Will Taking MDMA and Magic Mushrooms to Save Your Marriage One Day Be Normal?

Think of who takes drugs like MDMA and magic mushrooms and images of waved, 20-somethings partying is more likely to come to mind than a middle-aged couple sat in front of a marriage counselor, thrashing out their deepest regrets and long-held resentments. But, according to the authors of a new book, that scene could—and indeed should—become more common in the near future.

In Love Drugs: The Chemical Future of Our Relationships, co-authors Brian D. Earp, an expert in health and ethics at institutions including Yale University, and Julian Savulescu, director of the Uehiro Centre for Practical Ethics at the U.K.'s University of Oxford, explore how both legal and currently illicit substances could be used to improve our relationship with our emotional state.

The book comes amid what is known as the psychedelic renaissance, as researchers around the world investigate the potential benefits of using psychedelic drugs in controlled medical settings to treat mental disorders like depression, anxiety and PTSD.

Newsweek spoke to Earp about the future and ethics of toying with love and drugs.

Which drugs do you think will become commonly used to deal with problems related to love in the near future, and in which scenarios? Will we stick to existing substances like MDMA for couples therapy, or do you envision new ones being created? For instance, are we far from having a pill to help us get over our ex?

One of the big takeaways from the book is that a lot of us are already taking "love drugs"—in the form of common medications like selective serotonin reuptake inhibitors (SSRIs), often used to treat depression. Basically, there is evidence that pills we are prescribed for other purposes can have profound effects on our relationships and romantic neurochemistry, only in ways that aren't widely appreciated or fully understood.

This is because Western medicine tends to measure the effects of drugs on individuals and their personal symptoms, without paying as much attention to potential interpersonal effects. We think that's a mistake and in our book we call for a shift in scientific research norms toward a more relational focus.

Now, many people know that SSRIs can dampen libido for some people, and where sex is an important part of a romantic relationship, that has obvious implications. But there is also some evidence that SSRIs can interfere with "higher level" processes, like the ability to care about a partner's feelings. And of course, when SSRIs work as intended and help a person actually function and engage with the others, including their romantic partner, they can have positive effects for relationships as well.

Other drugs that have under-studied effects, both positive and negative, on things like sexual desire, attraction, and attachment include hormonal birth control, treatments for obsessive-compulsive disorder, the hair-loss drug finasteride, certain blood pressure medications, and so on. We think we should study the effects of these drugs on relationships more systematically, so that we can avoid any bad effects they might be having and, potentially, direct any positive effects to better ends. On the more deliberate side, there are now some studies looking at the effects of oxytocin—a brain chemical involved in pair-bonding that's normally released through physical intimacy, but which now comes in the form of a nasal spray—on outcomes like trust, empathy, and even conflict resolution in close relationships.

But perhaps the biggest area of research right now is on drugs like MDMA (the key ingredient in Ecstasy) or psilocybin (from "magic" mushrooms) being used as adjuncts to psychotherapy. The clinical trials that are currently looking at these drugs are focused on serious mental conditions like post-traumatic stress disorder (PTSD) or major depression, but again the focus is on individuals and their symptoms. However, there are some recent studies that are starting to zoom out to take relationships into account, like a trial on MDMA-assisted "conjoint" therapy for couples where one of the partners has PTSD. That's a step in the right direction.

But in the book we call for research on MDMA-assisted couples counseling where neither partner has PTSD, to see whether people struggling with "ordinary" relationship troubles might benefit from drug-enhanced therapy, and to identify those cases where it might not be a good idea, for various reasons.

In fact, this is how MDMA was originally used in the late 1970s and early 1980s by therapists and their clients, apparently to good effect in many cases, before it became associated with rave culture and triggered a conservative backlash. So it isn't a new idea. But if these drugs are going to find their way back into modern medicine as treatments for individual-level psychiatric issues, we should be studying their wider effects—on couples, families, and other relationships—as well.

Are regulations for drugs like MDMA standing in the way of such substances being used for helpful practices like couple's therapy, ways that might help make society more cohesive?

Because MDMA, and some of the psychedelic drugs from earlier generations now coming back into use through medicine, are so powerful, they have the potential to bring great benefit—if used responsibly, in a therapeutic setting, under the guidance of a trained professional—but they can also bring great harm, if used irresponsibly outside of properly regulated environments.

So we support government regulation in this area, and we definitely don't think these drugs should be mass-released on the population for immediate experimental use. Rather, what's needed is slow, careful science to uncover the benefits and risks of these drugs at different doses and used in different ways (including with couples), alongside intensive ethical and public policy deliberation to figure out what institutional structures, guidelines and protections need to be put in place to reduce the chance of misuse or unintended harm.

Most likely, these drugs should eventually be made more widely available, but not in a free-for-all where you just pick them up over the counter. Rather, they should only be available through licensed clinics, and administered in a therapeutic environment by an appropriately qualified therapist who could help couples work through any drug-facilitated lessons and see how to integrate them into their daily lives.

How easy is it to study love and the potential drugs we can use to change the emotion when it's so subjective?

Every mental experience is subjective, in the sense that only the person who is having the experience can be certain what it feels like for them. But as with pain, sadness, anger, fear, guilt, embarrassment, longing, desire, attraction and other subjective experiences, we can "compare notes" with each other by describing what we feel, noticing the typical causes and effects of those feelings, and—increasingly—looking at what happens in the brain while people report on their mental states.

In our book we talk about love as a "dual nature" phenomenon, drawing on the work on the philosopher Carrie Jenkins. She points out that love is neither just an abstract psychological state, nor just a bunch of brain chemicals swirling around in our skulls. Instead, it is both a biological and psychosocial phenomenon, and we can make progress on understanding it—and even influencing it—along both of those dimensions.

On the biological side, we know that our ability to feel love at all depends on certain brain systems that evolved to suit the reproductive needs of our ancestors: libido to draw us toward a range of potential mating partners, attraction to focus our attention on a smaller number of partners, or maybe one in particular, and attachment to help us form long-term pair bonds (often in the context of parenting).

How exactly those underlying systems relate to "love" depends on which philosophical theory of love you find most convincing, but on pretty much any common sense understanding of what love is, and what it feels like to be in love, those biological systems will play an active role.

Isn't it unethical to popularise the idea that we can tweak love with drugs? Or do you think we could benefit from changing our view of love as something romantic and mysterious that shouldn't be tinkered with, and see it for what it is as just a biological process?

Since love is both a biological and a psychosocial phenomenon, it can be "tweaked" along both dimensions. We are already comfortable as a society with the idea that love "takes work" as can be seen with the example of couples counseling. We don't have to just passively sit there and hope that love will "happen" to us, or—in the context of a long-term relationship—last. People go on romantic vacations, try to spice up their sex life, and so on, all in an effort to influence love in a positive direction.

Of course, those kinds of activities also have "biological" effects: having sex with your partner, for example, causes the release of serotonin, dopamine, oxytocin and other brain chemicals that may reinforce attachment directly, while at the same time the subjective feelings you're having, the narrative meanings associated with those experiences, and so on, are playing a role as well. So if you believe it's okay to work on love—to try to bring it back into a tired marriage, or help it last in a committed relationship, or improve its quality through talk therapy—then the sheer idea of taking steps to actively influence love's course in your life should not be controversial.

The idea here is not to replace existing measures of "tweaking" love psychosocially, but rather, to identify those cases where supplementing those well-worn measures with biological interventions, as in the case of MDMA-assisted couples counseling, could enhance the effects of the counseling, and so help people meet their relationship goals and contribute to their romantic flourishing.

How worried are you that people will exploit MDMA therapy for nefarious things, like trying to pseudoscientifically "convert" people from being gay or to abuse their partners?

This is a serious worry. There are documented cases of certain fundamentalist religious groups, for example, exploiting the "side effect" of SSRIs to intentionally dampen the libido of people with same-sex desires in their communities, while also framing this a treatment for depression (ironic, since the depression is likely to be rooted in the oppressive social norms, not the same-sex desires in and of themselves).

That is why we are trying to jump-start this conversation: drugs that are available today are being (mis)used to influence love and sexuality, and even more powerful drugs may be available in the future. So it is imperative to set up ethical guidelines, and even legal measures, to prevent any kind of coercive application of these drugs, or the unjust use of them to target sexual orientation minorities or other vulnerable people.

What is your advice for those tempted to take drugs to improve their relationships? For example, someone in a marriage on the rocks turning to microdosing LSD after seeing this in the media.

There is currently no good scientific evidence on the benefits or risks of microdosing, or even how it differs from a sugar pill placebo. All we have is anecdotes (and a handful of qualitative studies). The practice remains illegal.

Some people advocate for "pharmacological freedom" and believe that adults of sound mind have a moral right to ingest whatever substances they like, and that it is wrong for governments to prohibit the use of certain drugs, especially those that occur in nature, like psilocybin (from magic mushrooms). We don't take a stand on that issue, but what we do call for is careful scientific research into these substances.

If they can be shown to be sufficiently safe and to have genuinely positive effects for certain people under certain conditions, then we would support them being made more widely available. But these drugs are potent; they can have seriously bad effects if used irresponsibly; and we think the culture needs to move cautiously in this area, not changing norms overnight, but rather, adopting practices and institutions that will minimize harmful outcomes associated with the use of these drugs, or indeed any drugs, including potentially dangerous drugs that are currently used for medicine (think prescription opioids).

What have we learned about drugs and our brains in recent years, particularly in relation to what is known as the psychedelic renaissance, that has led us to the idea that love can be changed with drugs?

A big lesson from the recent research on psychedelics is that we can't just focus on what happens "in our brains" when we are under the influence of these drugs if we want to understand their effects on complicated, high-level phenomena like PTSD, addiction, or indeed love. In the case of PTSD, for example, a lot of the treatment effect seems to come down to the subjective experiences people have in the context of drug-assisted psychotherapy, including whatever life-insights may be facilitated by the "trip."With MDMA-enhanced psychotherapy, for example, there is a direct effect on the brain in terms of serotonin release, a temporary override of hair-trigger fear responses, and so on; but it's what the person does with the altered state of mind that is induced by these effects that appears to drive the reported healing.

Approaching traumas and working through them while you feel less fearful, for example, is something that happens in large part at the level of your conscious experience, reflection, engagement with the therapist, and so on. Similarly, in the historical cases of MDMA-enhanced couples counseling, it wasn't that the drug, all by itself, directly "cured" relationship problems. Rather, it facilitated a less-defensive posture between couples, motivated them to take each other's perspective more willingly than they normally would, and so on, so that they could actively, and more productively, address the underlying issues that were hampering their romantic connection.

Isn't taking drugs for love just a way of patching over things that make us miserable that need to be tackled? Maybe there is a reason so many marriages end in divorce that needs to be addressed. Isn't it comparable to telling stressed people to practice mindfulness, when in reality the world is an unjust place for many people in structural ways, and they are right to feel stressed?

Some relationships definitely should end, especially if they involve abuse or other serious mistreatment. And other relationships may have simply run their course. But in the case of couples that have enough in common, shared values, and a reasonable desire to try to work on their relationship despite difficulties—especially if there are children involved who depend on them for love and care—we think society should support them, including by making resources available to help promote healthy and loving connections.

A lot of currently-used drugs, like SSRIs for depression, do indeed seem to "patch over" underlying problems in many cases (though in other cases they can be genuinely helpful). But MDMA and psilocybin as adjuncts to psychotherapy don't seem to typically work that way: instead, they may help a person clear away the "patchwork" of defense mechanisms, trauma, and other impediments to a healthy mind or relationship they've acquired over the years, finally allowing them to address the deeper issues in a more lasting way. At least, that is what the initial evidence suggests; a lot more work is needed.

But you are absolutely right that individual-level solutions are not enough; there does need to be structural change. In the epilogue to our book, we put it like this: "Do we really need more drugs?" We actually think the answer is no. What we need are changes to society: political action that puts human welfare ahead of special interests; resources to help people make good choices about forming and maintaining close relationships; less stress, and more time with friends and family.

But so long as we use drugs for medicine—as societies have always done and will continue to do indefinitely—we will need better drugs. More effective drugs. Drugs with milder side effects, with less risk of dependency and abuse, and with the capacity to encourage more serious engagement with the underlying problems that plague our minds and relationships.