4 - (SYM 24) Does Intranasal Oxytocin Improve Outcomes in Alcohol Behavioral Couple Therapy? Results from a Double-blind Randomized Controlled Trial

Alcohol use disorder (AUD) can disrupt relationship functioning, and relationship conflict is often a motivator for seeking AUD treatment. Conversely, adaptive relationship functioning facilitates successful AUD treatment engagement and outcomes. Alcohol Behavior Couple Therapy (ABCT) is an efficacious 12-session dyadic alcohol intervention. Despite having the ability to outperform individual alcohol treatment and strong evidence for target mechanism engagement, there is still room to improve ABCT outcomes. Oxytocin is a promising experimental medication to achieve this goal. Studies suggest oxytocin can increase prosocial behavior and cognition and; it has shown both favorable and mixed results in clinical mental health research, including its ability to improve positive communication during couple conflict.

This randomized trial compared the effects of oxytocin (40 IU) vs. placebo delivered to both partners prior to each ABCT session on alcohol consumption (Aim 1; % days abstinent, % days of hazardous drinking via TLFB) and dyadic functioning (Aim 2; DAS-7). Exploratory aims tested drug effects on therapeutic processes such as treatment retention (EA1; number of sessions completed) and working alliance (EA2; HAQ). We hypothesized that the oxytocin group would demonstrate greater reductions in alcohol consumption (H1); greater improvements in relationship functioning (H2); and better treatment retention (EH1) and working alliance (EH2) at the end of treatment as compared to the placebo group. 

Due to the COVID-19 pandemic, the trial transitioned to remote implementation in March 2020. The final sample included 97 couples where at least one partner met DSM-5 diagnostic criteria for current AUD (M_age = 40.69, SD = 12.48, 51% women, 90.2% white, 4.6% Hispanic). Criteria for severe AUD were met by 39.7% of participants; both partners met AUD criteria in 49.5% of couples. At baseline, participants reported drinking on 54.2% (SD = 33.9%) of days assessed and hazardous drinking on 29.7% (SD = 33.7%) of days assessed. Couples also presented with relationship distress (DAS M = 105.48, SD = 18.92). While 12-week treatment retention was 67% for in-person participants (n=52), retention for telehealth participants was approximately 90% (n=142). Data collection was completed in January 2024, and the full results from both a priori hypothesis-testing and 3- and 6-month post-treatment follow ups will be presented, in addition to implications for telehealth delivery and including couples with severe conflict (i.e., intimate partner violence).