WERNERSVILLE, Pa. — To make sense of the reds and greens dancing across a computer monitor displaying a scale image of a human brain, one requires a vivid vocabulary. At this upscale addiction treatment facility, “neurofeedback therapy” and “quantitative electroencephalogram” are part of the holistic, no-expenses-spared treatment philosophy on offer.
But customized brain scans aren’t the technology that has both staff and patients here most excited. Lately, the bigger paradigm shift has come in the form of semaglutide — the blockbuster medication commonly used for weight loss and branded as Ozempic or Wegovy.
In recent months, doctors at Caron Treatment Centers, an elite nonprofit rehab facility, have begun prescribing semaglutide to patients not to address obesity or diabetes but to help treat the addictions that brought them here in the first place.
“I don’t think of this as doing anything wild west,” said Steven Klein, one of the staff physicians who has pioneered the practice of prescribing GLP-1s, as the class of medications is known, as a treatment for addiction. “We’re using something off-label under the umbrella of addiction, whether that be food, sex, alcohol, or opioids.”
Despite Klein’s attempts to downplay the program, Caron is, without a doubt, in uncharted territory. While the medications show significant promise as addiction treatments, only a handful of clinical trials are underway to measure their ability to reduce substance use. Several are unlikely to publish results within the next two years.
At this idyllic facility 70 miles outside Philadelphia, however, Klein and two fellow doctors are bypassing the speculation and the slow-moving scientific enterprise. No program has so openly and aggressively touted GLP-1s as a means of treating substance use disorder. And while their operation is backed by limited clinical data, their own eyes are giving them more confidence day by day.
Remarkably, all three of the physicians are in long-term recovery from addiction: Mo Sarhan, who recently decamped Pennsylvania to run Caron’s sister facility in Florida; Adam Scioli, the organization’s chief medical officer; and Klein, who evangelizes GLP-1s both because they’ve helped his patients’ recovery and because, in 2023, he used them to drop 40 pounds.
With a combined 250,000 Americans dying each year from drug overdose and alcohol-related causes, the field of addiction treatment is ripe for a paradigm shift. What few medications do exist for substance use disorders are either marginally effective or sorely underutilized. For opioid addiction, buprenorphine — which Caron also offers — and another medication, methadone, face immense stigma. For alcohol, medications like naltrexone or acamprosate have only marginal benefits. For some substances, like methamphetamine or cocaine, there’s no medication treatment at all.
Until now — that is, if Caron’s doctors are right.
The Caron doctors, outwardly, try to temper their optimism, but it’s clear that each views GLP-1s as a potential game-changer. Sarhan, who had noticed in his own Alcoholics Anonymous group that people using the medications for weight loss fared better in their recovery, said in a recent interview that semaglutide has “obliterated” many of his patients’ cravings for the substances they previously used, including opioids, alcohol, and stimulants.
And even outside the context of addiction, it seems the medications could redefine human beings’ relationship with many forms of pleasure.
In interviews, experts reported to STAT a remarkable array of potential uses or, in some cases, anecdotes of GLP-1s appearing to transform people’s addictive relationships with tobacco, nail-biting, drinking, gambling, drugs, sex, shopping, and more.
Even Klein, who never exhibited problem gambling behavior, has seen his habits shift: Years ago, while driving to family vacations on the Jersey Shore, he’d stop for an hour of blackjack at the Borgata in Atlantic City. Now, he said, he’d rather just get to the beach.
The shift fits perfectly into his broader philosophy on GLP-1s: That brains battling addiction often generate urges to take part in a harmful behavior, be it big or small. The medications, in his own experience, clearly play a role in quieting those voices.
“I had this record in my brain that meant when I’m stressed, I overeat,” Klein said. “The GLP-1s just lifted the needle off that record. I know what drug addiction feels like. I know that those voices are the same. I know they’re my voice, convincing me to do things I really don’t want to do.”
Addiction and trauma: one doctor’s story
Like so many stories of addiction and redemption, Klein’s tale begins with an acute trauma.
As a high-school sophomore on the track and field team, Klein was practicing shot put when an elderly assistant coach wandered into the path of his throw. The metal sphere struck the coach in the head, and he died a week later.
Klein’s substance use began almost immediately: a means of staving off memories of the nightmare scene that had played out in front of him.
“I still can recall aspects of the facial expression that he had, and being picked up from school by my parents and going to the hospital with my dad,” he said. “I just really started to fear sleep. So I started using stimulants to not go to sleep, or drinking alcohol until I would pass out into a blacked-out stupor. It was less that the amount of those substances mattered, but more that I developed that neurocognitive link where if I have a feeling and I don’t want to deal with it, substances are the answer.”
But throughout his childhood and into his medical training, Klein’s substance use largely remained under control. In the early going, it was no match for the more productive half of his brain: the half that led him to California in pursuit of an M.D.-Ph.D. with a focus in genetics.
Klein, briefly, was living the good life: a full ride at UCLA, bylines in prestigious medical journals, contributions to significant advances in genetics research, and engaged and planning a Napa Valley wedding with a wealthy fiance. But when his partner confessed to an affair and the relationship collapsed, his addiction quickly escalated.
“My life kind of fell apart,” he said. “All of this armor just disappeared, and I proceeded to drink the way, as it’s been explained to me, that I’d always wanted to, which was without any concern for what was going on. I found myself in the midst of a very bad drug and benzodiazepine and cocaine addiction that was probably going to ruin me.”
Klein, at one point, even moved to an apartment in West Hollywood just steps from his favorite bar — a defense mechanism of sorts, aimed not only at convenience but also at preventing him from drinking and driving.
Luckily, Klein’s home was also steps away from the famed West Hollywood Recovery Center, an epicenter of addiction recovery in Southern California known as the “Log Cabin.”
In 2016, he began attending an Alcoholics Anonymous meeting there. He has been sober since.
But even as his sobriety remained consistent, other aspects of his health flagged — particularly during and after the Covid-19 pandemic, when his weight jumped and his metabolic panels looked, in the words of Klein’s doctor, “kind of crap.”
After several cycles of an enthusiastic week of dieting and exercise followed by several weeks with neither, the doctor suggested he might be a candidate for Mounjaro, a formulation of the GLP-1 tirzepatide, a close relative of semaglutide.
The effect was transformative. Klein quickly began losing weight and experienced next to no side effects: He threw up only once, he said, on the day of one of his largest dose increases, but has since learned to navigate the gastrointestinal issues common in those who take GLP-1s.
Today, Klein is happily married, planning to start a family, and has made peace with pivoting from a high-octane research career to a calmer existence in the Philadelphia exurbs.
Now, he spends his long drives sponsoring other AA participants by phone, leads group therapy sessions, and offers lectures on neurobiology to Caron participants. He’s adopted a regimen of strength training that has made his Mounjaro-backed weight loss both healthy and sustainable. And he has established himself as a sounding board for other doctors hoping to use GLP-1s to help their patients fight addiction, lecturing in webinars and even orchestrating a Google group in which he tutors other doctors on semaglutide treatment, often sharing the consent forms he gives his patients and strategies for fighting obstinate insurance companies.
“I truly think these medications work,” he said, “because obesity is an addiction to food.”
As Klein reeled from his breakup and his substance use spiraled, a different doctor was also seeking recovery along the California coast: Mo Sarhan.
As part of his treatment plan at a facility in Malibu, Sarhan was regularly driven east across the Pacific Coast Highway, through Santa Monica, all the way to the West Hollywood Recovery Center.
At the time, the GLP-1 craze was just beginning. But in a city known for its focus on both looks and physical fitness, the medications’ use was already widespread, even in Sarhan’s Alcoholics Anonymous group.
“I would hear people say they got put on medications for diabetes or weight loss, and then all of a sudden they’re feeling happier and healthier, and they’re not craving as much, and their periods of sobriety are getting longer and longer,” he said.
Soon after Sarhan began attending the meeting, he met Klein’s sponsor, who, upon learning Sarhan also worked in medicine, suggested he meet. The two quickly became friends, even attending group sessions known as caduceus meetings, tailored specifically to medical professionals in recovery.
When Sarhan moved to Pennsylvania and eventually wound up as an addiction medicine fellow at Caron, he began prescribing the medications, too: not explicitly for addiction, but to patients who otherwise met criteria for GLP-1s based on their body mass index or a diagnosis of type 2 diabetes. The results were so compelling that he soon created what he called “The Ozempic Files”: a specific repository of data about his own patients and their successes on semaglutide.
And as Klein continued to pursue his prestigious career as a physician-scientist, focused on treating pediatric patients navigating complex genetic conditions, it was Sarhan who observed that he seemed “miserable” and suggested he apply to the same addiction medicine fellowship at Caron.
Sarhan, upon moving to work at Caron’s facility in Delray Beach, Fla., effectively handed the baton to Klein, who stepped into his role working with the “relapse unit” — patients making a new attempt at recovery after trying, unsuccessfully, before.
It was in this unit that Sarhan first noticed GLP-1s’ potential, in the subset of patients eligible for the drugs on weight loss grounds.
“I started to hear from them that things felt different,” Sarhan said. “They weren’t craving as much, and they were more engaged in their recovery programs. So I started doing it a little bit more frequently and with a little more intention. And then, when Steve joined, we joined forces.”
Caron’s current protocol for using GLP-1s bears only a passing resemblance to the protocol for patients seeking treatment for obesity, diabetes, sleep apnea, or a related condition.
While doses for the brand-name drugs often exceed 2 milligrams per week, Caron uses an initiation dose of 0.25 mg and then doubles it if patients remain comfortable. And instead of the high-priced injector pens like Mounjaro or Ozempic, Klein has largely opted for cheap, compounded versions of the medications, especially for patients who are not otherwise eligible for GLP-1s.
But it remains an open question whether Caron’s early success in employing semaglutide is more broadly applicable across addiction medicine.
Caron is an elite nonprofit dating back to 1957 that reported $85 million in revenue in 2024, according to a recent tax disclosure. The hourlong drive to its campus from Philadelphia separates some of the nation’s most drug-ravaged neighborhoods from rolling hills and impressive mansions lining roads dotted with yellow signs depicting a horse and buggy, warning motorists to leave room for Amish carriages on the side of the road.
Beyond using high-tech brain scans, Caron patients have access to dietitians and a full suite of medical services, with specific wards for older patients or those with severe physical impairments. As an inpatient rehab facility, its environment is tightly controlled, making weekly injections practical here in a way they likely wouldn’t be for someone using fentanyl or meth on the street.
Many patients pay dearly for this privilege: While some have insurance coverage, others pay $30,000 for a standard one-month course of treatment or as much as $65,000 for a premium package and private room.
The clinical support is also robust. Besides the wealth of services, patients have access to three doctors whose lived experience with substance use gives them unparalleled insights into their patients’ journey. Scioli, the chief medical officer, is a former board chair of International Doctors in Alcoholics Anonymous.
Even for successful patients at Caron, however, it’s difficult to apportion credit to GLP-1s or to the many other bells and whistles their treatment program offers.
“It’s really hard to extract what role these medications really played,” Sarhan said. “I put him on Mounjaro for type 2 diabetes. He’s lost a lot of weight, he was on the men’s relapse unit and was still sober a year after treatment, which is the second-longest period of sobriety he’s had. He’s been really engaged in 12-step programming, and he personally attributes his ongoing success to his engagement in AA.”
The reality, Sarhan said, is likely more nuanced: AA is certainly playing a role, but so are Caron’s other treatment offerings, and so is Mounjaro.
Caron maintains a strict confidentiality policy. Visitors sign documentation swearing to not reveal the identity of anyone they might come across on Caron’s campus, and the staff bars current and former participants from media interviews until they’ve achieved a full year in stable recovery. Given that Caron’s new GLP-1 program only began in April, no patients were available to describe their experience with the medications firsthand.
Among the doctors, however, optimism abounds, and not just when it comes to substances. Amid a sharp rise in gambling and associated harms, Sarhan, in particular, is intrigued by GLP-1s’ potential use to treat other behavioral disorders.
“Gambling disorder is the one that has the most of my attention,” Sarhan said. “The neurobiology and neurochemistry are remarkably similar.”
It is unclear, however, whether Sarhan and Klein’s degree of optimism is justified: In particular, the two largely gloss over concerns about side effects, even though more than half of patients in one small study of GLP-1s for opioid use disorder withdrew from the three-week study because of gastrointestinal discomfort.
Unlike typical GLP-1 patients, not all who use the medications to treat addiction are overweight. But Klein and Sarhan don’t appear worried about malnutrition or muscle loss, in part because Caron’s 0.5-mg dosing protocol is so much lower than that for obesity. As of July, Klein said 229 Caron patients have received a GLP-1 since the start of 2024, the majority of whom started using the medication during treatment (though some arrived already taking them).
That includes 47 patients who were given compounded GLP-1s specifically for addiction under a new program. Of that group, Klein said 70% have a BMI above 30, and 80% meet the criteria for receiving the medications on physical health grounds alone.
Still, Caron’s specific initiative is unlikely to yield satisfying answers. The project is not being run as a formal study, but rather as a “clinical initiative” that will tabulate patient data and record outcomes but does not qualify as a clinical trial.
“We don’t want people to get too far ahead of where the evidence currently is in terms of using these drugs,” said Stephanie Weiss, a staff clinician at the National Institute on Drug Abuse whose research focuses on GLP-1s and addiction, but is not involved in Caron’s new semaglutide initiative. “There’s no such thing as a silver bullet, and it’s probably better not to think of addiction as one single disease.”
But she allowed that logically, the mechanisms that make GLP-1s so effective at curbing hunger and “food noise” are deeply interrelated with the mental processes of addiction, and that the medications likely represent a paradigm shift in addiction medicine.
“All these things interconnect in the central nervous system, and we don’t fully even understand all these pathways yet,” she said. “The level of impact we’re talking about does seem to be on a different plane.”
The future of Caron’s program is uncertain. It was launched with a grant from the Center for Addiction, Science, Policy, and Research, an advocacy group founded in 2024 that has spent its first year advocating for wider access to GLP-1s as an addiction treatment. But the program relies on Caron’s ability to source cheap, compounded semaglutide. To date, no GLP-1 medication has received a formal indication as an addiction treatment. No insurer has agreed to reimburse for expensive, brand-name GLP-1s for addiction, and many are even rolling back their coverage of the medications when prescribed for weight loss.
Caron’s access to compounded versions may soon disappear, thanks to a Food and Drug Administration ruling that would bar compounding pharmacies from continuing to produce them.
Klein is already scheming a fix. A select few compounding pharmacies, for instance, were licensed to produce semaglutide with a 12-month expiration date, taking supply well into 2026. Generic medications could become available in Canada next year.
Beyond the result of Caron’s experiment, much remains to be seen about the GLP-1s’ effectiveness as addiction treatments — particularly for the typical patient unable to afford a clinic like Caron — as well as drug companies’ willingness to market them as addiction treatments, and patients’ ability to access and tolerate them.
To Sarhan, two things already seem clear: Patients are interested in GLP-1s, and the medications are producing results unlike any he’s seen.
“GLP-1 medications are all-around more attractive to patients: They’re new, they’re sexy, they cause weight loss, they jump-start wellness,” he said.
“I’ve never had a person who I’ve started on naltrexone turn around and tell me that their cravings have been obliterated,” he added, referencing a common treatment for alcohol and opioid addiction. “Whereas I have had that happen with people who’ve been started on GLP-1 medications.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
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