Podcast Summary: "The Future of Addiction Treatment Starts Here: GLP-1s Explained With Dr. Ken Spielvogel"

Podcast: We're Out of Time
Host: Richard Taite
Guest: Dr. Kenneth Spielvogel (Senior Medical Officer, Carrera Treatment Wellness and Spa)
Date: January 20, 2026

Episode Overview

In this highly engaging episode, host Richard Taite sits down with Dr. Ken Spielvogel to break down the game-changing role of GLP-1 medications (like Ozempic and Zepbound) in the future of addiction treatment. Conceived initially for diabetes and weight management, these meds are making waves for their surprising effects on cravings and relapse rates among those battling addiction. With incoming price drops and widened access, Taite and Spielvogel dive into the clinical realities, emerging science, and the potential—and limitations—of this revolution in addiction care. Both bring candor, humor, and hard-won clinical perspective to a topic that’s just entering mainstream addiction medicine.

Key Topics & Insights

GLP-1s: From Diabetes Drug to Addiction Game-Changer

• GLP-1 medications were developed for diabetes and weight loss but are showing promise in reducing substance cravings and relapse risk. They may represent the most significant medical advance in substance use treatment since Narcan. (00:58, 19:36)
• Initial skepticism to acceptance: Richard admits at the start, "I laughed in your face" about GLP-1s for addiction. He’s now a convert, crediting the medication for reducing his own nicotine use. (01:53, 02:10, 02:20)

Mechanism: Dopamine’s Role & How GLP-1s Disrupt Craving

• Craving Reduction: GLP-1s blunt the dopamine response in the brain’s reward system. Dr. Spielvogel likens them to a "dopamine traffic cop," tempering the surges that reinforce addictive behaviors. (09:06–09:35)
• Richard’s experience: "On Zepbound, I’m literally about one-tenth of my smoking consumption because there’s receptors. And I’m not enjoying it, doing it. I am not enjoying it." (07:51 – 08:16)

“Now along comes the dopamine traffic cop... They kind of squash and temper that dopamine response.” — Dr. Spielvogel (09:34)

Medication Details: Ozempic vs. Zepbound & Dosing Nuances

• Difference between drugs: Ozempic (semaglutide) is a pure GLP-1 agonist; Zepbound (tirzepatide) is both a GLP and GIP receptor agonist. Zepbound generally causes stronger appetite suppression and seems more effective for reducing cravings. (06:57–07:42)
• Dosing matters: Starting at too high a dose (e.g., 5mg) can cause misery; gradual increases, tailored to the patient, are critical. (15:01–16:17)
• Route & compliance: Weekly injections beat oral medication for compliance, especially in early addiction recovery when routines are still being established. (05:02–05:32)

Real-World Impact & Surprising Success Stories

• Clinical examples: A patient with severe, multi-addiction issues (alcohol, cocaine, sex addiction) reported the “noise” around alcohol disappeared within weeks of starting low-dose GLP-1 therapy. (13:37–17:03)
• Richard’s verdict: “This is the best drug I’ve seen for the treatment of drug addiction and alcohol... This is the one.” (19:36–20:08)

Broader Health Benefits & Longevity

• GLP-1s offer multi-system protection:
  • Reduce cardiovascular risk (by smoothing arterial walls, lowering blood pressure and cholesterol)
  • Lower cancer risk (by reducing obesity and inflammation)
  • Potentially reduce risk of Alzheimer’s by limiting brain plaque formation
  • Improve diabetes control and reduce obesity (20:38–24:51)

“You have a medication... that's going to keep them smooth... lower your blood pressure... control weight... increases your insulin sensitivity, which in turn is going to lower inflammation... less risk of cancer for sure.” — Dr. Spielvogel (22:33–23:45)

Access, Cost, and the Role of Medical Oversight

• Price Drops: Recent policy changes have dropped GLP-1 med costs from over $1000/mo to $150–250/mo for many, “a game changer” for access. (26:55–27:36)
• Proper Supervision Needed: Dr. Spielvogel warns against getting GLP-1s online or without proper oversight, emphasizing the risk for muscle loss without diet and exercise guidance. Supplementing with protein, creatine, and weight training is essential for healthy weight loss and long-term success. (04:03, 29:33–34:02)

“Using these drugs without a supervised medical professional... you’re doing yourself a disservice, and so is the person that's just giving it to you.” — Dr. Spielvogel (31:07)

Off-Label Use & Medical Innovation

• GLP-1s for addiction is “off-label,” but many critical therapies—like baby aspirin for heart disease—are, too. The field is slow to adopt innovations, with “science always 15 years ahead of practice.” (17:48–18:52)
• The only center using GLP-1s for addiction for 2+ years is Carrera; Spielvogel expresses surprise more haven’t started as mounting evidence builds. (17:03–17:19)

Cautions and Side Effects

• Gastrointestinal symptoms (bloating, nausea, constipation, gas) are most common, especially at therapy onset.
• Rare/experimental risk: Thyroid tumors were observed in mice, not humans so far.
• Muscle loss: Significant if not countered by exercise and supplementing.
• Noncompliance risk: For those not engaged in their recovery or not supervised, benefits rapidly erode. (24:53–34:02)

“There is no greater intervention than to save your life than exercise, period.” — Dr. Spielvogel (35:15)

Supplements, Testosterone, and the Full Recovery Picture

• Testosterone therapy: Used judiciously in both men and women at Carrera to preserve muscle mass.
• Creatine and protein: Strong recommendations for all patients aiming to maximize the health gains of GLP-1 therapy. (40:19–42:09)
• Comprehensive care: Addiction is multifaceted; GLP-1s are one tool among many, including therapy, lifestyle change, and medical tune-ups. True long-term sobriety and health require integrating all of these. (43:18–44:12)

“We have a way of truly, truly keeping people sober and leading happy, healthy lives they’re proud of. There is no—I’m gonna cry—there’s no better way to make a living.” — Dr. Spielvogel (44:12)

Notable Quotes & Memorable Moments

• On clinical impact:

  “This is the best drug I’ve seen for the treatment of drug addiction and alcohol... This is the one.” — Richard (19:36–20:08)

• On skepticism turned believer:

  “I want to say that I was wrong. You were right, and I was wrong, and I apologize.” — Richard (02:10) “This is recorded, right?” — Dr. Spielvogel (02:17)

• On medical responsibility:

  “If you’re a doctor out there and you’re a fat ass and you smoke and drink and don’t exercise, don't expect one patient to listen to a word you're saying...” — Dr. Spielvogel (36:09)

• On online pharmacies:

  “This is why I hate the online pharmacies... you get these doctors that just rubber stamp everything, don’t teach you anything.” — Richard (31:08)

• On off-label use:

  “We use drugs off label all the time... Baby aspirin for the prevention of cardiovascular disease... That’s not at all what it was made for.” — Dr. Spielvogel (18:05)

• Humor & candor:

  “You're dating the mother of my children, so. You took her, too.” — Richard (02:59)
  “How many people out there can say, I got a Christmas card from Cold Stone Creamery?” — Dr. Spielvogel (34:43)

Timestamps for Key Segments

• Intro & Skepticism/Humor: 00:58–04:41
• How GLP-1s Work: 05:01–10:17
• Comparing Ozempic & Zepbound: 06:38–07:51
• Addiction & Dopamine: 08:17–10:17
• Patient Story/Clinical Use: 13:29–17:03
• Adoption in Addiction Medicine: 17:03–18:52
• Dosing, Side Effects, Risks: 15:01–26:55
• Cost & Access Evolution: 26:55–29:33
• Quality Treatment vs. Online Pharmacies: 29:33–34:02
• Diet, Exercise, Muscle Loss, Real-Life Challenges: 33:33–36:09
• Holistic & Preventative Medicine Advocacy: 37:27–38:14
• Future of GLP-1 Delivery: 38:22–39:57
• Testosterone, Supplements, Muscle: 40:19–43:18
• Wrap-up, Gratitude, and Outtake: 43:18–44:45

Takeaways for Listeners

• GLP-1s are about to become central to addiction medicine, but only with competent, hands-on care and lifestyle changes.
• Access is improving, but supervision matters: muscle loss and poor dietary habits can undercut benefits.
• This isn’t a magic pill. Without exercise and good nutrition, you risk trading one kind of harm for another.
• Carrera is leading, but the rest of the field is catching up.
• A new era is dawning: as the science accelerates, so too will treatment outcomes for obesity, addiction, and possibly other chronic diseases.

Packed with clinical stories, hard-won expertise, and laugh-out-loud candor, this episode is a must-listen for anyone curious about the cutting edge of addiction treatment.