I quit drinking after getting headaches, looking at the evidence and deciding it wasn’t worth it. Most people with alcohol use disorder can’t just decide. Fewer than 2% of them ever get medication for it, and the drugs we do have (naltrexone, acamprosate, disulfiram) produce small effects and get almost no uptake.
This drug could be different and have big impact.
Lilly has a drug Brenipatide in late-stage trials called brenipatide. Same class as tirzepatide (Mounjaro/Zepbound), but engineered with a much longer half-life. Dosed once a month, subcutaneous. That schedule alone is a big deal for addiction medicine, where adherence is half the battle. Vivitrol, the monthly depot of naltrexone, outperforms the daily pill for exactly that reason.
Two Phase 3 AUD trials are actively enrolling (RENEW-ALC-1 and RENEW-ALC-2), 1,100 patients each. Separate trials are running for smoking relapse, opioid use disorder, bipolar disorder, and asthma. Readouts start landing in 2027.
Here’s why Lilly is going hard at this. The signal in the existing data is almost hard to believe.
A BMJ study published last month followed 606,000 veterans on GLP-1s vs. SGLT2 inhibitors. In people with no prior substance use disorder, GLP-1 users had 18% less alcohol use disorder, 20% less nicotine, and 25% less opioid use disorder. In people with an existing SUD, GLP-1 use was associated with 39% fewer overdoses and 50% fewer substance-related deaths over three years.
A JAMA Psychiatry Phase 2 trial of semaglutide in AUD (48 people, 9 weeks) showed medium-to-large effect sizes on drinking outcomes and reduced cravings. That matters because approved AUD meds like naltrexone typically show only small effect sizes. And the semaglutide group hit those numbers at the two lowest clinical doses.
So here’s the case. A drug class that wasn’t designed for addiction is already outperforming drugs that were. Lilly is now testing a molecule engineered for it, with a dosing schedule that solves the adherence problem, in the largest randomized AUD trials ever run.
What makes this interesting despite all that is Lilly isn’t the only shot on goal. Baseline Therapeutics launched in January specifically to run Phase 3 trials of their own GLP-1 candidate (BT-001) in AUD. The VA is planning a semaglutide trial. Altimmune is in Phase 2 with pemvidutide. Thirty-three GLP-1 trials for substance use disorders are currently registered on ClinicalTrials.gov. Even if half of them fail, the other half would hand us more pharmacotherapy than AUD has gotten in a lifetime.
If these trials turn out positive, it’s the biggest thing to happen to addiction medicine in a generation.
Brenipatide vs Tirzepatide: Longer Half-Life, Fewer Shots, Bigger Potential?
If tirzepatide is the GLP-1/GIP drug that broke into the mainstream, brenipatide might be one of the more interesting “next wave” peptides to watch.
Tirzepatide is already the proven heavyweight. It is the active ingredient in Mounjaro and Zepbound, and it has moved from diabetes drug to weight-loss blockbuster to sleep-apnea treatment. For most people, tirzepatide is still the practical benchmark: strong appetite control, major weight-loss data, once-weekly dosing, and real-world use in people dealing with obesity, type 2 diabetes, and related metabolic problems.
Brenipatide is earlier in the story. It is not FDA-approved, and it should not be treated like something to casually buy, dose, or experiment with. But the reason it is starting to get attention is that brenipatide appears to sit in the same broad GLP-1/GIP universe while being studied for something that could be even more disruptive: alcohol use disorder, craving, and reward-driven behavior.
The biggest practical difference may be dosing. Tirzepatide lasts long enough for once-weekly injections. Brenipatide appears to be designed as a longer-acting peptide, with the potential for once-monthly dosing. If that holds up clinically, that is not a small tweak. That is the kind of difference that can change adherence.
For weight loss, weekly injections are already tolerable for a lot of motivated people. But for alcohol use disorder, smoking relapse, opioid use disorder, or other craving-driven problems, monthly dosing could be a much bigger deal. People dealing with compulsive behavior do not need more friction. They need fewer chances to miss, delay, rationalize, or fall off the plan. A once-monthly GLP-1/GIP-style drug aimed at cravings would be a very different animal from a weekly obesity shot.
That is where brenipatide gets exciting. Tirzepatide is mostly thought of as a metabolic drug. It helps people eat less, lose weight, improve blood sugar, and potentially reduce the downstream damage of obesity. Brenipatide may be pointing at a slightly different frontier: what happens when incretin-style drugs are aimed not just at hunger, but at reward, compulsion, alcohol intake, nicotine relapse, and addictive behavior?
This is why brenipatide could become a much bigger name than people realize. Retatrutide has already become the monster peptide everyone talks about in weight-loss circles — the “next thing” that has peptide forums, grey-market chatter, and biohacker types buzzing because of its huge obesity-trial results. Brenipatide might become a different version of that story. Not necessarily the next retatrutide for fat loss, but potentially the next peptide people obsess over because it goes after cravings in a broader way.
For men over 50, that matters. Weight gain, alcohol intake, poor sleep, blood pressure, low energy, and lousy recovery are rarely separate problems. They stack. A drug class that started with blood sugar and appetite is now being studied in places that look a lot more like real middle-aged life: drinking too much, eating too much, sleeping badly, carrying too much belly fat, and trying to claw back health before the wheels come off.
The simple version: tirzepatide is the established weapon. Brenipatide is the speculative one. Tirzepatide already has FDA-approved uses and massive clinical momentum. Brenipatide is still investigational, but it might be aimed at a deeper and potentially more explosive target: cravings and compulsive behavior, with a dosing schedule that could be far easier to stick with.
That does not mean brenipatide is “better” than tirzepatide. It means it may be playing a different game. If the alcohol-use-disorder trials are positive, and if the longer-acting/monthly-dosing angle proves out, this could move from obscure pipeline peptide to one of the most talked-about drugs in the GLP-1 world very quickly. Until then, it belongs in the “watch closely, don’t self-experiment” category.
Further Information
If you want to go deeper on this, the JAMA Psychiatry author interview with Hendershot and Klein on the semaglutide AUD trial is solid and short. The Might Ramble Podcast #17 with Lorenzo Leggio is the single best conversation I’ve found on the mechanism and the state of the field. NPR’s Jon Hamilton had a tight story on the veterans data that’s worth the ten minutes.