The Quiet Bar

At a dinner in Indiranagar last month, a woman left half a glass of wine on the table and did not notice until the bill came. She had not given anything up. Since April she has been taking a weekly injection for her weight, and somewhere around the sixth week the second glass stopped suggesting itself. She mentioned it the way people mention a side effect.

Stories like hers have been going round for three years. This summer they acquired data. At the end of April The Lancet published a trial in which people with both obesity and a serious drinking problem were given weekly semaglutide or a dummy injection for twenty-six weeks, alongside talking therapy; the authors report a strong effect on drinking. In July the American Journal of Psychiatry reported that the tablet form reduced craving and heavy-drinking days in adults with alcohol dependence. A smaller study last year had pointed the same way.

In India the timing is striking. The patent on semaglutide lapsed here on the twentieth of March. Within weeks there were dozens of generic brands, the cheapest at about thirteen hundred rupees a month, for a drug that had cost many times that. A medicine that may quieten craving is now cheaper than most of the cravings it might quieten.

How it works is only partly understood. The drug copies a gut hormone that tells the body it has had enough, and the receptors for that hormone also sit in the brain’s reward circuitry. People on it talk about the end of “food noise”, the background hum of wanting. Some report that the alcohol noise goes as well. They do not describe resisting a drink. They describe not being asked.

They do not describe resisting a drink. They describe not being asked.

Now the cautions, which are not small print. No regulator anywhere has approved these drugs for alcohol dependence. The trials are short and the numbers modest. Nobody yet knows which drinkers benefit, at what dose, or what happens on stopping; with weight, what was lost tends to return when the injections end, and there is no reason to assume craving behaves better. Heavy drinkers are often badly nourished, and an appetite suppressant is not a trivial thing to add to that. This is a conversation to have with a doctor who knows the whole history. It is not a purchase to make because of a reel.

There is a larger point inside the small one. For as long as anyone can remember, people with addictions have been told that craving is a failure of character, to be met with firmness. If a weekly pen can turn it down like a volume knob, then it was chemistry all along, which is what the people who treat it have been saying to a mostly unconvinced public for decades. That shift in understanding may turn out to matter more than the drug.

But nobody ever drank only because of craving. They drank because of seven in the evening, or the marriage, or something that happened at fourteen. The injection knows nothing about any of that. The quiet it produces appears to be real. What a person does inside the quiet is the same work it always was.

The woman in Indiranagar is delighted, for the record. She has also noticed that, without the second glass, she finds two of her oldest friends rather dull. There is no injection for that.

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