Aims
Addiction is a chronic relapsing condition characterised by compulsivity, an inability to stop consuming a substance or indulging in activities despite the harm they induce. Craving, the urge to obtain the object of addiction, is one of the DSM5 diagnostic criteria for substance use disorders and is a complex, established predictor of relapse. Preclinical studies suggest the peptide oxytocin is able to reduce drug seeking behaviours. However, the impact of oxytocin on craving in humans is less clear.

Methods
This systematic review aimed to synthesize the evidence for the effect of intranasal oxytocin in reducing craving and consumption in substance use disorders, compulsive eating and other addictive behaviours.

Results
Twenty-six studies published before July 2020 met inclusion criteria comprising of 1,145 participants (male n=755, female n=336, unspecified n=54). Fifteen studies demonstrated efficacy for oxytocin to reduce craving or consumption but were limited by heterogeneity across participant demographics. One gambling study found oxytocin reduced risk taking in a gambling task. Cocaine craving was increased in one study and ten studies found no significant effect for oxytocin to reduce craving or consumption.

Conclusions
Oxytocin is an exciting, emerging pharmacotherapy for substance use disorders. The use of oxytocin in non-substance related addictions is under-researched. Whilst there is clear suggestion for oxytocin to reduce cravings, questions surrounding who may benefit in relation to gender, severity of substance dependence, optimal dose and psychiatric comorbidities remain unanswered. The exact mechanism which allows oxytocin to reduce craving is unknown and further investigation is warranted.

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