Researcher seeks to harness good feelings from ‘cuddle hormone’ to improve alcohol therapy for couples

People trying to overcome alcohol-use problems are more successful when a spouse or family member joins them in therapy – but their alcohol use might also have frayed bonds to the point that family members don’t want to join them in therapy. 

MUSC researcher Julianne Flanagan, Ph.D., an associate professor in the Addiction Sciences Division of the Department of Psychiatry and Behavioral Sciences, decided to investigate whether incorporating oxytocin – known colloquially as the “cuddle hormone” – into a specific couples therapy regimen could help people stick with treatment.

She received a five-year, $2.75 million award from the National Institute on Alcohol Abuse and Alcoholism to test this idea and will begin recruiting participants in March. 

Flanagan said oxytocin is well-known for its prosocial effects, meaning it tends to increase feelings of trust and empathy and helps people to correctly recognize others’ emotions, which also contributes to empathy. The hormone also has anti-anxiety and anti-stress effects and has even been shown to reduce alcohol tolerance and withdrawal symptoms, she said.  

Her idea is to give couples an intranasal dose of oxytocin just before the therapy session. A couple dealing with alcohol addiction – and all the unpleasant history that resulted from the addiction – is probably less enthusiastic about working with each other, she said. 

“They’re not going to come into the room super excited about wanting to take the other person’s perspective, and they may not have the skills to do that very well,” she said. 

Oxytocin delivered by nasal spray lasts only two to four hours, but the positive effects of the hormone should allow the therapist to get right to substantive content, she said, rather than spending a lot of time calming the two participants.  

Flanagan’s research also uses a very specific form of couples therapy.  Alcohol Behavioral Couples Therapy (ABCT) is structured to target the patient’s drinking as well as the couple’s overall relationship. 

Barbara McCrady, Ph.D., distinguished professor of psychology at the Center on Alcoholism, Substance Abuse & Addictions at the University of New Mexico, developed the therapy. She is a co-investigator on the project and came to Charleston to train the therapists who will be involved in the study. The Ralph H. Johnson VA Medical Center even closed its clinic so its couples therapy providers, even those not involved in the study, could train with McCrady, Flanagan said. 

"I think it’s very interesting. It’s innovative,” McCrady said of Flanagan’s research. McCrady said she’s been trying to cut back on work but was intrigued enough by Flanagan’s premise that she jumped into this project. She’ll be checking in from afar, offering critiques to the therapists and making sure they stick to the ABCT script.  

ABCT isn’t commonly offered, despite its efficacy, because few providers are trained in the method, Flanagan explained. 

It’s a therapy that’s been tested and that works, Flanagan said. Even so, people drop out. That’s why she began to think about combining the benefits of oxytocin with behavioral therapy. 

“It’s not very common in the literature for folks to be looking at a combined behavioral and pharmacological intervention for couples. Typically, the couples literature is very siloed. It doesn’t often include a multidisciplinary approach,” Flanagan said. 

Another reason couples therapy isn’t used as much is because of reluctance on the part of family members or partners.  

“A lot of time folks with substance-use problems have burned their bridges with family members. So depending on how far along the substance-use problem is, they might not have a partner who’s willing or able to participate with them,” Flanagan said. 

Every couple in the project will receive 12 weeks of treatment. The couples will be randomized, so some will receive the oxytocin and some will get a placebo, but each individual in a couple will get the same thing. Flanagan said investigators will look at how much and how often the patient drinks after the therapy and also how well the relationship is functioning overall. 

Participants will self-report, but they’ll also have their brains scanned to see whether markers of alcohol use are more improved in people who got the oxytocin over people with the placebo. 

Investigators will also review video of each therapy session and categorize each participant’s words and actions to see whether the oxytocin helped improve how the couple related to each other. 

Flanagan said the study will accept people who are also using drugs, but the primary focus is on alcohol use.