Could these drugs save your relationship?

Two bioethicists explore the ecstatic (and thorny) future of chemical-infused relationship therapy.

You love your partner and they love you. Or you used to love each other, viscerally, in a way that didn’t involve any second-guessing. Now your love is more of an abstract idea: a thought more than a feeling. Closer to a memory than something that defines your daily lives.

So here you are in couples therapy, trying to do something about it — trying to bring back a sense of intimacy — and yet it’s words, words, words, with no improvement.

What if you could take a pill, some kind of “love drug,” to jump-start the process? Not as a replacement for therapy but as a therapy enhancer?

Does such a thing even exist?

It does. But before we get to that, let’s acknowledge the elephant in the room. Mixing drugs and troubled relationships might sound like a terrible idea. (Taking drugs at all sounds like a bad idea to some.) And depending on the drug — or the relationship — it can be exactly that.

Or perhaps you imagine a magical love potion that overrides your free will and turns you into a starry-eyed zombie. That, too, would be perilous, at best.

It’s also the stuff of fiction. In our new book, Love Drugs: The Chemical Future of Relationships, we write about real-life neurotechnologies that can affect your romantic feelings, but in more subtle and nuanced ways — not through witchcraft or wizardry, or by bypassing your will completely, but by acting as a chemical “nudge” on the brain systems involved in love and attachment.

Testosterone, estrogen, oxytocin, vasopressin, serotonin, dopamine, adrenaline, and more — all are ingredients in our brain’s chemical cocktail of love, and all of them can be tweaked in various ways.

Flibanserin (Addyi), for example, has been controversially marketed as a means of increasing sexual desire in women, by modulating serotonin and dopamine. Oxytocin, normally produced in our bodies and released during sex and orgasm, now comes in the form of a nasal spray. Scientists are looking at the effects of those sprays on things like conflict resolution in close relationships.

And now that a wave of research is exploring the therapeutic uses of magic mushrooms, MDMA, LSD, and other powerful substances associated with certain subcultures in previous generations, it will be important to study the effects of these drugs on relational experiences (and on our romantic neurochemistry).

In fact, drugs we ingest today for more prosaic purposes, like serotonin boosters used as antidepressants, are already shaping our relationships through their effects on our brains and bodies. You probably know about the risk of a dampened libido that can come with these drugs. But did you know that messing with serotonin levels can also make some people less able to care about their partner’s feelings? Maybe they should put that on the label.

Of course, antidepressants can be good for some relationships, too. The point is that we should be researching these interpersonal effects, carefully and systematically, not dousing ourselves with medicinal molecules and hoping for the best. That way, we can avoid the worst harms that drugs might cause to our relationships, while also potentially harnessing their effects to better ends.

There is more to love than brain chemicals, we know. And there is more to a good relationship than sniffing oxytocin or downing any drug. But brain chemicals are an important part of the picture, and we shouldn’t ignore the biological bases of our most intimate bonds — assuming we want them to last.

The practical details matter. One of us (Brian) is trained in cognitive science, the other (Julian) in neuroscience and medicine. We both have degrees in philosophy with a focus on bioethics.

But even more relevant, we’re human beings who have experienced the highs and lows of romance and the searing pain of heartbreak. We don’t take love lightly, and despite our science backgrounds, we don’t believe in technological quick fixes. Love drugs, as we envision them, are potential tools to be used in conjunction with more traditional ways of working on relationships.

Take MDMA, the illegal drug more commonly known as molly or ecstasy and usually associated more with raves than research. Right now, it’s being studied for its use during psychotherapy for post-traumatic stress disorder, or PTSD. In these clinical trials — in a safe, therapeutic environment — it’s showing treatment effects that were previously unheard of.

MDMA unleashes a flood of serotonin, putting users in a blissful state (one reason it’s also a popular party drug). It works directly on the emotional centers of the brain, inducing a feeling of warmth and openness while also reducing knee-jerk fear responses — like the ones that might make you feel defensive and shut off to your partner’s perspective. It may also make you more receptive to physical affection.

Soldiers in the trials, some of whom had been suicidal after coming home from Iraq or Afghanistan, found a reason to keep living. MDMA enhanced the effects of psychotherapy, allowing a kind of healing that would have been less likely with either one alone.

Of course, PTSD doesn’t just hurt individuals. It can hurt relationships. So if MDMA, combined with talk therapy, can help someone with PTSD get better, it might also heal their connections with others.

A similar thing seems to happen as “side effect” of magic mushrooms — another drug from the psychedelic ’60s making a comeback as a potential treatment for major depression. As Rosalind Watts, a clinical psychologist at Imperial College London who has guided patients through shroom-assisted psychotherapy, reports that six months after the treatment, virtually every romantically involved patient in the study had noticed positive changes in their relationships.

“During the trip, they would have revelations about how important their partner was to them,” Watts said. “One man went to dinner with his wife for the first time in six years. He said they were like teenagers again.”

The partners confirmed what the patients were saying. “They reported that their partner was more open with them, more able to express emotion, and more willing to have deep conversations after the [drug-enhanced] experience.”

There is anecdotal evidence — much of it from the 1970s and early ’80s, before MDMA and psilocybin became illegal — that drug-assisted couples counseling can be therapeutic for both partners, even when neither of them has a mental illness. This work continues today but is unfortunately happening mostly underground and out of sight, through a secretive network of renegade counselors who have developed their own protocols.

One thing these counselors emphasize is the importance of screening couples in advance to make sure they understand what they are getting into. Couples need to know, for example, that MDMA will not “cure” them of psychological problems or problems within the relationship. Instead, it will temporarily put them into an altered state of mind where they might feel more willing to face up to old traumas and work through them, rather than keep them locked away — similar to what is being seen in the clinical trials for the patients with PTSD.

MDMA and psilocybin — the active ingredient in magic mushrooms — are just two examples of drugs that may one day be used in couples therapy. Research in this vein is only just beginning. And as the biological underpinnings of love — including lust, attraction, and attachment — become better understood in the coming years, they will become more susceptible to manipulation. As this work progresses, we’ll need to think seriously about how we want to respond as a society to the prospect of biochemically bolstering love.

There are real dangers to what we’re proposing. Some love drugs, if used in the right way, could be helpful for many couples. But they could also be harmful if used in the wrong way, with the wrong people, or without the appropriate research, institutional support, ethical deliberation, and public policy in place.

There is a long, sordid history, for example, of people trying to alter others’ biology, often to reinforce a narrow-minded vision of “normal.” (Attempted “conversion therapies” for LGBTQ people come to mind.) So we will need to move slowly and carefully, while also discussing — together, as a society — the ethical and political dimensions of drug-assisted couples counseling so that nobody is caught flat-footed.

Protecting against any kind of coercive misuse of these drugs will have to be a top priority. Getting a clear sense of who should not be eligible for drug-assisted therapy — because the risks would be too high — is an absolute must as well.

Other worries are a bit more philosophical. You might think that love that’s been influenced by a drug just cannot be the real deal. And there are concerns about authenticity here, like crushing on someone while you’re high on ecstasy only to later realize you have nothing in common. That’s why we recommend that, if they ever become legal, MDMA or other similar drugs be used in the context of existing relationships, as a supplement to talk therapy, under the guidance of a trained professional.

Another worry is that the existence of love drugs will lead to “medicalizing” romantic relationships — soon, “lovesickness” would no longer be a metaphor. If certain drugs, in conjunction with therapy, are made available to help people improve their relationships, won’t this require first “diagnosing” them with some kind of relationship disorder so that the drugs can be characterized as medicine, and therefore be seen as acceptable?

Not necessarily. Just because a drug or other technology can be used for medical purposes does not mean this is its only legitimate use. Surgery, for example, can be used to fix a medical problem, such as a horrible burn or gunshot wound; it can also be used for purely cosmetic purposes, a means of aesthetic self-expression. In both cases, the aim is to improve the person’s life in accordance with their needs and values.

Traditional couples counseling (without the help of drugs) is a case in point. Most people understand that ordinary relationship problems can sometimes helpfully be addressed through talk therapy: The point is not to “cure a disease” in that case but simply to work on improving the relationship, from whatever baseline that couple happens to be at.

The same idea would apply to MDMA or to other potential love drugs used alongside existing forms of therapy. The point would be to strengthen the effects of the therapy, allowing a couple to engage with each other more deeply and less defensively, toward a more authentic connection.

Long-term relationships are hard. There can be conflict, grudges, money issues. Sometimes there are problems with infidelity or broken trust. But a common situation is that partners simply fall into a rut. They no longer feel a sense of passion or excitement for each other. They’ve built up various defense mechanisms over the years to avoid dealing with criticism or other problems. And as a result, they find it hard to listen to each other anymore, to really see each other at all. They take each other for granted and just go through the motions.

Suppose they’ve tried everything, from romantic vacations to years of expensive talk therapy, and nothing really seems to work. What is there left for them to do?

Maybe the relationship should end. Maybe things have truly run their course. But if a couple wants to make one last effort to shake themselves loose of their tired and unproductive patterns and really “see” each other again with fresh eyes — well, you can grasp why trying love drugs might be worth exploring.

Brian D. Earp is associate director of the Yale-Hastings Program in ethics and health policy and a research fellow in the Uehiro Center for Practical Ethics at the University of Oxford.

Julian Savulescu is a philosopher and bioethicist who holds degrees in neuroscience and medicine. He is currently the Uehiro chair in practical ethics at the University of Oxford.