A myriad of factors can be attributed to drug dependence and substance abuse including genetics, psychological and social factors. Genetic studies associate alcohol and drug dependence to the interaction of genes to the environment. According to the incentive-sensitization theory, the dopamine system may play an important factor in drug intake through the brain pathways. Psychological factors such as reduction of stress and tension, increase of sex drive and, increase of violent behavior can also be attributed to the use of alcohol and drugs. Social and cultural factors including access to substance, family dynamics, social support, and advertisements also influences the individual to take alcohol and drugs (Kring, Et. Al, 2014). The complexity of drug and alcohol dependence entails a comprehensive therapeutic program including detoxification and psychotherapy.
Music, as a creative medium, opens the window for healing. It provides avenue to both children and adults to become self-aware and to communicate and express their feelings. It can also be utilized to complement therapeutic programs to address various mental health issues, including addiction and substance abuse. Music can serve as an essential and manageable technique recommended for therapists who work with clients with such problems (James, 1988; Treder- Wolff, 1990).
The American Music Therapy Association (AMTA) defines music therapy as, “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” Music therapists combine the use of therapeutic relationship and various musical activities to assist clients or patients in their physical, cognitive and socio-emotional needs, in this case, addiction and substance abuse (AMTA, 2015). The therapist is guided with a comprehensive assessment to determine the modality of the intervention to be provided to the client or patient. Clients can utilize music through singing, playing instruments, listening to songs or music, dancing, and even acting through a structured or non-structured program that works on general and specific therapeutic goals.
Music therapy offers a multitude of physical, cognitive and psychosocial benefits. For physical health, music helps in reducing stress and helps relax muscles. It also helps in lowering blood pressure, assists in treating hypertension, and protects the heart from various diseases and complications. It also boosts the body’s immune system and prevents multiple illnesses. It also reduces chronic pain. The psychological health benefits of music include lessening the symptoms of depression, dealing with anxiety and developing a more positive attitude. It also lessens boredom and can even nurture spirituality. It also helps in facilitating catharsis, and more importantly, it can be an effective medium to recovery and rehabilitation (AMTA, 2015).
The abovementioned benefits prove that music indeed can facilitate the healing process. Clients can utilize music through singing, playing instruments, listening to songs or music, dancing, and even acting through a guided program that works on general and specific therapeutic goals.
Considering the abovementioned benefits, a sample case here demonstrates what therapeutic goals should the client target to achieve?
John, not his real name, grew up in a family of alcoholics. His father and mother died of liver cancer due to their excessive alcoholism. As child, his parents were critical of him and deprived of playing. He never voiced out his feelings because he is often reprimanded, scolded and in several occasions, beaten. He learned to drink at the age of 13 due to peer pressure and when he discovered pleasure in drinking alone, he drank alone. At the age of 19, he became alcohol-dependent and chilled every time he cannot drink. He lived with his foster mother (his aunt) who cannot take care of him due to her busy work as a lawyer. He became a loner, afraid to interact with others because of his condition. He was brought to the detoxification center for rehabilitation after his aunt discovered that he dropped out of school. John showed interest in playing guitars so the social worker working with him suggested that he undergo music therapy as part of his program.
Psychotherapy, in general, focuses in holistically treating the person through the therapeutic relationship. The main concern is not the “problem” but the “whole person” himself. Music therapy can address individual goals including, but not limited to:
Self-exploration: the client explores his/her feelings and emotions.
The goal is to break defenses mechanisms including rationalization, manipulation, denial, lying, and projection. This is done through guiding the client in acknowledging his emotions through listening, analysis of lyrics, and songwriting that could effectively address emotional conflicts and inner barriers using creative experiences (Treder-Wolf, 1990). Musical themes that explore issues of anger, frustration, disappointment and loneliness can reveal the client’s acknowledgement of these emotions, realize their differences, understand them further (Purdon-Ostertag, 1986). It is imperative for the client to recognize his feelings and take responsibility for his actions, in this case, addiction.
Development of self-worth: the client’s understanding of his self-concept, self-esteem and self worth
After recognition of thoughts and feelings, an important goal in music therapy is develop a positive self-concept, improve his self-esteem and work out his self-worth as they continue to discover and acknowledge his feelings and take full responsibility for his recovery. According to Adelman & Castricone (1986), music can facilitate in helping the client recognize his role in his addiction and his role in improving the meaning of his life. This can be done through the development of skills, making decisions, and taking concrete action to change major life occurrences.
Development of interests: the client’s ability to maximize his leisure time through development of more meaningful and productive activities
Research supports that music provides opportunities for clients to “have a good time” through a wide range of positive activities. The client experiences satisfaction, independence, motivation, and optimism as a result of musical activities in a non-threatening environment (Soli, Borg and Rolsvjord, 2013). Music diverts the attention of clients from drugs and other substance to more meaningful activities.
Social interaction: the client’s ability to develop his social skills, relationships with family and peers, and identity with a certain group
The goal is to open an arena for clients to increase their social interaction whether with their families or peers. Groups activities can help foster a sense of belongingness, teamwork, and participation. Individuals learn how to interact and find a common interest with the group (Soli, Borg, and Rolsvjord, 2013). Substance abuse counselors also found that music therapy promotes a sense of community and connectedness which primarily taught clients to appreciate the presence of others after group drumming sessions (Winkelman, 2003).
After determining the therapeutic goals, the music therapist must prepare for the following considerations for the therapy. In the case of John, the therapist must consider the following:
Rapport: The therapist must provide an opportunity of a non-threatening environment, and give a warm, positive regard and respect to the client. For John who is not able verbalize his emotions, it would be very helpful if the therapist to explain the benefit of the intervention to guide the client in making his decisions and for him to understand the therapists concern and respect to him.
Program: the therapist must be able to plan a program of intervention to the client-group, individualized, structure/unstructured activities, among others.
Follow-up: a constant follow-up and communication must be done by the therapist to determine the modality of interventions to be applied in the process. Monitoring and evaluation are essential to determine if the client has graduated or relapsed.
Strategies vary from one client to another. Music therapy can be both facilitated individually or in group. Both individual and group works aim to foster changes in personal well-being and group relations.
Loveszy (2005) emphasizes that approaches to music therapy may be through the use of activities-based techniques or improvisation-oriented techniques where freedom, creativity, and spontaneity can be maximized. Winkelman (2003) supports this idea in his research where a combination of drumming, meditation, altered state of consciousness, and shaman practices were conducted to treat substance abuse clients; thus, results show that drumming induces relaxation and enhances the production of theta-wave and organization of brain waves. It also provides pleasure to clients, release of traumatic feelings, increased awareness of the dynamics of preconscious, and more importantly, restoration of the self. It also connects the self to others and lessens isolation and self-centeredness, and development of the spirituality of the client. John’s therapist may use other instruments such as guitar, being his interest, in the process of therapy.
Helpful strategies such as the improvised advertisement jingles and songs about alcoholic drinks, cigarettes and other products can help clients understand that substance abuse may be social in context and cannot be solely pinpointed to individual or familial decisions (Treder-Wolff, 1990b). In the case of John, using songs can promote the importance of critical thinking to avoid being easily influenced in his decision-making. The therapist can also use guided imagery, biofeedback using music, and training on autogenic skills in the program, depending on the needs of the client (James, 1988). Music-assisted meditation, journal-writing and exercise can also complement therapeutic strategies.
Strategies that encourage group interaction can be effective to John. Group activities such as collective songwriting can facilitate interaction among the group. Use of songs that depict team work and cohesion can be utilized and serve as theme for their support for each other in the process of their recovery.
Alcohol and drug dependence can be chronic and relapse could happen. High stress levels, emotional and familial problems could trigger dependency depending on the coping mechanism of the client. Testimonies from former substance-dependent patients prove that there is a need to develop new and effective methods of treatment to shed a ray of hope to patients suffering from various forms of addiction. John’s therapist must conduct a continuous follow-up until the program is completed. He/she must work in consultation with the team of service providers: the doctor, social worker, psychologist and psychiatrist to ensure that he is treated comprehensively using both medical and psychological approaches. In fact, the AMTA requires an interdisciplinary approach in the helping process. Music therapists must recognize their clinical role, understand the nature of the problem, in this case, addiction, and finally, work with an interdisciplinary team of scientists developing ethical approaches for the client’s holistic recovery.
American Music Therapy Association. What is Music Therapy. 2015. Retrieved from: www.amta.org
Loveszy, R. Musical Journeys: Music Therapy With Latin American Mother-Infant Dyads In A Substance Abuse Rehabilitation Program.2005. New York University
Music Therapy Association of BC. Music Therapy and Chemical Dependence N.d. Retrieved from: www.mtabc.com/page.php?71
Robb, Sheri L. Journal of Music Therapy: Advancing the Science and Practice of Music Therapy. Spring 2014. American Music Therapy Association Journal of Music Therapy
Soli, Borg and Rolsvjord. Toward Understanding Music Therapy as a Recovery-Oriented Practice within Mental Health Care: A Meta-Synthesis of Service Users’ Experiences 2013. American Music Therapy Association Journal of Music Therapy
Winkelman, M. Complementary Therapy for Addiction: “Drumming Out Drugs” 2003. American Journal of Public Health