experience at a clinic, it’s worth asking whether a mobile or street outreach team operates in your area. Many are run by community health centers rather than hospitals. Two things to keep in mind, though. A mobile program is an entry point rather than a replacement for the full continuum of care, and it is worth asking any program whether it can start medication at the first visit or whether it refers you elsewhere and makes you wait.

Conclusion

The theme this week is not that we lack tools. Alcohol-related liver disease is killing twice as many people as it did back in 1999, and the disease is largely silent until it’s advanced. But there is a blood test that catches it early and three approved medications that treat the drinking behind it. The VA is carefully testing a fourth possibility, but that may take years. Meanwhile, a fleet of vans in Massachusetts has more than 1,200 people started on medication who are not going to a walk-in clinic.

Every part of that points in the same direction. What works is often already available. The harder question is who it actually reaches.

If you or someone you love is looking for treatment, Rehab.com lists thousands of verified centers across the country, and free confidential support is available anytime through the SAMHSA National Helpline at 1-800-662-4357. And if you are in crisis, you can call or text 988 at any time.

Those are the top stories in the news. For more, visit Rehab.com. We will be back next week. Thank you for listening.

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  4. Medication-Assisted Treatment

Sources in This Episode

  1. Krag A, Åberg F, Mellinger J, Lee BP, Israelsen M, et al. Alcohol-related liver disease. JAMA. 2026;336(5):413-425. doi:10.1001/jama.2026.12038. https://pubmed.ncbi.nlm.nih.gov/42406571/. Accessed August 18, 2026.
  2. U.S. Department of Veterans Affairs. Minneapolis VA Medical Center named one of 18 VA sites to test efficacy of GLP-1 as treatment for alcohol use disorder. Published July 28, 2026. https://www.va.gov/minneapolis-health-care/news-releases/minneapolis-va-medical-center-named-one-of-18-va-sites-to-test-efficacy-of-glp-1-as-treatment-for-alcohol-use/. Accessed August 18, 2026.
  3. Cai M, Choi T, Xie Y, Al-Aly Z. Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: cohort study. BMJ. 2026;392:e086886. doi:10.1136/bmj-2025-086886. Accessed August 18, 2026.
  4. Tschampl C, et al. Multisite mobile addiction services: four-year outcomes. Int J Environ Res Public Health. 2026. doi:10.3390/ijerph23060756. https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/expanding-mobile-addiction-clinics. Accessed August 18, 2026.