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• Published: 22 June 2021

Mental health and music engagement: review, framework, and guidelines for future studies

• Daniel E. Gustavson   ORCID: orcid.org/0000-0002-1470-4928 1 , 2 ,
• Peyton L. Coleman   ORCID: orcid.org/0000-0001-5388-6886 3 ,
• John R. Iversen 4 ,
• Hermine H. Maes 5 , 6 , 7 ,
• Reyna L. Gordon 2 , 3 , 8 , 9 &
• Miriam D. Lense 2 , 8 , 9  

Translational Psychiatry volume  11 , Article number:  370 ( 2021 ) Cite this article

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• Medical genetics
• Psychiatric disorders

Is engaging with music good for your mental health? This question has long been the topic of empirical clinical and nonclinical investigations, with studies indicating positive associations between music engagement and quality of life, reduced depression or anxiety symptoms, and less frequent substance use. However, many earlier investigations were limited by small populations and methodological limitations, and it has also been suggested that aspects of music engagement may even be associated with worse mental health outcomes. The purpose of this scoping review is first to summarize the existing state of music engagement and mental health studies, identifying their strengths and weaknesses. We focus on broad domains of mental health diagnoses including internalizing psychopathology (e.g., depression and anxiety symptoms and diagnoses), externalizing psychopathology (e.g., substance use), and thought disorders (e.g., schizophrenia). Second, we propose a theoretical model to inform future work that describes the importance of simultaneously considering music-mental health associations at the levels of (1) correlated genetic and/or environmental influences vs. (bi)directional associations, (2) interactions with genetic risk factors, (3) treatment efficacy, and (4) mediation through brain structure and function. Finally, we describe how recent advances in large-scale data collection, including genetic, neuroimaging, and electronic health record studies, allow for a more rigorous examination of these associations that can also elucidate their neurobiological substrates.

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Introduction

Music engagement, including passive listening and active music-making (singing, instrument playing), impacts socio-emotional development across the lifespan (e.g., socialization, personal/cultural identity, mood regulation, etc.), and is tightly linked with many cognitive and personality traits [ 1 , 2 , 3 ]. A growing literature also demonstrates beneficial associations between music engagement and quality of life, well-being, prosocial behavior, social connectedness, and emotional competence [ 4 , 5 , 6 , 7 , 8 ]. Despite these advances linking engagement with music to many wellness characteristics, we have a limited understanding of how music engagement directly and indirectly contributes to mental health, including at the trait-level (e.g., depression and anxiety symptoms, substance use behaviors), clinical diagnoses (e.g., associations with major depressive disorder (MDD) or substance use disorder (SUD) diagnoses), or as a treatment. Our goals in this scoping review are to (1) describe the state of music engagement research regarding its associations with mental health outcomes, (2) introduce a theoretical framework for future studies that highlight the contribution of genetic and environmental influences (and their interplay) that may give rise to these associations, and (3) illustrate some approaches that will help us more clearly elucidate the genetic/environmental and neural underpinnings of these associations.

Scope of the article

People interact with music in a wide variety of ways, with the concept of “musicality” broadly including music engagement, music perception and production abilities, and music training [ 9 ]. Table 1 illustrates the breadth of music phenotypes and example assessment measures. Research into music and mental health typically focuses on measures of music engagement, including passive (e.g., listening to music for pleasure or as a part of an intervention) and active music engagement (e.g., playing an instrument or singing; group music-making), both of which can be assessed using a variety of objective and subjective measures. We focus primarily on music engagement in the current paper but acknowledge it will also be important to examine how mental health traits relate to other aspects of musicality as well (e.g., perception and production abilities).

Our scoping review and theoretical framework incorporate existing theoretical and mechanistic explanations for how music engagement relates to mental health. From a psychological perspective, studies have proposed that music engagement can be used as a tool for encouraging self-expression, developing emotion regulation and coping skills, and building community [ 10 , 11 ]. From a physiological perspective, music engagement modulates arousal levels including impacts on heart rate, electrodermal activity, and cortisol [ 12 , 13 ]. These effects may be driven in part by physical aspects of music (e.g., tempo) or rhythmic movements involved in making or listening to music, which impact central nervous system functioning (e.g., leading to changes in autonomic activity) [ 14 ], as well as by personality and contextual factors (e.g., shared social experiences) [ 15 ]. Musical experiences also impact neurochemical processes involved in reward processing [ 10 , 13 , 14 , 16 , 17 , 18 ], which are also implicated in mental health disorders (e.g., substance use; depression). Thus, an overarching framework for studying music-mental health associations should integrate the psychological, physiological, and neurochemical aspects of these potential associations. We propose expanding this scope further through consideration of genetic and environmental risk factors, which may give rise to (and/or interact with) other factors to impact health and well-being.

Regarding mental health, it is important to recognize the hierarchical structure of psychopathology [ 19 , 20 ]. Common psychological disorders share many features and cluster into internalizing (e.g., MDD, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD)), externalizing (e.g., SUDs, conduct disorder), and thought disorders (e.g., bipolar disorder, schizophrenia), with common variance shared even across these domains [ 20 ]. These higher-order constructs tend to explain much of the comorbidity among individual disorders, and have helped researchers characterize associations between psychopathology, cognition, and personality [ 21 , 22 , 23 ]. We use this hierarchical structure to organize our review. We first summarize the emerging literature on associations between music engagement and generalized well-being that provides promising evidence for associations between music engagement and mental health. Next, we summarize associations between music engagement and internalizing traits, externalizing traits/behaviors, and thought disorders, respectively. Within these sections, we critically consider the strengths and shortcomings of existing studies and how the latter may limit the conclusions drawn from this work.

Our review considers both correlational and experimental studies (typically, intervention studies; see Fig. 1 for examples of study designs). We include not only studies that examine symptoms or diagnoses based on diagnostic interviews, but also those that assess quantitative variation (e.g., trait anxiety) in clinical and nonclinical populations. This is partly because individuals with clinical diagnoses may represent the extreme end of a spectrum of similar, sub-clinical, problems in the population, a view supported by evidence that genetic influences on diagnosed psychiatric disorders or DSM symptom counts are similar to those for trait-level symptoms in the general population [ 24 , 25 ]. Music engagement may be related to this full continuum of mental health, including correlations with trait-level symptoms in nonclinical populations and alleviation of symptoms from clinical disorders. For example, work linking music engagement to subjective well-being speaks to potential avenues for mental health interventions in the population at large.

Within experimental studies, music interventions can include passive musical activities (e.g., song listening, music and meditation, lyric discussion, creating playlists) or active musical activities (e.g., creative methods, such as songwriting or improvisation and/or re-creative methods, such as song parody).

The goal of this scoping review was to integrate across related, but often disconnected, literatures in order to propose a comprehensive theoretical framework for advancing our understanding of music-mental health associations. For this reason, we did not conduct a fully systematic search or quality appraisal of documents. Rather, we first searched PubMed and Google Scholar for review articles and meta-analyses using broad search terms (e.g., “review” and “music” and [“anxiety” or “depression” or “substance use”]). Then, when drafting each section, we searched for additional papers that have been published more recently and/or were examples of higher-quality research in each domain. When giving examples, we emphasize the most recent and most well-powered empirical studies. We also conducted some targeted literature searches where reviews were not available (e.g., “music” and [“impulsivity” or “ADHD”]) using the same databases. Our subsequent framework is intended to contextualize diagnostic, symptom, and mechanistic findings more broadly within the scope of the genetic and environmental risk factors on psychopathology that give rise to these associations and (potentially) impact the efficacy of treatment efforts. As such, the framework incorporates evidence from review articles and meta-analyses from various literatures (e.g., music interventions for anxiety [ 26 ], depression [ 27 ]) in combination with experimental evidence of biological underpinnings of music engagement and the perspective provided by newly available methods for population-health approaches (i.e., complex trait genetics, gene–environment interactions).

Music engagement and well-being

A growing body of studies report associations between music engagement and general indices of mental health, including increased well-being or emotional competence, lending support for the possibility that music engagement may also be associated with better specific mental health outcomes. In over 8000 Swedish twins, hours of music practice and self-reported music achievement were associated with better emotional competence [ 5 ]. Similarly, a meta-ethnography of 46 qualitative studies revealed that participation in music activities supported well-being through management of emotions, facilitation of self-development, providing respite from problems, and facilitating social connections [ 28 ]. In a sample of 1000 Australian adults, individuals who engaged with music, such as singing or dancing with others or attending concerts reported greater well-being vs. those who engaged in these experiences alone or did not engage. Other types of music engagement, such as playing an instrument or composing music were not associated with well-being in this sample [ 4 ]. Earlier in life, social music experiences (including song familiarity and synchronous movement to music) are associated with a variety of prosocial behaviors in infants and children [ 6 ], as well as positive affect [ 7 ]. Thus, this work provides some initial evidence that music engagement is associated with better general mental health outcomes in children and adults with some heterogeneity in findings depending on the specific type of music engagement.

Music engagement and internalizing problems

MDD, GAD, and PTSD are the most frequently clustered aspects of internalizing psychopathology [ 19 , 24 , 29 , 30 ]. Experimental studies provide evidence for the feasibility of music intervention efforts and their therapeutic benefits but are not yet rigorous enough to draw strong conclusions. The most severe limitations are small samples, the lack of appropriate control groups, few interventions with multiple sessions, and publications omitting necessary information regarding the intervention (e.g., intervention fidelity, inclusion/exclusion criteria, education status of intervention leader) [ 31 , 32 , 33 ]. Correlational studies, by contrast, suggest musicians are at greater risk for internalizing problems, but that they use music engagement as a tool to help manage these problems [ 34 , 35 ].

Experimental studies

Randomized controlled trials have revealed that music interventions (including both music therapies administered by board-certified music therapists and other music interventions) are associated with reduced depression, anxiety, and PTSD symptoms [ 26 , 27 , 33 , 36 ]. A review of 28 studies reported that 26 revealed significantly reduced depression levels in music intervention groups compared to control groups, including the 9 studies which included active non-music intervention control groups (e.g., reading sessions, “conductive-behavior” psychotherapy, antidepressant drugs) [ 27 ]. A similar meta-analysis of 19 studies demonstrated that music listening is effective at decreasing self-reported anxiety in healthy individuals [ 26 ]. A review of music-based treatment studies related to PTSD revealed similar conclusions [ 36 ], though there were only four relevant studies. More recent studies confirm these findings [ 37 , 38 , 39 ], such as one randomized controlled trial that demonstrated reduced depression symptoms in older adults following musical improvisation exercises compared to an active control group (gentle gymnastic activities) [ 39 ].

This work is promising given that some studies have observed effects even when compared to traditional behavior therapies [ 40 , 41 ]. However, there are relatively few studies directly comparing music interventions to traditional therapies. Some music interventions incorporate components of other therapeutic methods in their programs including dialectic or cognitive behavior therapies [ 42 ], but few directly compare how the inclusion of music augments traditional behavioral therapy. Still other non-music therapies incorporate music into their practice (e.g., background music in mindfulness therapies) [ 43 , 44 ], but the specific contribution of music in these approaches is unclear. Thus, there is a great need for further systematic research relating music to traditional therapies to understand which components of music interventions act on the same mechanisms as traditional therapies (e.g., developing coping mechanisms and building community) and which bolster or synchronize with other approaches (e.g., by adding structure, reinforcement, predictability, and social context to traditional approaches).

Aside from comparison with other therapeutic approaches, an earlier review of 98 papers from psychiatric in-patient studies concluded that promising effects of music therapy were limited by small sample sizes and methodological shortcomings including lack of reporting of adverse events, exclusion criteria, possible confounders, and characteristics of patients lost to follow-up [ 33 ]. Other problems included inadequate reporting of information on the source population (e.g., selection of patients and proportion agreeing to take part in the study), the lack of masking of interviewers during post-test, and concealment of randomization. Nevertheless, there was some evidence that therapies with active music participation, structured sessions, and multiple sessions (i.e., four or more) improved mood, with all studies incorporating these characteristics reporting significant positive effects. However, most studies have focused on passive interventions, such as music listening [ 26 , 27 ]. Active interventions (e.g., singing, improvising) have not been directly compared with passive interventions [ 27 ], so more work is needed to clarify whether therapeutic effects are indeed stronger with more engaging and active interventions.

Correlational studies

Correlational studies have focused on the use of music in emotional self-regulation. Specifically, individuals high in neuroticism appear to use music to help regulate their emotions [ 34 , 35 ], with beneficial effects of music engagement on emotion regulation and well-being driven by cognitive reappraisal [ 45 ]. Music listening may also moderate the association between neuroticism and depression in adolescents [ 46 ], consistent with a protective effect.

A series of recent studies have used validated self-reported instruments that directly assess how individuals use music activities as an emotion regulation strategy [ 47 , 48 , 49 , 50 ]. In adults, the use of music listening for anger regulation and anxiety regulation was positively associated with subjective well-being, psychological well-being, and social well-being [ 50 ]. In studies of adolescents and undergraduates, the use of music listening for entertainment was associated with fewer depression and anxiety symptoms [ 51 ]. “Healthy” music engagement in adolescents (i.e., using music for relaxation and connection with others) was also positively associated with happiness and school satisfaction [ 49 ]. However, the use of music listening for emotional discharge was also associated with greater depression, anxiety, and stress symptoms [ 51 ], and “unhealthy” music engagement (e.g., ‘hiding’ in music to block others out) was associated with lower well-being, happiness, school satisfaction, and greater depression and rumination [ 49 ]. Other work has highlighted the role of valence in these associations, with individuals who listen to happier music when they are in a bad mood reporting stronger ability for music to influence their mood than those who listen to sad music while in a negative mood [ 52 , 53 ].

This work highlights the importance of considering individuals’ motivations for engaging with music in examining associations with well-being and mental health, and are consistent with the idea that individuals already experiencing depression, anxiety, and stress use music as a therapeutic tool to manage their emotions, with some strategies being more effective than others. Of course, these correlational effects may not necessarily reflect causal associations, but could be due to bidirectional influences, as suggested by claims that musicians may be at higher risk for internalizing problems [ 54 , 55 , 56 ]. It is also necessary to consider demographic and socioeconomic factors in these associations [ 57 ], for example, because arts engagement may be more strongly associated with self-esteem in those with higher education [ 58 ].

It is also necessary to clarify if musicians (professional and/or nonprofessional) represent an already high-risk group for internalizing problems. In one large study conducted in Norway ( N  = 6372), professional musicians were higher in neuroticism than the general population [ 56 ]. Another study of musician cases ( N  = 9803) vs. controls ( N  = 49,015) identified in a US-based research database through text-mining of medical records found that musicians are at greater risk of MDD (Odds ratio [OR] = 1.21), anxiety disorders (OR = 1.25), and PTSD (OR = 1.13) [ 55 ]. However, other studies demonstrate null associations between musician status and depression symptoms [ 5 ] or mixed associations [ 59 ]. In N  = 10,776 Swedish twins, for example, professional and amateur musicians had more self-reported burnout symptoms [ 54 ]. However, neither playing music in the past, amateur musicianship, nor professional musicianship was significantly associated with depression or anxiety disorder diagnoses.

Even if musicians are at higher risk, such findings can still be consistent with music-making being beneficial and therapeutic (e.g., depression medication use is elevated in individuals with depressive symptoms because it is a treatment). Clinical samples may be useful in disentangling these associations (i.e., examining if those who engage with music more frequently have reduced symptoms), and wider deployment of measures that capture emotion regulation strategies and motivations for engaging with music will help shed light on whether high-risk individuals engage with music in qualitatively different ways than others [ 51 , 57 ]. Later, we describe how also considering the role of genetic and environmental risk factors in these associations (e.g., if individuals at high genetic and/or environmental risk self-select into music environments because they are therapeutic) can help to clarify these questions.

Music engagement and externalizing problems

The externalizing domain comprises SUDs, and also includes impulsivity, conduct disorder, and attention-deficit hyperactivity disorder (ADHD), especially in adolescents [ 20 , 24 , 60 , 61 ]. Similar to the conclusions for internalizing traits, experimental studies show promising evidence that music engagement interventions may reduce substance use, ADHD, and other externalizing symptoms, but conclusions are limited by methodological limitations. Correlational evidence is sparce, but there is less reason to suspect musicians are at higher risk for externalizing problems.

Intervention studies have demonstrated music engagement is helpful in patients with SUDs, including reducing withdrawal symptoms and stress, allowing individuals to experience emotions without craving substance use, and making substance abuse treatment sessions more enjoyable and motivating [ 62 , 63 , 64 ] (for a systematic review, see [ 65 ]). Similar to the experimental studies of internalizing traits, however, these studies would also benefit from larger samples, better controls, and higher-quality reporting standards.

Music intervention studies for ADHD are of similar quality. Such interventions have been shown to reduce inattention [ 66 ], decrease negative mood [ 67 ], and increase reading comprehension for those with ADHD [ 68 ]. However, there is a great amount of variability among children with ADHD, as some may find music distracting while others may focus better in the presence of music [ 69 ].

Little research has been conducted to evaluate music engagement interventions for impulsivity or conduct disorder problems, and findings are mixed. For example, a music therapy study of 251 children showed that beneficial effects on communication skills (after participating in a free improvisation intervention) was significant, though only for the subset of children above age 13 [ 70 ]. Another study suggested the promising effects of music therapy on social skills and problem behaviors in 89 students selected based on social/emotional problem behaviors, but did not have a control group [ 71 ]. Other smaller studies ( N  < 20 each) show inconsistent results on disruptive behaviors and aggression [ 72 , 73 ].

Correlational studies on externalizing traits are few and far between. A number of studies examined how listening habits for different genres of music relate to more or less substance use [ 74 , 75 , 76 , 77 ]. However, these studies do not strongly illuminate associations between music engagement and substance use because musical genres are driven by cultural and socioeconomic factors that vary over the lifespan. In the previously cited large study of American electronic medical records [ 55 ] where musicianship was associated with more internalizing diagnoses, associations were nonsignificant for “tobacco use disorder” (OR = 0.93), “alcoholism” (OR = 1.01), “alcohol-related disorders” (OR = 1.00), or “substance addiction and disorders” (OR = 1.00). In fact, in sex-stratified analyses, female musicians were at significantly decreased risk for tobacco use disorder (OR = 0.85) [ 55 ]. Thus, there is less evidence musicians are at greater risk for externalizing problems than in other areas.

Regarding other aspects of externalizing, some studies demonstrate children with ADHD have poor rhythm skills, opening a possibility that working on rhythm skills may impact ADHD [ 78 , 79 ]. For example, music might serve as a helpful scaffold (e.g., for attention) due to its regular, predictable rhythmic beat. It will be important to examine whether these associations with music rhythm are also observed for measures of music engagement, especially in larger population studies. Finally, musicians were reported to have lower impulsiveness than prior population samples, but were not compared directly to non-musicians [ 80 , 81 ].

Music engagement and thought disorders

Thought disorders typically encompass schizophrenia and bipolar disorder [ 20 ]. Trait-level measures include schizotypal symptoms and depression symptoms. Much like internalizing, music interventions appear to provide some benefits to individuals with clinical diagnoses, but musicians may be at higher risk for thought disorders. Limitations of both experimental and correlational studies are similar to those for internalizing and externalizing.

Music intervention studies have been conducted with individuals with schizophrenia and bipolar disorder. A recent meta-analysis of 18 music therapy studies for schizophrenia (and similar disorders) [ 82 ] demonstrated that music therapy plus standard care (compared to standard care alone) demonstrated improved general mental health, fewer negative symptoms of schizophrenia, and improved social functioning. No effects were observed for general functioning or positive symptoms of schizophrenia. Critiques echoed those described above. Most notably, although almost all studies had low risk of biases due to attrition, unclear risk of bias was evident in the vast majority of studies (>75%) for selection bias, performance bias, detection bias, and reporting bias. These concerns highlight the need for these studies to report more information about their study selection, blinding procedure, and outcomes.

More recent papers suggest similar benefits of music therapies in patients with psychosis [ 83 ] and thought disorders [ 84 ], with similar limitations (e.g., one study did not include a control group). Finally, although a 2021 review did not uncover more recent articles related to bipolar disorder, they argued that existing work suggests music therapy has the potential both to treat bipolar disorder symptoms and alleviate subthreshold symptoms in early stages of the disorder [ 85 ].

Much like internalizing, findings from the few existing studies suggest that musicians may be at higher risk for thought disorders. In the large sample of Swedish twins described earlier [ 54 ], playing an instrument was associated with more schizotypal symptoms across multiple comparisons (professional musicians vs. non-players; amateur musicians vs. non-players; still plays an instrument vs. never played). However, no associations were observed for schizophrenia or bipolar disorder diagnoses across any set of comparison groups. Another study demonstrated that individuals with higher genetic risk for schizophrenia or bipolar disorder were more likely to be a member of a creative society (i.e., actor or dancer, musician, visual artist, or writer) or work in a profession in these fields [ 86 ]. Furthermore, musician status was associated with “bipolar disorder” (OR = 1.18) and “schizophrenia and other psychotic disorders” (OR = 1.18) in US electronic health records (EHRs) [ 55 ].

Interim summary

There is promising evidence that music engagement is associated with better mental health outcomes. Music engagement is positively associated with quality of life, well-being, social connectedness, and emotional competence. However, some individuals who engage with music may be at higher risk for mental health problems, especially internalizing and thought disorders. More research is needed to disentangle these contrasting results, including clarifying how “healthy” music engagement (e.g., for relaxation or social connection) leads to greater well-being or successful emotion regulation, and testing whether some individuals are more likely to use music as a tool to regulate emotions (e.g., those with high neuroticism) [ 34 , 35 ]. Similarly, it will be important to clarify whether the fact that musicians may be an at-risk group is an extension of working in an artistic field in general (which may feature lower pay or lack of job security) and/or if similar associations are observed with continuous music engagement phenotypes (e.g., hours of practice). As we elaborate on later, genetically informative datasets can help clarify these complex associations, for example by tested whether musicians are at higher genetic risk for mental health problems but their music engagement mitigates these risks.

Music intervention studies are feasible and potentially effective at treating symptoms in individuals with clinical diagnoses, including depression, anxiety, and SUDs. However, it will be essential to expand these studies to include larger samples, random sampling, and active control groups that compare the benefits of music interventions to traditional therapies and address possible confounds. These limitations make it hard to quantify how specific factors influence the effectiveness of interventions, such as length/depth of music training, age of sample, confounding variables (e.g., socioeconomic status), and type of intervention (e.g., individual vs. group sessions, song playing vs. songwriting, receptive vs. active methods). Similarly, the tremendous breadth of music engagement activities and measures makes it difficult to identify the specific aspects of music engagement that convey the most benefits to health and well-being [ 87 ]. It is therefore necessary to improve reporting quality of studies so researchers can better identify these potential moderators or confounds using systematic approaches (e.g., meta-analyses).

Various mechanisms have been proposed to explain the therapeutic effects of music on mental health, including psychological (e.g., building communities, developing coping strategies) [ 10 , 11 ] and specific neurobiological drivers (e.g., oxytocin, cortisol, autonomic nervous system activity) [ 12 , 13 , 14 ]. However, it will be vital to conduct more systematic research comparing the effects of music interventions to existing therapeutic methods and other types of creative activities (e.g., art [ 88 ]) to quantify which effects and mechanisms are specific to music engagement. Music interventions also do not have to be an alternative to other treatments, but may instead support key elements of traditional interventions, such as being engaging, enjoyable, providing social context, and increasing structure and predictability [ 89 ]. Indeed, some music therapists incorporate principals from existing psychotherapeutic models [ 42 , 90 ] and, conversely, newer therapeutic models (e.g., mindfulness) incorporate music into their practice [ 43 , 44 ]. It is not yet possible to disentangle which aspects of music interventions best synergize with or strengthen standard psychotherapeutic practices (which are also heterogeneous), but this will be possible with better reporting standards and quality experimental design.

To encapsulate and extend these ideas, we next propose a theoretical framework that delineates key aspects of how music engagement may relate to mental health, which is intended to be useful for guiding future investigations in a more systematic way.

Theoretical framework for future studies

Associations between music engagement and mental health may take multiple forms, driven by several different types of genetic predispositions and environmental effects that give rise to, and interact with, proposed psychological and neurobiological mechanisms described earlier. Figure 2 displays our theoretical model in which potential beneficial associations with music are delineated into testable hypotheses. Four key paths characterize specific ways in which music engagement may relate to (and influence) mental health traits, and thus represent key research questions to be addressed in future studies.

Progression of mental health problems is based on a diathesis-stress model, where genetic predispositions and environmental exposures result in later problems (which can be remedied through treatment). Potential associations with music engagement include (Path 1; blue arrows) correlated genetic/environmental influences and/or causal associations between music engagement and trait-level mental health outcomes; (Path 2; red arrows) interactions between music engagement and risk factors to predict later trait-level or clinical level symptoms; and (Path 3; gold arrow) direct effects of music engagement on reducing symptoms or improving treatment efficacy. Path 4 (orange arrows) illustrates the importance of understanding how these potential protective associations are driven by neuroanatomy and function. MDD major depressive disorder, GAD generalized anxiety disorder, PTSD posttraumatic stress disorder, SUD substance use disorder(s).

Path 1: Music engagement relates to mental health through correlated genetic and environmental risk factors and/or causation

The diathesis-stress model of psychiatric disease posits that individuals carry different genetic liabilities for any given disorder [ 91 , 92 , 93 ], with disorder onset depending on the amount of negative vs. protective environmental life events and exposures the individual experiences. Although at first glance music engagement appears to be an environmental exposure, it is actually far from it. Twin studies have demonstrated that both music experiences and music ability measures are moderately heritable and genetically correlated with cognitive abilities like non-verbal intelligence [ 94 , 95 , 96 , 97 ]. Music engagement may be influenced by its own set of environmental influences, potentially including socioeconomic factors and availability of instruments. Thus, music engagement can be viewed as a combination of genetic and environmental predispositions and availability of opportunities for engagement [ 98 ] that are necessary to consider when evaluating associations with mental health [ 54 ].

When examining music-mental health associations, it is thus important to evaluate if associations are in part explained by correlated genetic or environmental influences (see Fig. 3 for schematic and explanation for interpreting genetic/environmental correlations). On one hand, individuals genetically predisposed to engage with music may be at lower risk of experiencing internalizing or externalizing problems. Indeed, music engagement and ability appear associated with cognitive abilities through genetic correlations [ 3 , 99 ], which may apply to music-mental health associations as well. On the other, individuals at high genetic risk for neuroticism or psychopathology may be more likely to engage with music because it is therapeutic, suggesting a genetic correlation in the opposite direction (i.e., increased genetic risk for musicians). To understand and better contextualize the potential therapeutic effects of music engagement, it is necessary to quantify these potential genetic associations, while simultaneously evaluating whether these associations are explained by correlated environmental influences.

Variance in any given trait is explained by a combination of genetic influences (i.e., heritability) and environmental influences. For complex traits (e.g., MDD or depression symptoms), cognitive abilities (e.g., intelligence), and personality traits (e.g., impulsivity), many hundreds or thousands of independent genetic effects are combined together in the total heritability estimate. Similarly, environmental influences typically represent a multitude of factors, from individual life events to specific exposures (e.g., chemicals, etc.). The presence of a genetic or environmental correlation between traits indicates that some set of these influences have an impact on multiple traits. A Displayed using a Venn diagram. Identifying the strength of genetic vs. environmental correlations can be useful in testing theoretical models and pave the way for more complex genetic investigations. Beyond this, gene identification efforts (e.g., genome-wide association studies) and additional analyses of the resulting data can be used to classify whether these associations represent specific genetic influences that affect both traits equally (i.e., genetic pleiotropy ( B )) or whether a genetic influence impacts only one trait which in turn causes changes in the other (i.e., mediated genetic pleiotropy ( C )). Environmental influences can also act pleiotropically or in a mediated-pleiotropy manner, but only genetic influences are displayed for simplicity.

Beyond correlated genetic and environmental influences, music engagement and mental health problems may be associated with one another through direct influences (including causal impacts). This is in line with earlier suggestions that music activities (e.g., after-school programs, music practice) engage adolescents, removing opportunities for drug-seeking behaviors [ 100 ], increasing their social connections to peers [ 101 ], and decreasing loneliness [ 41 ]. Reverse causation is also possible, for example, if experiencing mental health problems causes some individuals to seek out music engagement as a treatment. Longitudinal and genetically informative studies can help differentiate correlated risk factors (i.e., genetic/environmental correlations) from causal effects of music engagement (Fig. 2 , blue arrows) [ 102 ].

Path 2: Engagement with music reduces the impact of genetic risk

Second, genetic and environmental influences may interact with each other to influence a phenotype. For example, individual differences in music achievement are more pronounced in those who engage in practice or had musically enriched childhood environments [ 97 , 98 ]. Thus, music exposures may not influence mental health traits directly but could impact the strength of the association between genetic risk factors and the emergence of trait-level symptoms and/or clinical diagnoses. Such associations might manifest as decreased heritability of trait-level symptoms in musicians vs. non-musicians (upper red arrow in Fig. 2 ). Alternatively, if individuals high in neuroticism use music to help regulate their emotions [ 34 , 35 ], those who are not exposed to music environments might show stronger associations between neuroticism and later depressive symptoms or diagnoses than those engaged with music (lower red arrow in Fig. 2 ). Elucidating these possibilities will help disentangle the complex associations between music and mental health and could be used to identify which individuals would benefit most from a music intervention (especially preventative interventions). Later, we describe some specific study designs that can test hypotheses regarding this gene-environment interplay.

Path 3: Music engagement improves the efficacy of treatment (or acts as a treatment)

For individuals who experience severe problems (e.g., MDD, SUDs), engaging with music may reduce symptoms or improve treatment outcomes. This is the primary goal of most music intervention studies [ 27 , 33 ] (Fig. 2 , gold arrow). However, and this is one of the central messages of this model, it is important to consider interventions in the context of the paths discussed above. For example, if music engagement is genetically correlated with increased risk for internalizing or externalizing problems (Path 1) and/or if individuals at high genetic risk for mental health problems have already been using music engagement to develop strategies to deal with subthreshold symptoms (Path 2), then may be more likely to choose music interventions over other alternatives and find them more successful. Indeed, the beneficial aspects of music training on cognitive abilities appear to be drastically reduced in samples that were randomly sampled [ 103 ]. Therefore, along with other necessary reporting standards discussed above [ 32 , 33 ], it will be useful for studies to report participants’ prior music experience and consider these exposures in evaluating the efficacy of interventions.

Path 4: Music engagement influences brain structure and function

Exploring associations between music engagement and brain structure and function will be necessary to elucidate the mechanisms driving the three paths outlined above. Indeed, there are strong links between music listening and reward centers of the brain [ 104 , 105 ] including the nucleus accumbens [ 106 , 107 ] and ventral tegmental areas [ 108 ] that are implicated in the reward system for all drugs of abuse [ 109 , 110 , 111 , 112 ] and may relate to internalizing problems [ 113 , 114 , 115 ]. Moreover, activity in the caudate may simultaneously influence rhythmic sensorimotor synchronization, monetary reward processing, and prosocial behavior [ 116 ]. Furthermore, music listening may help individuals control the effect of emotional stimuli on autonomic and physiological responses (e.g., in the hypothalamus) and has been shown to induce the endorphinergic response blocked by naloxone, an opioid antagonist [ 18 , 117 ].

This work focusing on music listening and reward processing has not been extended to music making (i.e., active music engagement), though some differences in brain structure and plasticity between musicians and non-musicians have been observed for white matter (e.g., greater fractional anisotropy in corpus callosum and superior longitudinal fasciculus) [ 118 , 119 , 120 , 121 ]. In addition, longitudinal studies have revealed that instrument players show more rapid cortical thickness maturation in prefrontal and parietal areas implicated in emotion and impulse control compared to non-musician children/adolescents [ 122 ]. Importantly, because the existing evidence is primarily correlational, these cross-sectional and longitudinal structural differences between musicians and non-musicians could be explained by genetic correlations, effects of music training, or both, making them potentially relevant to multiple paths in our model (Fig. 2 ). Examining neural correlates of music engagement in more detail will shed light on these possibilities and advance our understanding of the correlates and consequences of music engagement, and the mechanisms that drive the associations discussed above.

New approaches to studying music and mental health

Using our theoretical model as a guide, we next highlight key avenues of research that will help disentangle these music-mental health associations using state-of-the-art approaches. They include the use of (1) genetic designs, (2) neuroimaging methods, and (3) large biobanks of EHRs.

Genetic designs

Genetic designs provide a window into the biological underpinnings of music engagement [ 123 ]. Understanding the contribution of genetic risk factors is crucial to test causal or mechanistic models regarding potential associations with mental health. At the most basic level, twin and family studies can estimate genetic correlations among music ability or engagement measures and mental health traits or diagnoses. Genetic associations can be examined while simultaneously quantifying environmental correlations, as well as evaluating (bidirectional) causal associations, by testing competing models or averaging across different candidate models [ 102 , 124 ], informing Path 1.

By leveraging samples with genomic, music engagement, and mental health data, investigators can also examine whether individuals at higher genetic risk for psychopathology (e.g., for MDD) show stronger associations between music engagement measures and their mental health outcomes (Path 2). As a theoretical example, individuals with low genetic risk for MDD are unlikely to have many depressive symptoms regardless of their music engagement, so the association between depressive symptoms and music engagement may be weak if focusing on these individuals. However, individuals at high genetic risk for MDD who engage with music may have fewer symptoms than their non-musician peers (i.e., a stronger negative correlation). This is in line with recent work revealing the heritability of depression is doubled in trauma exposed compared to non-trauma exposed individuals [ 125 ].

Gene–environment interaction studies using polygenic scores (i.e., summed indices of genetic risk based on genome-wide association studies; GWAS) are becoming more common [ 126 , 127 ]. There are already multiple large GWAS of internalizing and externalizing traits [ 128 , 129 , 130 ], and the first large-scale GWAS of a music measure indicates that music rhythm is also highly polygenic [ 131 ]. Importantly, is not necessary to have all traits measured in the same sample to examine cross-trait relationships. Studies with only music engagement and genetic data, for example, can still examine how polygenic scores for depression predict music engagement, or interact with music engagement measures to predict other study outcomes. Figure 4 displays an example of a GWAS and how it can be used to compute and apply a polygenic score to test cross-trait predictions.

A GWAS are conducted by examining whether individual genetic loci (i.e., single-nucleotide polymorphisms, or SNPs, depicted with G, A, C, and T labels within a sample (or meta-analysis) differentiate cases from controls. The example is based on a dichotomous mental health trait (e.g., major depressive disorder diagnosis), but GWAS can be applied to other dichotomous and continuous phenotypes, such as trait anxiety, musician status, or hours of music practice. Importantly, rather than examining associations on a gene-by-gene basis, GWAS identify relevant genetic loci using SNPs from across the entire genome (typically depicted using a Manhattan plot, such as that displayed at the bottom of A ). B After a GWAS has been conducted on a given trait, researchers can use the output to generate a polygenic score (sometimes called a polygenic risk score) in any new sample with genetic data by summing the GWAS effect sizes for each SNP allele present in a participant’s genome. An individual with a z  = 2.0 would have many risk SNPs for that trait, whereas an individual with z = −2 would have much fewer risk SNPs. C Once a polygenic score is generated for all participants, it can be applied like any other variable in the new sample. In this example, researchers could examine whether musicians are at higher (or lower) genetic risk for a specific disorder. Other more complex analyses are also possible, such as examining how polygenic scores interact with existing predictors (e.g., trauma exposure) or polygenic scores for other traits to influence a phenotype or predict an intervention outcome. Created with BioRender.com.

Finally, longitudinal twin and family studies continue to be a promising resource for understanding the etiology and developmental time-course of the correlates of mental health problems. Such designs can be used to examine whether associations between music and mental health are magnified based on other exposures or psychological constructs (gene-by-environment interactions) [ 132 ], and whether parents engaged with music are more likely to pass down environments that are protective or hazardous for later mental health (gene-environment correlations) in addition to passing on their genes. These studies also provide opportunities to examine whether these associations change across key developmental periods. The publicly available Adolescent Brain Cognitive Development study, for example, is tracking over 10,000 participants (including twin and sibling pairs) throughout adolescence, with measures of music engagement and exhaustive measures of mental health, cognition, and personality, as well as neuroimaging and genotyping [ 133 , 134 ]. Although most large samples with genomic data still lack measures of music engagement, key musical phenotypes could be added to existing study protocols (or to similar studies under development) with relatively low participant burden [ 135 ]. Musical questionnaires and/or tasks may be much more engaging and enjoyable than other tasks, improving volunteers’ research participation experience.

Neuroimaging

Another way to orient the design of experiments is through the exploration of neural mechanisms by which music might have an impact on mental health. This is an enormous, growing, and sometimes fraught literature, but there is naturally a great potential to link our understanding of neural underpinnings of music listening and engagement with the literature on neural bases of mental health. These advances can inform the mechanisms driving successful interventions and inform who may benefit the most from such interventions. We focus on two areas among many: (1) the activation of reward circuitry by music and (2) the impact music has on dynamic patterns of neural activity, both of which are likely vectors for the interaction of music and mental health and provide examples of potential interactions.

Music and reward

The strong effect of music on our emotions has been clearly grounded in its robust activation of reward circuitry in the brain, and motivational and hedonic effects of music listening have been shown to be specifically modulated by dopamine [ 16 , 105 , 136 ]. The prevalence of reward and dopaminergic dysfunction in mental illness makes this a rich area for future studies. For example, emotional responses to music might be used as a substitute for reward circuit deficiencies in depression, and it is intriguing to consider if music listening or music engagement could potentiate such function [ 137 , 138 ].

Music and brain network dynamics

The search for neuronally based biomarkers of aspects of mental illness has been a central thrust within the field [ 139 ], holding promise for the understanding of heterogeneity within disorders and identification of common mechanistic pathways [ 140 ]. A thorough review is beyond the scope of this paper, but several points of contact can be highlighted that might suggest neuro-mechanistic mediators of musical effects on mental health. For example, neurofeedback-directed upregulation of activity in emotion circuitry has been proposed as a therapy for MDD [ 141 ]. Given the emotional effects of music, there is potential for using musical stimuli as an adjuvant, or as a more actively patient-controlled output target for neurofeedback. Growing interest in measures of the dynamic complexity of brain activity in health and disease as measured by magnetic resonance imaging or magneto/electroencephalography (M/EEG) [ 142 ] provides a second point of contact, with abnormalities in dynamic complexity suggested as indicative of mental illness [ 143 ], while music engagement has been suggested to reflect and perhaps affect dynamic complexity [ 144 , 145 ].

The caveats identified in this review apply equally to such neuro-mechanistic studies [ 146 ]. High-quality experimental design (involving appropriate controls and randomized design) has been repeatedly shown to be critical to providing reliable evidence for non-music outcomes of music engagement [ 103 ]. For such studies to have maximal impact, analysis of M/EEG activity not at the scalp level, but at the source level, has been shown to improve the power of biomarkers, and their mechanistic interpretability [ 147 , 148 ]. Moreover, as with genetic influences that typically influence a trait through a multitude of small individual effects [ 149 ], the neural underpinnings of music-mental health associations may be highly multivariate. In the longer term, leveraging large-scale studies and large-scale data standardization and aggregation hold the promise of gleaning deeper cross-domain insights, for which current experimentalists can prepare by adopting standards for the documentation, annotation, and storage of data [ 150 ].

Biobanks and electronic health records

Finally, the use of EHR databases can be useful in quantifying associations between music engagement and mental health in large samples. EHR databases can include hundreds of thousands of records and allow for examination with International Statistical Classification of Diseases and Related Health Problems codes, including MDD, SUD, and schizophrenia diagnoses. This would allow for powerful estimates of music-mental health associations, and exploration of music engagement with other health outcomes.

The principal roadblock to this type of research is that extensive music phenotypes are not readily available in EHRs. However, there are multiple ways to bypass this limitation. First, medical records can be scraped using text-mining tools to identify cases of musician-related terms (e.g., “musician”, “guitarist”, “violinist”). For example, the phenome-wide association study described earlier [ 55 ] compared musician cases and controls identified in a large EHR database through text-mining of medical records and validated with extensive manual review charts. This study was highly powered to detect associations with internalizing and thought disorders (but showed null or protective effects for musicians for SUDs). Many EHR databases also include genomic data, allowing for integration with genetic models even in the absence of music data (e.g., exploring whether individuals with strong genetic predispositions for musical ability are at elevated or reduced risk for specific health diagnosis).

EHRs could also be used as recruitment tools, allowing researchers to collect additional data for relevant music engagement variables and compare with existing mental health diagnoses without having to conduct their own diagnostic interviews. These systems are not only relevant to individual differences research but could also be used to identify patients for possible enrollment in intervention studies. Furthermore, if recruitment for individual differences or intervention studies is done in patient waiting rooms of specific clinics, researchers can target specific populations of interest, have participants complete some relevant questionnaires while they wait, and be granted access to medical record data without having to conduct medical interviews themselves.

Concluding remarks

Music engagement, a uniquely human trait which has a powerful impact on our everyday experience, is deeply tied with our social and cultural identities as well as our personality and cognition. The relevance of music engagement to mental health, and its potential use as a therapeutic tool, has been studied for decades, but this research had not yet cohered into a clear picture. Our scoping review and framework integrated across a breadth of smaller literatures (including extant reviews and meta-analyses) relating music engagement to mental health traits and treatment effects, though it was potentially limited due to the lack of systematic literature search or formal quality appraisal of individual studies. Taken together, the current body of literature suggests that music engagement may provide an outlet for individuals who are experiencing internalizing, externalizing, or thought disorder problems, potentially supporting emotion regulation through multiple neurobiological pathways (e.g., reward center activity). Conducting more rigorous experimental intervention studies, improving reporting standards, and harnessing large-scale population-wide data in combination with new genetic analytic methods will help us achieve a better understanding of how music engagement relates to these mental health traits. We have presented a framework that illustrates why it will be vital to consider genetic and environmental risk factors when examining these associations, leading to new avenues for understanding the mechanisms by which music engagement and existing risk factors interact to support mental health and well-being.

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Acknowledgements

This work was supported by NIH grants DP2HD098859, R01AA028411, R61MH123029, R21DC016710, U01DA04112, and R03AG065643, National Endowment for the Arts (NEA) research lab grants 1863278-38 and 1855526-38, and National Science Foundation grant 1926794. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or National Endowment for the Arts. The authors would like to thank Navya Thakkar and Gabija Zilinskaite for their assistance.

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Gustavson, D.E., Coleman, P.L., Iversen, J.R. et al. Mental health and music engagement: review, framework, and guidelines for future studies. Transl Psychiatry 11 , 370 (2021). https://doi.org/10.1038/s41398-021-01483-8

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The mutual enhancing effect of music and drugs and its eventual cessation in the lives of people coping with substance abuse: A qualitative inquiry

• Published: 29 June 2023
• Volume 43 , pages 6995–7006, ( 2024 )

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• Jeffrey Lozon 1 &
• Moshe Bensimon   ORCID: orcid.org/0000-0002-0008-035X 1  

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Substance craving may be triggered in people recovering from substance use disorder when listening to the same music genres they had listened to during active addiction. Given the limited research on this topic, this study examined how the combination of music and drugs facilitate addiction among people with active addiction and the role of music within this phenomenon. This phenomenological study included semi-structured interviews with 36 non-active addiction participants. Content analysis was employed to reveal themes and sub-themes regarding participants’ views on the role and meaning of music during active addiction. Interview analysis revealed two main themes. The mutual enhancing effect theme relates to participants’ utilization of music in service of the drug and vice versa. This mutual enhancing effect had an impact on sharpening sensory abilities and the mood participants wanted to amplify or evoke. The full addiction and music theme relates to a timepoint during active use, when music ceased to be relevant, and drugs dominated the entire experience. Participants reported down spiraling into their abuse, seeking seclusion and feeling lonelier and more depressed. The findings are discussed in light of theories in addiction and psychology of music. Rehabilitative implications are suggested.

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Data Availability

Data for this qualitative study include interview transcripts and are not publicly available because of participant identifying information included in the transcripts. Upon request, the corresponding author can provide blinded interview transcript excerpts that are not already included in the manuscript results section.

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Acknowledgements

We are grateful to each one of the research participants for their willingness to share with us personal aspects of their lives.

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Jeffrey Lozon & Moshe Bensimon

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Lozon, J., Bensimon, M. The mutual enhancing effect of music and drugs and its eventual cessation in the lives of people coping with substance abuse: A qualitative inquiry. Curr Psychol 43 , 6995–7006 (2024). https://doi.org/10.1007/s12144-023-04839-z

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DOI : https://doi.org/10.1007/s12144-023-04839-z

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Effects of music therapy and music-based interventions in the treatment of substance use disorders: A systematic review

Louisa hohmann.

1 Department for Educational Sciences and Psychology, Freie Universität, Berlin, Germany

2 Department for Biological and Medical Psychology, University of Bergen, Bergen, Norway

3 Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, United States of America

Thomas Stegemann

4 Department of Music Therapy, University of Music and Performing Arts, Vienna, Austria

Stefan Koelsch

Associated data.

All relevant data are within the paper and its Supporting Information files. Our study is a systematic review so that there are no primary data sets. Our analyses are based on summaries of the primary studies. These are included in tables in the manuscript. Additionally, the supporting information file contains a Prisma Checklist.

Music therapy (MT) and music-based interventions (MBIs) are increasingly used for the treatment of substance use disorders (SUD). Previous reviews on the efficacy of MT emphasized the dearth of research evidence for this topic, although various positive effects were identified. Therefore, we conducted a systematic search on published articles examining effects of music, MT and MBIs and found 34 quantitative and six qualitative studies. There was a clear increase in the number of randomized controlled trials (RCTs) during the past few years. We had planned for a meta-analysis, but due to the diversity of the quantitative studies, effect sizes were not computed. Beneficial effects of MT/ MBI on emotional and motivational outcomes, participation, locus of control, and perceived helpfulness were reported, but results were inconsistent across studies. Furthermore, many RCTs focused on effects of single sessions. No published longitudinal trials could be found. The analysis of the qualitative studies revealed four themes: emotional expression, group interaction, development of skills, and improvement of quality of life. Considering these issues for quantitative research, there is a need to examine social and health variables in future studies. In conclusion, due to the heterogeneity of the studies, the efficacy of MT/ MBI in SUD treatment still remains unclear.

Introduction

The misuse of legal and illegal substances is a significant problem in modern societies. For example, in the United States, the estimated 12-months prevalence rates for addictions in 2014 were 3.0% for alcohol and 1.9% for illicit drugs [ 1 ]. Use and misuse of alcohol and drugs are associated with a variety of health, social, and economic disadvantages for the users themselves and others (e.g., family, friends, community, environment, and country [ 2 ]). Treatment programs for patients with substance use disorders (SUD) include body detoxification, pharmaceutical, psychosocial, and psychotherapeutic treatment, and recovery management [ 3 ]. Nevertheless, only a minority of people with SUD, i.e., about 10%, receives such professional help [ 4 ]. Moreover, the treatment completion rates are low (i.e., 47% in the USA in 2006 [ 5 ]) and the relapse rates are high (40–60% [ 6 ]). Thus, there is still need to improve addiction treatment.

Standard psychological treatments mostly consist of verbal therapies such as cognitive behavior therapy, motivational interviewing, and relapse prevention [ 7 ]. In addition, complementary and alternative medical therapies are utilized to allow for creative and expressive ways to address issues. Music therapy is one of such non-mainstream therapies [ 8 ]. According to the American Music Therapy Association [ 9 ], music therapy is defined 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”. Therefore, in this review, the term music therapy (MT) is used only for studies where music therapists were involved in the delivery of the intervention; for studies where the intervention was delivered without participation of music therapists, or their participation remains unclear, we will use the term music-based intervention (MBI). Furthermore, we include studies examining the effect of music stimuli presentation without presence of persons therapeutically guiding the interventions, which are referred to as music presentation (MP) studies.

How can MT/ MBI help patients with SUD? Compared to commonly used verbal psychological therapies, MT and MBI provide different opportunities for self-expression, cooperative group activity, imagination, and synchronized sensorimotor experience [ 10 ]. In addition to that, there is evidence of beneficial impact of MT/ MBI on mood [ 11 , 12 ], stress [ 13 ], self-esteem [ 14 ], motivation [ 15 ], emotional expression [ 16 ], and social cohesion [ 17 ]. Furthermore, MT/ MBIs appear to address general challenges of SUD treatment: For instance, in a study with patients with SUD and comorbid severe mental illnesses MT appreciation was associated with benefits in global functioning and motivation [ 15 ]. For patients with non-organic mental disorders and low treatment motivation positive effects of an individual three month MT program on negative symptoms, global functioning, clinical global impressions, social avoidance and vitality were reported [ 18 ]. Furthermore, for subgroups of addicted patients with special needs (e.g., women and adolescents [ 8 ]) MT/ MBI led to improvements in anxiety [ 19 ] and internal locus of control [ 20 ].

To clarify the clinical efficacy of MT/ MBIs in addiction treatment, a summary of their effects is warranted. Although there are many reports about the effects of MT/ MBI in patients with SUD in single studies, no meta-analyses are yet available on this topic. In 2008, Mays, Clark, and Gordon [ 21 ] systematically reviewed the use of MT for patients with SUD and emphasized a lack of evidence. In their review, they included five quantitative studies that greatly varied in terms of treatment settings, frequency, duration, persons guiding the session, and outcome variables. Furthermore, outcomes like drug consumption or long-term abstinence were not assessed in these studies. Therefore, the treatment effects of MT were primarily related to participants’ attitudes and emotions. In line with that, most of the MT studies in SUD treatment met the criteria of lower levels of evidence according to evidence-based practice hierarchies, indicating that high-quality research has not been conducted [ 22 ].

In this paper, we aimed to address the research question of whether MT and MBIs are clinically effective for people with substance use disorders (SUD) by reviewing the current state of research regarding this topic. Because little is known about the key outcomes affected by MT/ MBIs in patients with SUD [ 21 ], we evaluated the existing evidence to summarize the benefits of music interventions for this population.

Criteria for considering studies for this review

Types of studies.

We included all types of studies with quantitative or qualitative data assessed in a systematic way, e.g., by at least semi-structured interviews, video-taping, or questionnaires. We decided not to limit our inclusion criteria to randomized controlled trials (RCTs), even though there are many scholars who recommend focusing on this type of study for systematic reviews and meta-analyses [ 22 , 23 ]. We based this decision on the following rationale: (1) Silverman [ 22 ] and Mays et al. [ 21 ] emphasized the lack of RCTs available for our research question, and this is still valid at present; (2) for rare conditions and difficult clinical investigations (such as music therapy in psychiatry) the inclusion of other study types (such as case studies or case-control studies) is recommended because they may be the only available evidence [ 24 ]; (3) Furthermore, qualitative studies are useful to examine perspectives and experiences [ 22 , 25 ].

We also included MP studies examining the effects of music stimuli presentation on people with SUD without the presence of a music therapist or other persons therapeutically guiding the music intervention.

Types of participants

We considered studies that included patients or clients with SUD, regardless of age, gender or comorbid disorders. Studies examining subgroups like women or adolescents were included as well. If it was unclear whether all participants suffered from SUD (e.g., a study on residents and staff members of a rehabilitation center [ 26 ]), those studies were excluded. If separate conclusions about patients with and without SUD were drawn, those studies were included.

Types of interventions

All studies examining MT, MBI or MP were included. Articles were excluded if combined programs with music and other complementary approaches were used (e.g., combinations of art, video, music, group therapy, and individual counseling [ 27 ]) as this would not allow for the identification of separate effects of MT/ MBI/ MP.

Types of outcome measures

Similar to Mays et al. [ 21 ], we included all outcomes. For a listing of the outcomes included in the study, see Table 1 .

Search methods for identification of studies

First, we identified articles by conducting a literature search in the electronic databases ISI Web of Knowledge and Scopus on 1 st April, 2016. We used the search term “(music therapy AND addiction) OR (music therapy AND substance use disorder) OR (music therapy AND substance abuse) OR (music therapy AND alcohol*) OR (music AND intervention AND addiction)) OR (music AND intervention AND substance use disorder) OR (music AND intervention AND substance abuse) OR (music AND intervention AND alcohol*) ”. After deleting duplicate studies, we scanned the abstracts to include only articles published in English, focusing on MT/ MBI or MP and participants with SUD. Additionally, the bibliographies of the remaining records were scanned for further studies. Articles without systematic data assessment were excluded. Remaining sources were further subdivided with respect to the type of music/ intervention that was examined: (1) studies examining effects of the presentation of music stimuli without application of MT/ MBI (MP studies), (2) studies investigating one session of MT/ MBI, and (3) studies examining more than one session of MT/ MBI. With respect to category (1), for example examinations of simple listening to music without the presence of therapists or other persons guiding the session or experiments were included.

Data collection and analysis

General preparing procedure.

A review protocol does not exist. All unique articles (i.e. duplicates removed) were listed in a table. After their abstracts were scanned, we indicated whether or not the studies met the inclusion criteria listed above. Full texts of studies that met the inclusion criteria were analyzed. The study characteristics and results were summarized in separate tables.

Many studies included similar outcomes but used different terminology. Outcomes that were very similar were clustered under one common outcome term. For example, the outcomes depression, depressiogenic thought frequency, and feeling depressed were clustered under the outcome “depression” (See Table 1 for labels and included variables). For all studies, we extracted design aspects as well as statistical data. Based on this data, we examined if meta-analytic calculations would be useful.

We used three different types of data summary: (1) a description of the effects of MT/ MBI for the quantitative studies separated by outcomes, (2) a summary of effects of MT/ MBI/ MP for the quantitative studies separated by study characteristics, (3) a summary of the topics and themes described in the qualitative studies.

We did not conduct a meta-analysis due to the following reasons. First, according to the Cochrane systematic review guidelines [ 23 ], combining studies that use different types of control conditions may lead to meaningless results. After separating the studies per type of control condition, there were too few studies per outcome to allow for meta-analysis. Second, predominantly including studies by the same authors in the same meta-analysis would violate the assumption of independence of study reports [ 28 ]. As most of the studies with similar comparison designs were conducted by Silverman [ 29 – 37 ], there was too much dependency on the hierarchical level. A more detailed description of reasons for not conducting a meta-analysis is provided in the Results section below.

Descriptive summaries

We aimed to give an overview of the efficacy of MT/ MBI per outcome in consideration of the quality of the studies. To this end, we created a categorization system (see Fig 1 ) based on an evidence-based practice (EBP) taxonomy by Melnyk and Fineout-Overholt [ 52 ] that was developed for the nursing profession. As MT and nursing contexts appear to be similarly diverse, Silverman [ 22 ] recommended the use of this taxonomy when examining EBP for MT. This hierarchy contains seven levels of evidence with (I) being the highest rank and (VII) being the lowest rank in research. The articles we collected for our review did not cover the whole range. Therefore, we refer to Melnyk and Fineout-Overholt’s following levels: (II) well-designed RCTs, (III) well-designed controlled trials without randomization, and (VI) single descriptive or qualitative study. Based on these levels, we developed four main categories for our categorization system: (1) studies without reporting all necessary statistical data to compute a meta-analysis (e.g., means, standard deviations, sample sizes), (2) studies without a control group (CG), (3) non-randomized studies with CG, and (4) RCTs. Categories (3) and (4) are further subdivided into (3a)/ (4a) studies that reported no beneficial treatment effects of MT/ MBI and (3b)/ (4b) studies that reported treatment benefits of MT/MBI compared to a CG. For an overview of the categorization procedure see Fig 1 . To draw conclusions about MT/ MBI efficacy, RCTs are necessary [ 25 ]. Thus, studies fitting in categories (4a) and (4b), which are matching level (II) of Melnyk and Fineout-Overholt’s taxonomy, are categorized as high level evidence of efficacy . Categories (3a) and (3b) match level (III) in the EBP taxonomy, and categories (1) and (2) match level (VI), i.e., lower levels of evidence. Thus, the categories (1), (2) and (3a)/(3b) are referred to as of low level evidence of efficacy . Nevertheless, it is important to note that research designs other than RCTs are useful for research as well [ 25 ], so that our taxonomy of low and high level of evidence of efficacy only refers to the assessment of MT/ MBI efficacy.

CG = control group.

For the descriptive summaries we used the following rules: We counted how many unique studies examined a certain outcome (cluster). For studies that included multiple measures (e.g. two different scales) per outcome, data from only one measure was included. This was to avoid artificially inflating the weight of single studies. Articles that reported results of two separate studies within a single publication were used more than once (e.g., [ 20 ]). If different raters (e.g. client ratings and therapist ratings) were included only client ratings were counted. Finally, for studies with repeated measures, only immediate post-intervention scores were used.

Summary of music and MT/ MBI effects

We created separate summaries for (1) MP studies, (2) studies that investigated only one session, and (3) studies that examined the effects of more than one session of MT/ MBI. For each of these three categories a separate table including study characteristics and results was created.

Summary of qualitative articles

Studies were read carefully, and described topics and themes were summarized in a separate table.

Description of the studies

The identification process is displayed in the flow diagram (adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 53 ]) in Fig 2 . Our database search resulted in 383 records (without duplicates), 50 of which met the inclusion criteria. The other records were excluded because (a) they were not written in English ( n = 44), (b) did not include MT/ MBI as single program or MP ( n = 250), or (c) did not primarily focus on SUD ( n = 39). One full-text could not be obtained [ 54 ], therefore it was excluded. Five of the initially included records turned out to be book reviews and conference abstracts, thus they were excluded. Full-texts were obtained for the remaining 44 articles and an additional 16 articles were found in their references lists, resulting in a total of 60 records. Twenty-one of them were descriptive articles without structured qualitative or quantitative data and were excluded.

Thirty-nine records with systematic data collection remained. One article included two quantitative studies [ 20 ], and one consisted of both qualitative and quantitative studies [ 55 ]. Two articles reported about the same dataset [ 16 , 56 ], so that these results were summarized as one study. Altogether, we identified 34 quantitative studies, which were further subdivided with respect to the type of music/ MT that was examined: (1) six studies examined effects of music stimuli presentation without application of MT/ MBI, (2) thirteen studies investigated only one session of MT/ MBI, and (3) fifteen studies examined more than one session of MT/ MBI. Six records included qualitative data obtained through semi-structured interviews, structured or video-taped observations or questionnaires.

Sample and setting characteristics

The characteristics of the studies are summarized in Table 2 for studies that examined the effects of music stimuli presentation, Tables ​ Tables3 3 and ​ and4 4 for quantitative studies about MT/ MBI, and Table 5 for qualitative studies about MT/ MBI. Sample settings and characteristics are presented separately in the following for (a) MT/ MBI studies with both qualitative and quantitative data, and (b) MP studies.

Studies examining the effects of music/ musical production, not including sessions of music therapy held by therapists or other conducting persons. Effect sizes are only listed when reported in the articles. Amp = amphetamines; BP = blood pressure; CC = Control condition; CG = Control group; EG = experimental group; fm = females; JC = Jymmin’ condition; HR = heart rate; HRVm = heart rate volume; m = males; MIP = mood induction procedure; pd = prescription drugs; SUD = substance use disorders

a Frequency counts

* p < .05.

** p < .01.

*** p < .001

All studies included one session only for data analysis. Effect sizes are only listed when reported in the articles. amp = amphetamines; CBMT = cognitive behavioral music therapy; CG = control group; DARTNA = Drum-Assisted Recovery Therapy for Native Americans; EG = experimental group; fm = females; GIM = Guided Imagery and Music therapy; m = males; MBI = music based intervention; MI = mental illness; MT = music therapy; pd = prescription drugs; SOCRATES = The Stages of Change Readiness and Treatment Eagerness Scale; SUD = substance use disorders

b N = 121 completed all measures

c N = 100 completed all measures

*p < .05.

Effect sizes are only listed when reported in the articles. For music-based intervention (MBI) studies, conducting persons are listed in brackets. BDI = Beck Depression Inventory; BSI = Brief Symptom Inventory; CG = control group; EG = experimental group; fm = female; m = male; MBI = music-based intervention; MI = Mental illness; MT = music therapy; pd = prescription drugs; SUD = substance use disorders

a Frequency counts.

b Results based on a criterion of clinical significance, i.e., changes by at least one standard deviation of the mean.

c Results based on scores from 36 participants.

For music-based intervention (MBI) studies, persons conducting the sessions are listed in brackets. MBI = music- based interventions; MT = music therapy.

MT/ MBI studies

For the majority of the studies, sessions were held in group settings, except a single-case study [ 40 ] and one study with individual application of the music-based program [ 41 ]. Most of the studies, i.e., three qualitative and 23 quantitative studies, were classified as “MT studies” (according to the music therapy definition provided in Introduction). With respect to MBIs, one study was conducted by vocal performance majors [ 57 ], one by different artists of the Council of Music [ 58 ], one by a cultural drumming teacher and a substance abuse counselor [ 48 ], one by a social worker [ 44 ], one by a counselor [ 41 ], and in three cases [ 15 , 40 , 55 ] the therapist’s background remained unclear.

Not considering the case study, sample size ranged from 8 participants [ 42 , 47 ] to 188 participants [ 49 ] for the quantitative studies, and from 3 participants [ 59 ] to 20 participants [ 55 ] for the qualitative studies. One quantitative [ 50 ] and one qualitative study [ 58 ] did not report sample sizes.

Six studies examined men only [ 40 , 45 , 50 , 55 , 59 , 60 ] and five women only [ 19 , 41 – 43 , 47 ].

Regarding the diagnosis, many samples included various drug addictions, i.e., polydrug abuse. Other studies only focused on chemical dependency [ 20 , 42 , 47 ], alcohol [ 45 , 50 , 60 ] or inhalant abuse [ 40 ].

With respect to the age of the participants, four studies investigated adolescents only with mean ages/ age ranges between 15 and 17 years [ 20 , 42 ] or as a single case study with a 14-year old boy [ 40 ]. For the other studies, mean age varied from 34.4 years [ 16 ] up to 52.5 years [ 48 ]. Eleven studies [ 16 , 19 , 39 , 43 , 47 , 50 , 51 , 55 , 57 , 58 , 60 ] did not report any measure of central tendency regarding age. In 16 cases [ 15 , 16 , 38 , 39 , 41 , 43 – 49 , 55 , 59 , 60 ] numeric age ranges were reported which varied from 21 years [ 44 ] (31–51 years) to 53 years [ 48 ] (19–71 years).

Music stimuli presentation studies

Sample sizes ranged from 19 participants [ 61 ] to 59 participants [ 62 ].

Two studies examined men only [ 55 , 62 ], and three investigated both men and women. One study did not report any information about gender [ 63 ].

Regarding the diagnosis, three studies focused on alcohol addiction [ 62 – 64 ], and the others included various drug addictions.

Regarding the age, mean age ranged from 31.1 years [ 61 ] to 43.1 years [ 64 ]. Two studies did not report any measures of central tendency [ 55 , 63 ] and one reported a median age of 46.4 years [ 62 ]. Age ranges (when reported) differed only slightly from 28 years [ 65 ] (20–47) to 33 years [ 64 ] (27–59).

Results of quantitative MT/ MBI studies separated by outcomes

For an overview of the efficacy of MT/ MBI per outcome (cluster) in consideration of the quality of the studies see Fig 3 . Studies were classified according to the categorization scheme presented in Fig 1 . None of the studies met the criteria of categories (3a) and (3b), i.e., studies with CG without randomization, so that these categories are not represented in Fig 3 . In the following section, we will describe the results in more detail.

Studies with effect or no effect compared to control group (CG) were classified as of high level evidence of efficacy (black and dark grey bars). Studies reporting insufficient statistical data to conduct meta-analyses and without CG were classified as of low level evidence of efficacy (light grey bars).

For the effect of MT/ MBI on variables related to this cluster (motivation, treatment eagerness, change readiness), 10 results were collected, and eight of them (80%) represent high level evidence of efficacy. For Silverman [ 32 , 34 ] who examined different motivational constructs within the same samples only motivation scores were used. All studies except one reported all statistical data and only one included pilot data without a CG [ 15 ]. In 37.5% of studies of high level evidence of efficacy (3/8), i.e. 30% of all studies (3/10), beneficial effects of MT/ MBI were found. All RCTs except one [ 38 ] were conducted by Silverman [ 29 , 31 – 36 ], and they differed widely with respect to CG designs and scales, so a meta-analysis was not conducted.

This outcome was examined in 11 studies including Howard [ 42 ] which reported on two separate samples. Five studies report insufficient statistical data and four were non-controlled studies, so that only 27% of the results (3/11) were categorized as of high level evidence of efficacy. None of the RCTs found benefits of MT/ MBI compared to CG. A meta-analysis was not conducted due to the different CG designs.

All three data sources of high level evidence of efficacy (i.e., 50% of all studies regarding this outcome) were reported by Silverman [ 29 , 31 , 32 ], so that we did not conduct a meta-analysis. Three further studies of low level evidence of efficacy [ 16 , 46 , 47 ] did not report all necessary statistical data. One out of three RCTs, i.e., 17% of all results (1/6), reported a positive effect of MT on enjoyment.

Withdrawal and craving

We decided to cluster these outcomes as the variables are closely linked. Patients in states of withdrawal often experience craving, and consumption of the substance may immediately and effectively reduce the symptoms [ 37 ]. Silverman [ 30 , 32 , 37 ] conducted three different RCTs examining craving and/or withdrawal in patients addicted to various drugs (e.g., alcohol, heroine, prescription drugs and cocaine). None of the studies showed beneficial effects of MT compared to different CG. A meta-analysis was not conducted because all results were reported by the same author.

MT helpfulness

Forty percent of the results (2/5) were of high level evidence of efficacy, comparing MT to group verbal therapy, and both RCTs were conducted by Silverman [ 31 , 32 ], so a meta-analysis was not appropriate. The lack of statistical details prohibited inclusion in meta-analysis for two further studies [ 44 , 47 ], and another study was a non-controlled study [ 15 ]. All in all, 50% of studies of high level evidence of efficacy, i.e., 20% of all studies (1/5) regarding helpfulness were in favor of MT/ MBI.

Locus of control (LOC)

All three studies considering LOC were RCTs, and two of them [ 20 ] (i.e., 67%) found positive effects of MBI/ MT. A meta-analysis was not conducted due to different CG designs.

Participation

For this category, many different constructs regarding the quantitative assessment of patients’ engagement and participation were subsumed, so six data sources were identified: Only one study included a CG [ 29 ] and did not identify benefits of MT. Furthermore, 50% of all data sources (3/6) did not report all statistical data [ 16 , 49 , 50 ] and 33% (2/6) were non-controlled studies [ 15 , 48 ].

Coping skills

Only one study out of three studies (33%) for this outcome, was of low level evidence of efficacy, i.e., a case study not including a CG [ 40 ]. None of the RCTs [ 36 , 38 ] found benefits of MT for coping skills.

Constructs examined without studies of high level evidence of efficacy

For five outcome clusters, namely anxiety , medical symptoms , anger , sadness , and stress , no RCTs could be identified, so conclusions about efficacy cannot be drawn.

Follow-up investigations

Only one RCT assessed follow-up scores regarding depression, enjoyment, perceived effectiveness and being clean [ 31 ] and did not identify differences between group verbal therapy and MT groups one month after intervention completion.

For at least eight categories of outcomes, studies of high level evidence of efficacy, i.e., RCTs, were identified. The descriptive summaries suggest that there is evidence for benefits of MT/ MBI compared to different control groups (CGs), especially for the variable locus of control (67% positive effects compared to CG). Additionally, regarding perceived helpfulness of the intervention, half of the RCTs reported higher values for MT compared to CG. For motivation and enjoyment there were inconsistent results, and more than half of the studies of high level evidence of efficacy did not identify statistically significant improvement for MT/ MBI participants. Regarding depression, withdrawal/ craving, participation, and coping skills none of the RCTs reported benefits for MT. Studies examining anxiety, medical symptoms, anger, sadness, and stress were all of low level evidence of efficacy, so that their results can only serve as a base for further research giving hints to constructs that should be evaluated with RCTs.

Results of quantitative studies separated by study characteristics

We now describe effects of MP, MT and MBI considering study characteristics according to the following categories: (1) effects of music in general, (2) effects of one session of MT/ MBI, and (3) effects of more than one session of MT/ MBI. Because most of the studies were not RCTs, conclusions about MT efficacy cannot be drawn. Thus, the summaries include descriptions of clinical effectiveness, i.e. the effects in clinical practice [ 67 ].

Studies comparing MT methods (e.g., lyric analysis and songwriting [ 46 ]) did not identify significant differences between the interventions, so that the methods are not differentiated in the following. With respect to the nomenclature, we noticed that regarding mood there is still no consensus, as mood , feelings , and emotions are often used interchangeably. For instance, Jones [ 46 ] refers to the terms “feelings and emotions” (p. 100), only to eventually assess “mood” using a visual analogue mood scale. Thus, due to the heterogeneity of the nomenclature used in the studies, it was not possible to differentiate these terms properly.

Effects of music presentation (MP)

Six studies examined the impact of music on patients with SUD without therapeutical involvement of an interventionist (see Table 2 ). The following effects of listening to music were reported: Short and Dingle [ 61 ] examined the impact of sad, happy, and relaxing songs on arousal in patients with SUD and a healthy control group (CG). Whereas the participants of the CG indicated different degrees of arousal and pleasantness for the three tracks, the SUD patients rated the three pieces of classical music equally arousing and pleasant. Furthermore, their degree of craving was linked to the personal relevance of songs: The patients reported increased craving after listening to a track associated with their substance use, whereas afterwards, listening to a track associated with abstinence resulted in decreased craving. These results indicate less emotional variations in SUD patients and a direct impact of music on relapse related variables. Furthermore, Fritz et al. [ 65 ] reported a strong context dependency of music effects. They conducted a musical feedback intervention with listening to a jointly self-produced music piece or a commercial track. Self-produced music showed positive effects on mood and locus of control (LOC) only when it was presented prior to the commercial music production. Jansma et al. [ 64 ] examined the effect of mood states on alcohol cue reactivity. They induced depressive mood by presentation of depressive music or distressed mood by negative feedback following a high performance task. Alcohol cue reactivity was present, but did not differ between negative or neutral mood states. Nevertheless, the patients were less irritated and more satisfied after depressive mood induction compared to distressing mood induction.

With respect to more abstract outcomes, patients with alcohol dependency perceived colors with greater intensity after listening to music compared to people (patients and staff of a therapeutic community) without exposure to music [ 63 ]. Similarly, music during LSD therapy was associated with colors, geometric designs, and past events. Between groups with and without music exposure, there was no difference in LSD experience. Nevertheless, only listening to familiar music appeared to have an effect on general music preference [ 62 ].

Additionally, there was experimental evidence for positive effects of music listening over a longer period of time. For members of a therapeutic community for drug users, music listening before falling asleep was related to increased sleep quality and mood on the following day as well as to decreased drop-out rate during a one-month-intervention [ 55 ].

Effects of one MT/ MBI session

MT/ MBIs typically include more methods than simply listening to music [ 68 ]. Effects of quantitative studies examining single MT sessions (mostly lyric analysis, songwriting or improvisation) are summarized in Table 3 . Most of them were conducted in detoxification centers with a short duration of stay between three and five days. Compared to a verbal therapy CG, MT participants showed similar measures of change readiness, depression, sobriety [ 31 ], client-rated working alliance [ 29 ], LOC [ 30 ], treatment eagerness, drug avoidance self-efficacy [ 34 ], craving [ 32 ], and withdrawal symptoms [ 30 ]. Silverman compared MT groups to wait-list CGs with pretest only, and found no differences regarding craving and withdrawal [ 37 ]. Positive effects of MT vs. group verbal therapy were found for therapist-rated working alliance [ 29 ], comfort [ 31 ], and motivational variables: MT participants had higher realization that aspects of change can be better than the status quo and more active changes [ 32 ]. In line with that, MT groups showed increased problem recognition, desire for help, treatment readiness, and total motivation compared to a wait-list CG with pretest only [ 33 , 35 ]. Furthermore, Silverman [ 36 ] found higher motivation to reach and maintain sobriety for participants of educational MT compared to patients receiving education without music or a music game. In the same study, treatment eagerness and knowledge of coping skills or triggers did not differ between groups. In three other studies, similar motivation scores between MT groups and verbal therapy or pretest CG were identified [ 29 , 32 , 34 ], indicating that the effects of single MT sessions on motivational aspects are not coherent. Regarding perceived enjoyment and helpfulness, the results were not consistent as well [ 29 , 31 , 32 ].

Other studies with single sessions for data analysis were conducted in an inpatient non-medical detoxification unit [ 46 ], an in- and outpatient rehabilitation unit [ 16 ], an inpatient dual diagnosis treatment unit [ 51 ] and an inpatient gender-specific residential program [ 19 ]. All these studies reported beneficial effects on mood: For instance, 65% of the participants showed a positive mood change [ 16 ]. More specifically, a great amount of the participants reported decreased anxiety [ 19 ], anger, and sadness [ 51 ], and or an increase in acceptance, enjoyment, happiness, and joy [ 46 ]. Furthermore, 87.5% of the participants used MT for mood regulation [ 16 ]. Nevertheless, one study found no differences between pre- and posttest regarding anxiety and depression [ 46 ].

Effects of multiple MT/ MBI sessions on mood

Effects of studies examining more than one session are summarized in Table 4 . Awareness, expression, and change of emotions are often mentioned as important intended therapy goals [ 50 ]. Therefore, five studies in inpatient settings [ 38 , 39 , 42 , 45 , 47 ] and five studies in outpatient settings [ 40 , 41 , 43 , 44 , 49 ] examined treatment effects on mood and emotions. Generally, MT participation was associated with positive mood changes [ 49 ], and the scores for perceived enjoyment and effectiveness of MT were almost at the maximum [ 47 ]. With respect to negative emotions, MT was linked to reduced anger, depression, stress, and anxiety [ 40 , 41 , 43 – 45 ]. Two RCTs identified beneficial effects of MT regarding therapist-reported, but not self-reported depression scores [ 38 , 39 ].

Effects of multiple MT/ MBI sessions on other outcomes

MT and MBI also affected other psychological variables: Adolescents with chemical dependency completing MT showed increased internal LOC compared to a wait-list CG engaging in alternative activities [ 20 ]. Results regarding motivation and coping skills were not clear: While in one RCT similar levels for both variables after standard treatment (CG) and additional Guided Imagery and Music (GIM) therapy were reported [ 38 ], a single case study found improved coping skills and motivation [ 40 ]. This patient had also reduced psychiatric symptoms after the MT intervention. In line with this finding, a cultural-based drumming treatment was associated with improved psychiatric and medical status in Native Americans [ 48 ]. In a non-randomized pilot study conducted in an inpatient treatment for dually diagnosed people with SUD and mental illness, Ross et al. [ 15 ] examined relationships between MT variables, psychiatric symptoms, general functioning, aftercare appointment, and motivation measured by the Stages of Change, Readiness and Treatment Eagerness Scale (SOCRATES). They found positive associations between MT appreciation and global functioning during hospital stay. Therapist appreciation was positively related to changes in global functioning and the Taking Steps subscale of SOCRATES measuring active changes. Furthermore, cross-sectional analyses at discharge revealed associations between MT appreciation and Taking Steps as well as between therapist appreciation and the Ambivalence and Taking Steps subscales of SOCRATES. Although MT variables did not directly predict improvement in psychiatric symptoms, the number of attended sessions was positively related to aftercare appointment in a following outpatient program within one week after hospital discharge. With regard to long-term effects beyond the hospital treatment, MT was also associated with sobriety and reduced substance use in another study [ 48 ]. As this pilot sample consisted of a small number of Native Americans not involved in inpatient settings, it remains unclear whether the results are transferrable to other populations. Nevertheless, MT was associated with beneficial behavioral aspects like high involvement, attendance and on-task behavior in several studies [ 42 , 49 , 50 ]. These findings suggest that MT and MBI may be important tools for recovery in line with the participants’ subjective evaluations of treatment effects and perceived helpfulness.

Qualitative studies

Six qualitative studies examined and described the participants’ reactions, attitudes, and subjective associations in the context of MT and MBI. In four studies, the patients’ behavior during the session was recorded using video-tapes [ 55 , 59 ] therapist’s notes [ 60 , 66 ] and lyric analysis [ 66 ]. Some authors conducted semi-structured interviews [ 57 , 59 ] or used questionnaires that were analyzed qualitatively [ 58 ]. Four general themes were identified: Firstly, music served as a tool for expression of thoughts and feelings. Secondly, in all qualitative studies the role of music and MT/ MBI for group interaction, cohesion, and relationships to others, including the therapist [ 60 ] was emphasized. Thirdly, MT/ MBI were related to the learning of skills regarding music [ 57 ], problem solving [ 66 ], and social interaction [ 59 ]. Finally, MT/ MBIs were associated with benefits for health and quality of life [ 59 ]. In line with the quantitative data, the behavioral observations revealed high engagement and involvement of the participants [ 55 , 59 , 66 ].

In order to address the research question whether music therapy (MT) and music-based interventions (MBIs) are clinically efficient for people with substance use disorders (SUD), we obtained a systematic collection of articles resulting in 34 quantitative and six qualitative studies. Regarding MT/MBI efficacy, we used a descriptive approach to summarize the efficacy evidence of quantitative studies. Furthermore, we summarized effects of exposure to music stimuli, MT and MBIs to describe findings regarding effectiveness. In the following, we discuss these effects, focusing on motivation and on findings regarding the four main themes identified in qualitative analyses. Furthermore, we discuss the quality of the studies. Taken together, the studies do not show clear common effects. Additionally, only few studies have assessed outcomes related to substance use even though such outcomes are critical for treatment success. Thus, variables such as long-term sobriety need to be examined in future studies. Possible mechanisms that may contribute to positive effects of MT/MBI remain to be investigated and specified as well.

Effects of music stimuli presentation

There is evidence for the direct impact of listening to music on emotions and craving without application of MT/ MBI [ 61 ]. In addition, frequent listening to relaxing tracks had a beneficial effect on sleep, mood, and treatment completion [ 55 ]. Neuro-imaging studies have demonstrated that music listening engages many brain structures important for cognitive, emotional, and sensorimotor processing [ 69 ], in particular the mesocorticolimbic system [ 70 , 71 ]. Positive short-term effects on variables like craving may reflect benefits for mental health even on a neurobiological level [ 72 ].

Short-term effects of single MT/ MBI sessions

Apart from the general impact of music stimuli presentation, participation in single MT sessions may result in additional short-term effects. Those are important to examine because many patients with SUD attend detoxification treatments with a low frequency of therapy sessions [ 3 ]. Single MT sessions appear to be as effective as single verbal therapy sessions for various psychological outcomes (e.g., withdrawal, LOC, craving, client-rated working alliance, and depression), and there were higher scores for MT for comfort [ 31 ], therapist-rated working alliance [ 29 ], and some aspects of change readiness [ 32 ]. These findings support the use of MT in short-term treatments for SUD. Results regarding enjoyment, helpfulness, and motivation differed between studies [ 29 , 31 , 32 ], although these aspects may be especially important in short-time interventions. As they may be related to positive therapeutic experiences, these factors may facilitate the participation in additional interventions. Importantly, the only RCT with follow-up assessment did not find any beneficial effects of single MT sessions on depression, enjoyment, perceived effectiveness and sobriety [ 31 ] after a one-month period. Additional longitudinal analyses of single session effects are necessary.

Effects of MT/ MBI on motivation

Lack of motivation is a crucial problem in the treatment of SUD [ 73 ], and beneficial effects of MT and MBI on motivation were commonly described [ 74 , 75 ]. Music itself is motivating and empowering for many people and it has been suggested that engagement in music making may lead to enhanced internal change motivation [ 76 ]. High rates for on-task behavior and engagement reported in qualitative and quantitative studies included in this review support this assumption [ 55 ]. Ten studies quantitatively assessed motivation, and eight of them were RCTs. Most of them investigated single sessions [ 29 – 36 ], and two included longer interventions [ 15 , 38 ]. Despite the positive qualitative reports of patients, not all of these studies identified significant benefits for MT/ MBI. Silverman reported higher treatment and sobriety motivation after MT compared to a wait-list CG with pretest only [ 33 , 35 ], whereas others identified no differences compared to verbal therapy or pretest [ 32 , 34 ]. Different results may be due to different study designs, comparisons or measurement instruments. For instance, a Likert scale for the assessment of motivation revealed similar ratings across groups, whereas the use of a multidimensional scale resulted in higher scores for experimental group than CG in the same sample [ 32 ]. In line with that, most studies with Likert scales did not identify benefits for MT groups [ 32 , 34 , 36 ], whereas the use of some multidimensional instruments revealed significant treatment effects [ 32 , 33 , 35 ]. There is actually no consistent definition for motivation in the context of research on addiction [ 77 ]. Therefore, it is difficult to find an adequate outcome measure capturing all relevant aspects and fitting to the treatment setting. For instance, Silverman [ 33 ] examined treatment motivation and readiness with the Circumstances, Motivation, and Readiness Scales for Substance Abuse Treatment [ 78 ] and did not identify benefits for MT. The use of this instrument as a clinical assessment tool is not recommended [ 77 ] because it was originally developed in the context of a therapeutic community. It is, at this point, not possible to claim that issues with instrument selection are related to incongruence of findings; however, this is certainly an issue worthy of further investigation in future studies.

Prochaska and DiClemente [ 79 ] argued that behavior change always occurs as process with different stages of change, so that differentiating aspects of motivation regarding these stages might be useful. Considering this, beneficial effects of MT on problem recognition, desire for help, treatment readiness, and overall motivation were reported [ 35 ]. Furthermore, there might be a benefit of therapeutic use of music compared to solely music engagement without therapeutic context as MT participants showed higher motivation scores than patients playing a music game instead [ 36 ]. Nevertheless, there were no differences for treatment eagerness in the same study, suggesting that there is need to differentiate between the motivational variables. More RCTs that use the same outcome measures and use the same control group interventions are needed to draw further conclusions.

Examining more than one session of MT, K. M. Murphy [ 38 ] did not identify benefits in motivation for patients with an additional GIM intervention compared to those with standard program only. Because this study did not include a sufficient amount of participants ( N = 16), long-term effects on motivation should be systematically examined in larger samples in more detail.

Effects of MT/ MBI on mood and emotions

In many studies, MT/ MBI had beneficial effects on mood and emotions, i.e., positive mood change, decreased negative emotions, e.g., anxiety, depression, and anger, and increased positive feelings, e.g., enjoyment and happiness. This is in line with the importance of MT for the expression and regulation of feelings, as identified in our qualitative analyses. MT provides opportunities for the exploration and expression of feelings without drugs and appears to be a non-threatening intervention [ 80 ]. Therapist-selected songs as well as songs written or selected by the participants themselves contain aspects related to feelings [ 33 ]. Many music therapy studies have demonstrated that songs may be used as a verbal and nonverbal tool for the exploration of feelings [ 12 , 16 , 46 , 81 , 82 ]. Jones reported that over the course of lyric analysis and songwriting interventions, emotional expression appears to increase, and suggests that positive mood changes may have a positive influence on further treatment-related variables such as therapeutic alliance [ 46 ]. Additionally, support by other group members may facilitate emotional expression [ 50 ]. Nevertheless, it should be noted that for many emotional variables (e.g., anxiety, anger, sadness) RCTs are needed to assess MT/ MBI efficacy.

Effects of MT/ MBI on skills and locus of control

Qualitative analyses suggested that MT/ MBI provide opportunities to learn in various areas. Many patients with SUD have poor psychosocial skills, which improved over the course of MT/ MBI [ 46 , 59 ]. M. Murphy [ 83 ] has suggested that music, as part of the participants’ everyday life, is adaptable to low levels of psychosocial functioning, and group interventions may be helpful in reducing social isolation. According to Ghetti [ 76 ], in group music therapy sessions, the therapist structures the active music making purposefully to enable group interaction in a non-threatening atmosphere. Successful group interactions in music making may help to develop social and problem solving skills. Furthermore, discussion of lyrics of popular songs can help enhance understanding of the individual’s dynamics regarding substance use and may lead to the development of more healthy coping strategies [ 76 ]. Only very few studies examined effects of MT/ MBI on cognitive abilities quantitatively. In contrast to the findings reported in qualitative studies, in RCTs no positive effects of MT on coping abilities could be identified [ 36 , 38 ], and also no effects of MBI on cognitive functioning were reported [ 48 ]. In contrast to that, a single case study showed enhanced coping after individual sessions [ 40 ]. However, these studies differed with respect to many variables, e.g., age, drugs, MT/ MBI methods, and duration so conclusions regarding treatment effect cannot be drawn at this time.

As internal change motivation is a critical aspect for the treatment of addictions, effects of MT/ MBI on locus of control (LOC) were examined as well. After a single session, MT participants did not differ regarding LOC compared to a verbal therapy group [ 30 ]. Furthermore, in an experimental setting examining effects of music stimuli presentation, increased internal LOC depended on the context [ 65 ], but after longer MT interventions, enhanced internal LOC was identified [ 20 ]. These results suggest that MT/ MBI may lead to increased internal LOC over time. When patients experience that their own abilities and actions determine what happens [ 84 ] during MT/ MBIs, this may be transferred to life outside the therapy setting and result in better outcomes of addictions’ therapy in the long term [ 85 ]. Typically in MT, music experiences are carefully structured and supported by the music therapist to enhance the potential for positive experiences by the patient [ 86 ]. This may lead to positive effects of MT on factors such as self-esteem [ 87 ] or self-efficacy [ 88 ]. However, it is important to acknowledge that asking patients to engage in music making may lead to some anxiety and insecurity as well for some patients, as has been reported in studies outside of the SUD population [ 89 ]. However, no studies to date have directly examined the relationship between mastery in music therapy and long-term treatment outcomes for patients with SUD. More research is necessary to explore this possible mechanism.

MT/ MBI effects on group interaction and relationships

Positive group dynamics were identified as important motivators in all qualitative studies. Over the course of the intervention, behavioral observations revealed increased exchange and cohesion [ 57 , 59 , 66 ]. Nevertheless, in their study with offenders in a substance abuse/mental illness treatment program, Gallagher and Steele [ 49 ] reported that 53% of their participants were “not sociable” (p. 121). For planning of the sessions, clinicians need to keep in mind that many patients with SUD have poor social skills. However, none of the quantitative studies in our review systematically examined group-related variables, so future research should examine social skills or aspects like group cohesion. Summarizing studies with respect to the outcome cluster, participation reveals a lack of studies of high level evidence of efficacy regarding this topic as well.

Regarding working alliance between therapist and patients, beneficial effects from the therapist’s perspective were identified quantitatively [ 29 ] as well as qualitatively [ 60 ]. By contrast, patients attending MT did not perceive a better working alliance compared to a verbal therapy CG [ 29 ]. This is in line with previous studies identifying weak reliability between therapist-rated and patient-rated working alliance in drug treatment [ 90 ]. Regarding the relationship between different perspectives of working alliance and therapeutic success, results are not consistent: Some studies found stronger relationships between the counsellor’s/ therapist’s view and success [ 90 – 94 ], whereas in other studies the patient’s view was identified as a more important predictor [ 95 ] or both measures were only weakly correlated with success [ 96 ]. Furthermore, levels of working alliance had different effects on outcome for different types of therapies [ 97 ]. These inconsistent results indicate that working alliance may be more complex and depend on many aspects. As most of the studies emphasized the importance of the therapist’s view, especially ratings at early time points after starting the therapy [ 98 ] as examined by Silverman [ 29 ], working alliance should be examined in further MT studies.

MT/ MBI effects on quality of life and health

In many studies, MT and MBI were associated with a great amount of perceived enjoyment and also reported to enhance quality of life and improve health [ 59 ]. In line with this, longer MBI were related to positive psychiatric and medical outcomes [ 40 , 48 ]. Nevertheless, these investigations were conducted in very specific settings, so that there is still a lack of studies examining health-related and long-term variables in common treatments for SUD. Especially, variables related to substance use are understudied. Furthermore, all studies examining medical symptoms were categorized as of low level evidence of efficacy in our descriptive summaries. Thus, high quality evidence has not been conducted.

Study quality and methodological recommendations

Our descriptive summaries considered the quality of the identified studies and revealed that in the last years, since the review of Mays et al. in 2008, more RCTs were conducted. Thus, for outcomes like motivation, depression, enjoyment, withdrawal and craving, perceived helpfulness, working alliance, and locus of control studies of high level evidence of efficacy already exist. Nevertheless, we did not calculate meta-analyses due to study heterogeneity or because similar variables were only examined by the same author. Furthermore, across all studies included in our descriptive approach, still only 38% (25/65) were RCTs, and especially for mood variables and long-term abstinence, high quality research has not been conducted. Due to the low quality of most of the studies, in the end, strong key outcomes cannot be substantiated.

It is important to consider that in studies that examine the impact of group interventions, the independence of observations, a common assumption for standard statistical tests, may have been violated because of interactions between group members. This may have resulted in biased standard errors and erroneous inference [ 99 ].

In Table 6 , methodological recommendations are summarized that are aimed at helping to overcome issues in future research. Most importantly, studies should investigate long-term outcomes such as abstinence and use randomized controlled trial designs. In order to reduce problems related to the independence of observations, hierarchical analyses taking into account the group structure of the data or cluster randomization should be applied. However, designing and executing of cluster randomized trials is difficult because for example larger sample sizes are needed or recruitment bias could occur [ 100 ].

If in the clinical context randomization is not possible, studies should at least include control groups as reference frameworks. In within subjects designs aimed at examining pre to post MT/MBI intervention improvements in functioning, one needs to consider that the statistical regression to the mean may be an explanation for the patients’ improvement. Including a control group may solve this issue. Studies of low level evidence of efficacy can be useful for generating hypotheses, getting information about subjective experiences, exploring effects on individual levels, or assessing the ecological validity of treatments [ 25 ]. Thus, we also included them in our review, but in 50% of these non-RCT studies (20/40), the results were reported without sufficient statistical information. Furthermore, across all studies, reports about characteristics of intervention, studies and participants varied widely, so that giving a transparent overview and comparing the studies regarding these aspects was difficult. In addition to that, only few studies reported standardized effect sizes [ 31 – 37 , 39 , 41 ], so the effects of MT/ MBI could hardly be interpreted and compared across studies. Therefore, we recommend the inclusion of reports that clearly describe characteristics of intervention, studies and participants, including diagnostic criteria, transparent information about statistical procedures, and all necessary statistical data (including effect sizes) according to the guidelines of the Task Force on Statistical Inference [ 101 ] in the articles. In addition to that, as described in the paragraphs above, high-quality research for outcomes related to skills, group interaction and relationships has not been conducted although these aspects are important topics mentioned in qualitative research. Thus, future studies should investigate variables such as cognitive abilities, group cohesion or medical symptoms among others. Measurement instruments for the same outcomes widely varied across studies (e.g., Likert scales vs. standardized tests) and they mostly captured different aspects, so comparisons were difficult. Therefore, in future research authors should use the same standardized measurement instruments that are suitable for the addiction and music therapy context. Furthermore, the researcher often acted also as music therapist and collected the data which may lead to procedural bias (such as Rosenthal effect [ 102 ]) or response bias in the data. It also remains unclear whether effects are due to the music therapy or the person of the music therapist. To reduce these tendencies, we recommend the inclusion of external researchers for data collection and analysis.

Conclusions

There is still no consensus regarding the effects of music therapy (MT) and music-based interventions (MBI) for patients with substance use disorders (SUD). Previous reviews [ 21 , 22 ] highlighted the need for more randomized controlled trials (RCTs) regarding long-term outcomes like maintenance of sobriety. The current literature includes additional RCTs, but most of them focused on short-term effects after single sessions in detoxification units. One RCT examined sobriety after a one-month period without significant differences between a single session of MT or group verbal therapy [ 31 ]. The only study examining abstinence after more than one session was conducted with one specific ethnic group without inpatient participants [ 48 ]. Therefore, future studies should include long-term investigations and follow-up measurements, in particular regarding variables related to substance use. Due to the great fluctuation in SUD treatments, planning of these studies may be a challenge. However, reduction of substance use and abstinence are critical aspects regarding the success of addictions’ treatment, so evaluations of treatment effects for these outcomes are necessary for future investigations. MT/ MBI appeared to be effective in the regulation of emotions and subjective outcomes, as also indicated by qualitative analyses. Nevertheless, the quantitative studies in our review were very diverse which was one important reason for not conducting meta-analyses. As MT/ MBI are commonly and specifically used in the treatment of groups and subgroups with SUD, e.g., women or adolescents [ 8 ], it is important to examine its efficacy and effectiveness in these specific populations as well. However, these results may not be generalizable across general SUD settings. Additionally, it is important to be aware that music can also trigger relapse (e.g. if the music is associated with substance abuse [ 61 ]), and that, therefore, music has to be used with great care in SUD patients.

Regarding limitations of the current review it must be noted that collecting the characteristics of the studies was particularly difficult because of missing information. We did not consider the patients’ additional diagnoses and treatment options, methods or specific therapy goals. These topics could be included in future reviews to provide additional insights in characteristics of effective MT/ MBI/ MP. Due to the small number of MT studies, separations regarding these aspects are currently not useful. Whereas this systematic review summarizes the available evidence in terms of treatment efficacy, it does not provide information about potential mechanisms of action of MT/ MBI for SUD. Furthermore, a methodological review of MT/ MBI/ MP and SUD studies may be warranted in the future. For example, studies could be codified regarding methodological strengths and weaknesses to make further methodological recommendations with respect to the investigation of concrete outcomes.

From a methodological point of view, future studies examining the efficacy of MT/ MBI/ MP for patients with SUD should include RCTs, so that meta-analytic calculations will be possible. Regarding content and outcome variables, future studies should consider including outcomes related to the qualitative findings as well as variables related to substance abuse so that a comprehensive picture of the efficacy of MT/ MBI/ MP can be drawn. In addition, we urgently need mechanistic studies that identify and examine the impact of potential treatment mediators and moderators. Additionally, the effects on problem solving, cognitive, and coping abilities and the role of MT/ MBI/ MP for different stages of motivation should be clarified. Furthermore, effects of the interventions on long-term medical and psychiatric outcomes, treatment retention and completion should be examined, while considering additional moderating and mediating variables like MT appreciation. Based on these findings, implications for future MT/ MBI as independent or adjunctive treatment programs for SUD can be developed. As individual preferences regarding music and MT as well as group dynamics appeared to be important for the success of MT [ 21 ], careful group composition and selection of materials are necessary. All in all, due to its high acceptance, flexibility, easy accessibility and low costs, MT/ MBI provide opportunities for SUD treatment for various groups in various settings. Nevertheless, its efficacy and effectiveness have to be evaluated more systematically and should focus on further long-term outcomes.

Supporting information

Funding statement.

The authors received no specific funding for this work.

Data Availability

Music Analysis: Drug Abuse in Music Essay (Critical Writing)

Introduction, analysis of the musical lyrics, other materials and peer reviewed articles.

Popular culture refers to a set of ideas, feelings, perceptions, descriptions or impressions that are constantly reasoned through informal agreements in a given society (Mashable.com, 2005). This notion is commonly known as “pop culture” and is mostly prominent in the mass media where detailed accounts of people’s lives usually flood on a daily basis (Mashable.com, 2005).

Today’s society is facing a lot of challenges such as drug abuse, war, prevalence in crime among others (Mashable.com, 2005); all these have grown to create many social problems and therefore, there is greater need for the community to work hard in order to eliminate this social problem that is becoming rampant in many societies. One of the major social evils is the issue of drug abuse that has become so prevalent in the society especially among young generation.

Drug abuse is an issue that should be addressed with a lot of concern and it is important for every individual in the society to tackle this issue as a personal responsibility in order to safeguard the next generation. The topic under discussion for this paper will mainly focus on issues of drug abuse since this is a major social challenge that is rapidly taking roots in the society at all levels which means everyone is affected in one way or another. It is therefore necessary to educate and make people aware of the dangers of drug and substance.

It is no doubt that pop culture has both positive and negative influence on issues of drug abuse especially in this era of globalization due to the easy access to information especially through the internet which happens to be one of the major medium of information such as musical lyrics, videos and films among others. In this regard, the discussion below will also focus on popular culture that is positive and educative on issues of drug abuse.

The five category of music lyrics includes music by; Ben Harper, in the album Radiohead (2008) “The drugs don’t work”, Bare-naked Ladies, in the album Everything to Everyone “war on drugs” (2003), Lily Allen, in the album Everyone’s at It “Everyone’s at it” (2008) and finally the lyrics by Alice in Chains, Album Dirt “Hate To Feel”, (1992) (Songmeanings.net, 2007).

First let us discuss the work of art by Ben Harper, in the album Radiohead “The drugs don’t work” (2008) (Songmeanings.net, 2007); this is a music lyrics that targets the young generation.

The artist has been very persistence in educating youths on the dangers of drug and substance abuse; in this song he is discouraging the youths from using drugs for many reasons. The theme of this song is “drugs do no work” and therefore anyone using drugs should try to put a stop to this habit because drug abuse has no positive impacts to human life (Songmeanings.net, 2007).

Secondly, there is the music by a group known as Bare-naked Ladies, in the album “everything to everyone” (2003) which also advocates for drug free society (MacKenzie, 2011). The artists laments how drugs have destroyed youths in many societies because of the dangers that they pose to the users; a vice that is described by the artist as evils of the society in the music lyrics which states “drugs are demons” hence the humanity should now realize the need to get over drugs and substance abuse (MacKenzie, 2011).

The third music lyrics is by Weezer in the album Make Believe “we are all on drugs” (2005) (Beemp3.com, 2011); this is creative work of art in which the artist is ridiculing the youths who are doing drug abuse, the artist argues that, “The youths think they are cool” when they are under influence of drugs (Beemp3.com, 2011).

According to the artist, it is time the youths face issues of life from a sober angle since the reality of life does not care whether you’re using drugs or not, the reality is tough and life is hard, drugs can’t work they will only destroy one’s life; that is the advice of the artist in this song (Beemp3.com, 2011).

Another positive music lyric is one by Lily Allen in the album “Everyone’s at it” (2008) (Musicloversgroup.com, 2008). In this creative work, the artist is very keen and observant about issues that affects the society one of the main and dangerous one being drug abuse (Musicloversgroup.com, 2008).

So in this song the artist is also lamenting the dangers of drugs and the theme of the music is one that advocates against tackling the problem with issues of drug abuse by arguing the youths to refrain from using drugs that has now become the culture in the society. This is the reason that the artist asserts in the music lyrics that “Everyone is at it” which is the title of the music album (Musicloversgroup.com, 2008).

Finally, the music lyrics by Alice in Chains in the album Dirt, “Hate To Feel” (1992) is educative work of art because the artist is sharing her personal experience after having done drugs which she eventually stopped (Cduniverse.com, 2011). The artist says that, when she tried to abuse heroin drug, it was a bad experience which she says was not anything she would want to ever feel again.

After this incidence, the artist is very cautious and sensitive about drugs abuse, and for this particular reason she is advising the youths and general public not to make an attempt or try to use drugs at any one time because they have severe effects to the body (Cduniverse.com, 2011).

In addition to the music lyrics, the following internet resources address the issues of drug abuse; these sources are “Taking Drugs to Make Music to Take Drugs to” (Last.fm, 2011) and “Report: teens using digital drugs to get high” (Thebeerbarrel.net, 2011).

The first online resource is a joint policy that was drafted with an intention of enlightening the youths in order to persuade them from listening to music that encouraged drug abuse (Last.fm, 2011). The article was written with an aim of educating the mainly young generations who are most affected by drugs and often influenced through music that portray drugs as cool and great to use; thus the theme of this article “just say no” (Last.fm, 2011).

The other source also an online article is a report released on how the young generation are listening to music on the internet to take drugs, the procedure through which drugs are taken is so dangerous as it involves use of digital drugs or i-drugs absorbed through the internet when an individual is listening to music as claimed by this paper (Thebeerbarrel.net , 2011). This particular report is meant to enlighten the parents about what is really happening in order for the parents to take precautions that prevent this.

Furthermore, substance abuse treatment and prevention policy ( SAPPT ) is a peer reviewed article that is also addressing this social problem (Substanceabusepolicy.com, 2011). This journal article is mainly discussing ways in which good environment can be created especially on the internet where the public can be able to discuss various ideas on ways of reducing drug and substance abuse (Substanceabusepolicy.com, 2011).

Popular culture is a very influential work of art; thus, it is important for artists to use such art in communicating positive information that can address issues of importance especially those that pertain social problems so as to facilitate positive social change.

Besides, artists themselves should also be enlightened on dangers of drug abuse which is also rampant amongst them this is because they are the role models of the society. They should understand that, they are the mirror of the society and therefore they should be sensitive on those ideas that they are communicating to the public because some people especially the youths are very keen to take the message.

Beemp3.com. (2011). Weezer – We Are All On Drugs: Free MP3 Download. Web.

Cduniverse.com. (2011). Alice in Chains, Album: Dirt . Web.

Last.fm. (2011). Taking Drugs to Make Music to Take Drugs to Group . Web.

MacKenzie, W. (2011) Everything to Everyone – Barenaked Ladies . Web.

Mashable.com. (2005). Popular Culture . Web.

Musicloversgroup.com. (2008). Lily Allen – Everyone’s at It Lyrics and Video . Web.

Songmeanings.net. (2007). Songmeanings Lyrics The – The Drugs Don’t Work . Web.

Substanceabusepolicy. (2011). SAPPT . Web.

Thebeerbarrel.net (2011) Report: Teens Using Digital Drugs to Get High. Web.

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IvyPanda. (2024, January 26). Music Analysis: Drug Abuse in Music. https://ivypanda.com/essays/music-analysis/

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1. IvyPanda . "Music Analysis: Drug Abuse in Music." January 26, 2024. https://ivypanda.com/essays/music-analysis/.

Bibliography

IvyPanda . "Music Analysis: Drug Abuse in Music." January 26, 2024. https://ivypanda.com/essays/music-analysis/.

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Going For a Song

Can listening to music be addictive.

Posted May 22, 2014

• What Is Addiction?
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“Music acts on our emotions and feelings. Drugs act on our emotions and feelings. We generally recognise that the feelings created by drugs are not ‘real’. Does the same apply to music? Is music a drug?” (Philip Dorrell, 2005; author of ‘What is Music? Solving a Scientific Mystery’ )

This opening quote from Philip Dorrell is something that I have pondered many times—especially because people that know me can vouch that I am a self-confessed music obsessive. This blog is based on an article that I had published in an issue of Record Collector magazine on music mania and addiction . Although most lists of manias include ‘musomania’ (i.e., an obsession with music), there is very little in the way of academic or clinical literature on the topic. Jillyn Smith in her 1989 book Senses and Sensibilities interviewed Michael Koss (at the time, the President of the Koss Stereo Headphone Corporation . He was quoted as saying:

“The excitement that people, especially teenagers , get from high-decibel music results from activation of the peripheral nervous system by low frequency sound waves beating against the body…people can get ‘high’ from this feeling, because it switches on the body’s fight or flight mechanism, bringing a rush of adrenalin (a reason for battle music)”

There are certainly anecdotal reports of people being obsessed and/or ‘addicted’ to music’. One notorious case, is a Swedish man in his forties (Roger Tullgren) who receives state benefits from the Employment Service because of his ‘addiction’ to heavy metal music. Tullgren (with the help of three occupational psychologists) campaigned for ten years to get his condition classed as a ‘handicap’ so that he would not be discriminated against. In 2006 he claimed to have attended almost 300 heavy metal gigs and constantly missed work as a consequence. He was then sacked from his job because of his continual inability to turn up for work. With the help of psychologists, his lifestyle was subsequently classed as a disability (which in turn meant he was entitled to wage supplements). He now works at a hotel washing up and has been given a special dispensation to listen to heavy metal while he works. Other Swedish psychologists have found the ruling strange. Quoted in a Swedish newspaper, The Local, one unnamed male psychologist was reported to have said:

"I think it's extremely strange. Unless there is an underlying diagnosis it is absolutely unbelievable that the job centre would pay out. If somebody has a gambling addiction, we don't send them down to the racetrack. We try to cure the addiction, not encourage it”.

Part of me can empathize with Tullgren as I too constantly play music while I am working, and I play my i-Pod whenever I am in transit. However, my love of music has never interfered with my job, and as far as I am concerned there are no negative detrimental effects as a consequence of my excessive listening to music. However, that doesn’t mean that some people may not be addicted to music. In an online essay, Philip Dorrell explored the question theoretically and noted:

“For drugs like heroin, the notion of addiction is relatively uncontroversial…For a not-quite-so-strong drug like cocaine, it becomes less clear as to where the boundary between regular use and addiction lies. Looking at the more popular alcohol, some people get addicted to it, and some don't…There is the weaker notion of "psychological dependence", which implies that you will miss not having something, but not to the extent that you would deem yourself to be suffering. I think that might be a fair description of many people's relationship with music…So, is music a drug? The short answer is ‘yes, sort of’”.

For Dorrell, the long answer to the question of whether music is a drug is that (theoretically) music could be considered “similar in the strength and nature of its effects to a mild recreational drug” because (i) it generates ‘false’ feelings, (ii) the maximum level of effect is roughly equivalent to a couple of ‘standard’ alcoholic drinks, (iii) it is not strictly addictive, but may cause psychological dependence, and (iv) excessive consumption can cause some health problems.

I have operationally defined addictive behaviour as any behaviour that features what I believe are the six core components of addiction (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict and relapse ). I argue that any behaviour (e.g., excessive listening to music) that fulfils these six criteria can be operationally defined as an addiction. Theoretically, and in relation to “music addiction”, the six components would therefore be:

• Salience – This occurs when music becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour). For instance, even if the person is not actually listening to music they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with music).

• Mood modification – This refers to the subjective experiences that people report as a consequence of listening to music and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).

• Tolerance – This is the process whereby increasing amounts of listening to music are required to achieve the former mood modifying effects. This basically means that for someone engaged in listening to music, they gradually build up the amount of the time they spend listening to music every day.

• Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to listen to music because they are without their i-Pod or have a painful ear infection.

• Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (work, social life , other hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time listening to music.

• Relapse – This is the tendency for repeated reversions to earlier patterns of excessive music listening to recur and for even the most extreme patterns typical of the height of excessive music listening to be quickly restored after periods of control.

I have also argued that the temporal dimension and context of the addiction needs to be taken into account. With regard to the temporal dimension, most people can think of periods in their lives when listening to music has taken over for a short time (e.g., listening to music 12- to 16-hour days for a month). This alone does not mean that such people are addicted to listening to music. To be genuinely addictive, the activity must be something that has been sustained and have been going on over a long period of time. The difference between a healthy excessive enthusiasm and an addiction is that healthy excessive enthusiams add to life whereas addiction takes away from it.

Most recently, a 2011 study published in Nature Neuroscience reported that on a neurochemical level, the pleasurable experience of listening to music releases the neurotransmitter dopamine that is important for the pleasures associated with rewards such as food, psychoactive drugs and money. This led to many headlines in newspapers along the lines of “people who say that they are ‘addicted’ to music are not lying ”.

In their study, Dr. Valorie Salimpoor and her colleagues (at Montreal’s McGill University in Canada), measured dopamine release in response to music that elicited "chills". Participants in their experiments were asked to listen to their favourite songs while their brains were being observed using a neuro-imaging technique known as Position Emission Tomography (PET). They found that changes in heart rate, skin conductance, temperature, and breathing, were correlated with how pleasurable the music was. Furthermore, their findings suggested that dopamine release was greater for pleasurable music when compared to “neutral” music. In newspaper interviews, Dr Salimpoor said:

“Dopamine is important because it makes us want to repeat behaviors. It’s the reason why addictions exist, whether positive or negative. In this case, the euphoric ‘highs’ from music are neurochemically reinforced by our brain so we keep coming back to them. It’s like drugs. It works on the same system as cocaine. It’s working on the same systems of addiction, which explain why we’re willing to spend so much time and money trying to achieve musical experiences. This is the first time that we’ve found dopamine release in response to an aesthetic stimulus. Aesthetic stimuli are largely cognitive in nature. It’s not the music that is giving us the ‘rush.' It’s the way we’re interpreting it”.

The team also reported that just the anticipation of pleasurable music led to increased dopamine release. Therefore, this helps explain why individuals (like myself) continually repeat songs or albums all the time as we want to re-experience those sensations repeatedly.

References and further reading

Dorrell, P. (2005). Is music a drug? 1729.com, July 3. Located at: http://www.1729.com/blog/IsMusicADrug.html

Dorrell, P. (2005). What is Music? Solving a Scientific Mystery. Located at: http://whatismusic.info/ .

Griffiths, M.D. (2012). Music addiction. Record Collector , 406 (October), p.20.

The Local (2007). Man gets sick benefits for heavy metal addiction. June 19. Located at: http://www.thelocal.se/7650/20070619/

Morrison, E. (2011). Researchers show why music is so addictive. Medhill Reports, January 21. Located at: http://news.medill.northwestern.edu/chicago/news.aspx?id=176870

Salimpoor, V.N., Benovoy, M., Larcher, K. Dagher, A. & Zatorre, R.J. (2011). Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nature Neuroscience, 14, 257–262.

Smith, J. (1989). Senses and Sensibilities. New York: Wiley.

Mark Griffiths, Ph.D., is a chartered psychologist and Director of the International Gaming Research Unit in the Psychology Division at Nottingham Trent University.

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Acclaimed singer Renee Fleming probes the relationship of 'Music and Mind' in new book

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• Emiko Tamagawa

Famed soprano Renée Fleming wants people to better understand the link between music and health.

Musical activities can help nonverbal children speak, aid in recovery after a stroke, and improve the stride of people with Parkinson's, according to research. To spread the word, Fleming edited the new book " Music and Mind: Harnessing the Arts for Health and Wellness ," which features essays by researchers, music therapists and artists including Yo-Yo Ma, Ben Folds and Anna Deveare Smith.

The book’sroots run back to 2015, when Fleming helped launch a collaboration between the Kennedy Center and the National Institutes of Health to explore how the arts and health intersect.

When she first started at the Kennedy Center as an artistic advisor, Fleming attended a Washington, D.C. gathering attended by Supreme Court Justices Anthony Scalia and Ruth Bader Ginsberg, as well as former NIH Director Francis Collins.

Despite some high tensions after the Supreme Court ruled in favor of same-sex marriage, Fleming and Collins brought the room together with song.

“Music has historically created social cohesion between people. It happened that night,” Fleming says. “I said, ‘Francis, why are scientists studying music and the brain?’ And he said, ‘well, we're interested in it because we have a new brain institute. And the key is technology because this ability to look at the brain enables scientists to see the exact impact music is having.’”

Two years later, Fleming sat on a panel among scientists, music therapists and fellow artists with the Kennedy Center, the NIH and the National Endowment for the Arts. Her work with the organizations inspired her to share with the public what she learned about how the arts affect people.

4 questions with Renée Fleming

How did scanning your brain show the impact of music?

“My brain scan at the NIH was an fMRI scan, functional MRI, which measures blood oxygen in the brain. And it had me singing, speaking and imagining singing. And interestingly, imagining singing, It was by far the most powerful for me. It impacted many more parts of my brain than the other two activities, which was a big surprise to the scientists.

“But they finally said, ‘Well, listen, you're a singer, so it makes sense that that's second nature to you.’ So that was a wonderful experience. It's an opportunity for me to see firsthand how this research is done.

“Imagining singing can also help Parkinson's patients who are having difficulty walking. If they just imagine a rhythmic song in their head, like ‘When the Saints Go Marching In,” they'll be able to cross the street without stopping. It's a simple benefit, but it's very powerful.”

Music psychotherapist Stacie Yeldell writes about a boy who found relief from the pain of sickle cell anemia in the viral song “ The Fox .” What’s the relationship between pain and music?

“Pain is what is very much impacted by music. And in fact, there's a huge focus on research in terms of pain and Joke Bradt's chapter, which is all about that. They don't really know exactly what mechanism is occurring now with that, but they do know music reduces pain.

“I have a friend who actually had a brain bleed and the only thing that alleviated her excruciating pain at first was the loudest possible music she could play.  So, it's possible that that's what was interrupting his pain as well.”

How can music serve as a “bridge” to people with dementia, as music therapy pioneer Concetta Tomaino writes in the book?

“Music and memory are so completely linked. We remember events in our lives: If we hear just a snippet of a song, we're back at our wedding. We're back at any number of events.

“With people with Alzheimer's disease, it is the last memory to stay because this memory area, as it pertains to music, is the last area of the brain that's impacted by the disease. So [Tomaino has] been trying to kind of prolong the sustainability of memory attached to music memories.

“Somebody came up to me after the Kennedy Center Honors and said, ‘I just want to say I heard one of your presentations and my dad was really becoming difficult and becoming a little bit violent. And we remembered suddenly because of what you said, that he was an opera lover and we put on opera. And he calmed down and he smiled, and we've been playing it ever since. It's made a huge difference in his mood and state.’ And so it can alleviate life for caregivers as well.”

Have these insights changed the way you sing?

“It doesn't change the way I sing, but for instance, I now tell the audience that our brain waves are aligning as we are in this space together, having a shared musical experience. That's why they've now shown that singing in a choir is more impactful than singing alone.

“How this work has changed me is that I am living my life now, being mindful of the fact that I need these artistic experiences, things that I thought were extra. ‘If I have time, I'll go to a concert.’ I now prioritize them in my life and I see a huge difference in my state of mind, less anxiety. I’m much happier, so I'm like a living example of how this works.”

Emiko Tamagawa  produced and edited this interview for broadcast with  Todd Mundt .  Allison Hagan  adapted it for the web.

Book excerpt: 'The Parting Glass' from 'Music and Mind'

By Richard Powers, edited by Renée Fleming

It’s morning, and dozens of thrushes, wrens, and warblers are singing their hearts out in the trees beneath the window of my house in the foothills of the Great Smoky Mountains. Spring in Appalachia, and you know how that piece goes. Some of the singers live here year‑round. Others are passing through on long journeys. I listen as the dawn chorus reaches its wild peak. No one is conducting. The music exhilarates me, and clearly the singers are thrilling one another. If you ask a scientist why birds sing, the answer will deal in courtship and territory. But if you asked the bird, and if you could understand its reply, it would probably be something like, “Because I have to, and it feels so good.”

I put on some music of my own, adding a descant to the morning mayhem. Here’s a miracle that I hope I’ll never get used to: I can stream just about any song ever recorded, any time I want, in every season, from any room in my house in the woods. I call up a fine old Scottish‑Irish song that always goes right through me: “The Parting Glass.” The song is at least four hundred years old, and no one is sure who wrote the music or the words. Traditional, as they say. And I have dozens of covers to choose from. I play one by three Canadian women singing a cappella, in crystalline harmony, as if they’re already a step or two beyond the grave.

The song partakes of an old Celtic tradition. When a guest rose to leave the party and climbed up in the stirrups of his horse, he’d be given a stirrup cup or parting glass, one more drink to fortify him for the night’s trip back home. The song is in the voice of a guest taking such a leave:

So fill to me the parting glass And drink a health whate’er befall, And gently rise and softly call Good night and joy be to you all.

Words fill my house and spill out into the woods. It’s just a folk song— plaintive, playful, a little melancholy. The tune traces out the basic moves of tonal expectation, traveling from home and back again with open grace. The harmonies are steadfast and simple, with no great surprises. The lyrics, however, are a little cheeky, a nice mix of sass, stoicism, and self‑effacement, even though it’s easy to hear that this singer is setting out on a journey somewhat longer than a night’s ride:

Of all the money that e’er I spent, I spent it in good company. And all the harm that e’er I’ve done, Alas it was to none but me. And all I’ve done for want of wit To mem’ry now I can’t recall. So fill to me the parting glass: Good night and joy be with you all!

A summing up, then, with the singers taking stock before a last depar‑ ture. The words could be about nothing at all—they might be in a foreign language, and I would still hear the farewell. It’s there in the suspended harmonies, in the way the chords waver between major and minor. I’m off now, out of here: drink to me, drink to my disappearance. The Celts have always been good at emigration and goodbyes.

For reasons that science may never quite put its finger on, I get chills and my eyes start to water. It happens to me with music, far more than with any other art. Music has a startling ability to make a listener sad over noth‑ ing, simply by unfolding chords in a certain order and weaving them through with a tuneful filigree. It’s not clear what the adaptive advantage of this might be, but the right pitches in the right rhythm can overwhelm us with sorrow. And we love every minute of that harmonious grief.

I’m reassured by a quick online search that reveals at least twenty health benefits of crying. The sheer abundance of weeping’s benefits makes me laugh and laughing brings at least ten benefits more. I don’t know why I chose this song—an evening’s last farewell—to add to the birds’ exuberant morning chorus. I don’t understand why I would willingly choose sadness. But it feels so good. It’s a bracing dive into a cold spring, a glimpse of mid‑ night just before breakfast.

Countless clinical studies have now tied the secret of health to moving. There is also great health in being moved, something that produces similar physiology. Think about the old meanings buried in the etymology of “emotion.” To move and to feel are complements, and the emotion that a tune triggers is a tune‑up in how to move more deeply through the wider world. Music makes us go somewhere. It propels us into new states, new vantages, new emotional affordances. If you ask a scientist why music is healthy, the answer will come in units of cortisol and heart rate and blood‑ oxygen levels. But if you ask this listener, I’d say that music is an off‑line cognitive therapy. By making us sad in the absence of real tragedy, it leaves us more adept in sadness when life calls for the real thing.

Being moved by a song holds the key to mental health. Music says: “Here’s what happens to us. We and those around us move like chords unfolding in time, throwing off fantastic sparks and harmonies. And then the chords end. Here’s how to feel sad about that. And how to hear how that sadness, too, will pass.”

I suspect that none of the dozen species of birds singing outside my window know that one day their song will stop. But every human does. We carry the knowledge of our own death with us all life long. Awareness of mortality is the first and hardest challenge to our sanity. In my life, the best consolation for my approaching death has always been to sing it and to hear it being sung. I think that’s why the world’s great sacred ways of coping with death are so often built around music. So many times in this life I’ve heard friends say, “I love this piece. Play this at my funeral.” Music can train us in goodbyes. In giving us a little taste of our own finitude, it lets us, for a moment, feel the infinite.

“The Parting Glass” lasts only two and a half minutes. Soon enough, it reaches its final stanza. But in those one hundred and fifty seconds, the song lights up my brain in several ways. First, there is the sheer glory of the sound: three clear voices tuned tightly to each other. Then there is the stepwise tune and its dramatic pauses, its phrases always taking their leave, always coming home. Those simple syncopations lay out the plainest two‑step dance, reminding me of all the dancing I won’t be doing when I no longer have a body. A good song—a great movement—is a way of saying, Dance now, if only in your mind, for there is no dancing where you’re going. Finally, there is music’s uniquely vertical trick, stacking up companion lines in step with the one that my ear keys to. The tune contains its own accompani‑ ment, and all the regions of my brain fire in harmony. It reminds me of what good company I’ve spent my life in.

Of all the comrades that e’er I’ve had Are sorry for my going away. And all the sweethearts that e’er I’ve had They’ d wish me one more day to stay. But since it falls unto my lot That I should rise and you should not, I’ ll gently rise and softly call Good night and joy be with you all!

Of all music’s health benefits, teaching us how to be okay with our own disappearance may be the deepest. A good song lets me hear how the chords go on, far beyond the double bar. As another good song puts it:

Music, music for a while Will all our cares beguile.

That it can do so with sadness is a pure delight.

“The Parting Glass” does what all good songs do: it ends. It gets up in the stirrups, takes a last deep drink, and is off. My Canadian singers spring a surprise minor final cadence, and the tune is done. The morning chorus starts to disperse. I land back on Earth, turn from the window, and get on with my full day’s work. For what it’s worth, I get a ton done.

As I fall asleep, the night is all melancholy owls and mournful whip‑ poor‑wills. Birdsong, too, knows the uses of sadness. At two a.m., when I briefly wake, there is nothing but dead silence. I’m fine with that. The song is ended, but the melody lingers on. Even in the long rests, I can hear how the morning chorus will begin again in the dark, just before sunrise, for whoever may or may not be there to listen.

From 'Music and Mind' edited by Renée Fleming, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2024 by Richard Powers.

This segment aired on April 9, 2024.

Robin Young Co-Host, Here & Now Robin Young brings more than 25 years of broadcast experience to her role as host of Here & Now.

Emiko Tamagawa Senior Producer, Here & Now Emiko Tamagawa produces arts and culture segments for Here & Now.

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Essay on Addiction

Students are often asked to write an essay on Addiction in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Addiction

Understanding addiction.

Addiction is a strong desire to do something repeatedly, even if it’s harmful. It’s like a brain disease. People can get addicted to different things like drugs, alcohol, or even activities like gambling.

Why People Get Addicted

People can get addicted for many reasons. Some may feel good when they do something, so they repeat it. Others may want to escape from problems or stress. Sometimes, it’s because of peer pressure or trying to fit in.

Effects of Addiction

Addiction can harm a person’s health. It can lead to diseases, mental problems, and even death. It can also ruin relationships and cause problems at work or school.

Overcoming Addiction

Overcoming addiction is hard, but possible. It needs strong willpower and often help from doctors or therapists. Support from family and friends is also important. Remember, it’s okay to ask for help.

Preventing Addiction

To avoid addiction, we should learn about its dangers. It’s also important to make good friends and have healthy habits. Always remember, it’s okay to say no if something doesn’t feel right.

250 Words Essay on Addiction

What is addiction.

Addiction is when a person can’t stop doing something, even if it’s harmful. It can be about drugs, alcohol, games, or even food. The person knows it’s bad but can’t stop. It’s like a strong pull that keeps them going back.

How Does it Start?

Addiction often starts with trying something new. This could be a friend offering a cigarette, or playing a new video game. At first, it seems fun and exciting. But over time, the person starts needing it more and more. It becomes a need, not just a want.

The Impact of Addiction

Addiction can hurt a person in many ways. It can make them sick, or cause problems at school or work. It can also hurt their relationships with family and friends. They may lie or steal to keep doing what they’re addicted to. This can lead to feelings of guilt and shame.

Fighting Addiction

Fighting addiction is hard, but not impossible. It starts with admitting there’s a problem. Then, the person needs help from professionals like doctors or counselors. They can give advice, medicine, or therapy to help the person quit. Support from family and friends is also important.

Remember, it’s okay to ask for help. Everyone struggles with something at some point. With the right help and support, anyone can overcome addiction.

Addiction is a serious problem that can harm a person’s health, work, and relationships. But with help and support, it can be overcome. It’s important to understand addiction so we can help others or ourselves if needed.

500 Words Essay on Addiction

Addiction is a serious issue that affects many people around the world. It is a state where a person cannot stop using a substance or engaging in a behavior, even if it is harmful. The person becomes dependent on the substance or the activity to feel good or normal.

Types of Addiction

Addiction can be of two types: substance addiction and behavioral addiction. Substance addiction involves drugs, alcohol, nicotine, or other substances. Behavioral addiction involves activities like gambling, eating, or using the internet.

Causes of Addiction

There is no single reason why someone becomes addicted. It can be due to a mix of genetic, environmental, and psychological factors. Some people may be more prone to addiction because of their genes. Others may turn to addictive substances or behaviors to cope with stress or emotional issues.

Addiction has a negative impact on a person’s health, relationships, and daily life. It can lead to physical health problems like heart disease or mental health issues like depression. Addiction can also strain relationships with family and friends and make it hard for the person to perform well at school or work.

Overcoming addiction is not easy, but it is possible with the right help and support. This can include professional treatment like therapy or medication, as well as support from loved ones. It is important for the person to learn healthy ways to cope with stress and other triggers that may lead to addictive behavior.

Prevention is key in the fight against addiction. This can involve teaching young people about the dangers of substance use and addictive behaviors. It also means creating supportive environments where people can talk about their struggles and seek help if they need it.

In conclusion, addiction is a complex issue that requires understanding, support, and prevention efforts. It is important for everyone to be aware of the signs of addiction and to seek help if they or someone they know is struggling. Remember, overcoming addiction is possible with the right help and support.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

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The Woes of Being Addicted to Streaming

By Jeremy D. Larson

I feel unsettled when I stream music on Spotify. Maybe you feel that way, too. Even though it has all the music I’ve ever wanted, none of it feels necessarily rewarding, emotional, or personal. I pay a nominal fee for this privilege, knowing that essentially none of it will reach the artists I am listening to. I have unfettered access to an abundance of songs I genuinely love, along with an abundance of great songs I’ve never heard before, but I can’t shake the eerie feeling that the options before me are almost too perfect. I have personalized my experience enough to feel like this is my music, but I know that’s not really true—it’s simply a fabricated reality meant to replace the random contours of life outside the app.

The truth is that if you’re using Spotify, Apple Music, Tidal, or any other streaming service, you’re not paying for music so much as the opportunity to witness the potential of music. Music becomes an advertisement for the streaming service, and the more time and attention you give it, the more it benefits the tech company, not necessarily the music ecosystem. In Spotify, each song’s play count is prominently displayed, in effect gamifying the music industry so that tracks tacitly compete against one another inside the app. They even go so far as to turn the amount of time you spend in their app into a badge of honor during their annual year-end promotional campaigns. So you’re in the top percentile of Big Thief listeners? That’s not just a measure of your love for an artist’s music , but also a reflection of the time spent enriching the value of a company.

In addition to co-opting corporate social media strategies to benefit from the attention economy, tech companies have inherently made songs fleeting, cheap, and sometimes intrusive , corrupting the cultural exchange between artist and listener. Music is now leased to you through a secret system that you don’t understand, by a company with which you should have no emotional connection. Instead of simply buying a physical product or even pirating music from Napster—both of which created uniquely personal libraries of songs that helped define the identities of a generation—millions of users now sit side by side at the ledge of one great big trough of recorded music for the monthly price of a Chipotle burrito.

There have been many passionate and excoriating essays written about how streaming services have short-changed artists with minuscule payouts. But as the reviews editor of this music publication, I find myself asking: What does a platform like Spotify afford the most engaged music fans and what are the lingering effects of its use? As the independent musician and writer Damon Krukowski once wrote, there are alternative and radical solutions to combat the upstreaming of profits and homogenization of sound that the streaming era has come to stand for. But as one of nearly half a billion people who pay a small fee to rent the vast majority of the history of recorded music—not to mention the 2 billion people per month who use YouTube for free—I have found that, after more than a decade under the influence, it has begun to reshape my relationship with music. I’m addicted to a relationship that I know is very bad for me.

I know I am addicted to Spotify the same way I was addicted to nicotine or Twitter. It makes me happy, aggrieved, needlessly defensive. Oh, you boycott Spotify and only buy CDs on Bandcamp? Good for you. I use Spotify every day for hours on end, when I’m working, at the gym, running, when I want to put some music on while making dinner, when I go to sleep.

I write off part of my Spotify use as a hazard of my job, but I just can’t get enough of that sweet streaming asbestos outside of work, too. Even though I buy a fair amount of records every year, Spotify is my main delivery system for music. It’s like being hooked on rolling papers or the yellowed smell of a casino—not the actual vice itself. The ease, the look, the familiarity—I’m addicted to the emotional labor it does for me when its “Radio” feature instantly creates a playlist of songs that kind of sound like, say, “Breakdown” by Tom Petty and the Heartbreakers while I’m sitting outside on a nice afternoon. It loosely organizes what I love and what I might love and, for the most part, it’s absolutely correct.

I’ve sometimes rationalized that it is not an unhealthy addiction: I use Spotify in a way that reflects who I am, I bend it to my whims. For the last 10 years, I have kept playlists of favorite songs—both old and new—I discovered each year, a living record of growth and change in taste. I listen to weekly playlists that are made by friends and colleagues and artists, silently connecting with their interests. I’m going beyond the algorithm, operating at a higher frequency, clipping between the walls that cannot contain my taste profile.

The seeds of this addiction were planted in the late 2000s, when the music industry was struggling to adapt to the new digital era, unsure of how to wrap a tourniquet around the vast hemorrhaging of money caused by such a fast-moving paradigm shift. The streaming era as we know it began in an unlikely place, with good intentions: On October 10, 2007, Radiohead released In Rainbows and allowed fans to pay what they wanted for its digital files. After 1.2 million downloads, the average price paid per album was $2.26. Case studies in setting a new market price don’t come in a tidier package than this.

But as free-market and egalitarian as it was, the experiment was meant to motivate fans to go out and buy an actual physical copy of the album. Devised by Radiohead’s managers Bryce Edge and Chris Hufford while they were “a bit stoned,” the pay-what-you-want stunt was a means to an end: “If we didn’t believe that when people hear the music, they will want to buy the CD, we wouldn’t do what we are doing,” Edge said at the time. A lot of Radiohead fans did buy the album when it came out—it sold 122,000 copies in America alone in its first week—but by then, the downloaders outnumbered them by a wide margin. So even though Thom Yorke later described Spotify as “the last desperate fart of a dying corpse,” his band all but invented the model of what would become the streaming era: turning music into an ad that you pay very little for, with no real incentive to go and buy what it is advertising.

Another important shift was happening in 2007. Seeing the writing on the wall, several high-profile artists were abandoning their longtime major labels to find other avenues of distribution: Madonna left Warner to sign with touring giant Live Nation, a bellwether of where the real money was being made in the industry. (JAY-Z would make a similar move the following year.) Nine Inch Nails left music mogul Jimmy Iovine’s label Interscope and independently put out an instrumental album, Ghosts I-IV ; by Trent Reznor’s estimation, the collection made millions more than it would have had they released it with the label.

Into this stew of major label woes—which included the lingering piracy boogeyman—came Spotify. Launched in 2008, the streaming start-up was a direct attempt to both stem piracy and circumvent anti-piracy laws in its native Sweden. In addition to offering a way for online listeners to legally play music, Spotify acquired its user base in markets around the globe because of how easy it was to use. No more paying per song on iTunes, no more navigating the murky waters of P2P servers, no more waiting for albums to download. Here, finally, was a solution: legal music, a lot of it, right now, for cheap.

After officially launching in the U.S. in 2011, Spotify quickly turned into a potential panacea for everything that was ailing the music industry. Two years later, newspapers were asking: Can Spotify Save the Music Industry? A race to market dominance ensued. By 2014, Reznor had mended fences with Iovine and became the chief creative officer of Iovine’s new streaming platform, Beats Music, which wanted to set itself apart from competitors like Spotify and Pandora. Instead of an algorithmic platform that served you what you wanted, its team of curators would provide you with a more human experience. Iovine saw that, through artist and influencer-created playlists, you could confer taste, status, and criticism—the stuff that the former record-buying public supposedly pined for. One of Iovine’s maxims at the time: Access is average; curation is everything. Seeing the promise of a more bespoke streaming experience, Apple bought Beats for $3 billion and relaunched the service as Apple Music in 2015.

That same year, JAY-Z stood on a stage with Madonna, Rihanna, Daft Punk, Kanye West, and several other A-list musicians to announce the artist-majority-owned service Tidal, with “a mission to re-establish the value of music.” Touting hi-fi streaming and better payouts for artists, Tidal seemed like a much-needed counterweight to Apple Music and Spotify. Finally, here was a platform not funded by Silicon Valley VCs but by (admittedly already wealthy) musicians who understood the art and work that goes into the process of creation. But since its launch, its growth has lagged dramatically behind its competitors. Last year, JAY-Z sold the majority of Tidal to Square, a mobile payment company owned by Twitter founder Jack Dorsey.

Each successive introduction of a new tech company into the streaming era sought to solve a problem created by the digital era: pirating, the devaluation of music, and the lack of human connections music once relied upon. At this point, music piracy has generally been on the decline for five years. Major labels have plugged the holes in their coffers by licensing the vast majority of their music to streaming services and meting out payouts to their signees. The exception has always been the independent-minded Bandcamp, which includes a Radiohead-style pay-what-you-want option at a record’s point of sale, and fosters holistic connection between musicians and listeners through hubs run by labels and artists. Earlier this year, Bandcamp was acquired by the software company Epic Games.

Much like social media, the streaming era has created a simulation of real life. Each company uses its technology to digitize and replace the analog practice of buying, listening, and connecting to music, all while capitalizing on the nostalgia of those activities. The seamlessness of the experience—the ease with which one song bleeds into the next, and the buffet of decisions laid before you on Spotify’s home screen—creates an artificial scarcity out of vast abundance. For me, it has caused a kind of nagging depersonalization, an experience so divergent from, say, holding an album in my hands, or being in a record store, that I feel like a little bit of a hack every time I open the app. But I also understand that for the majority of subscribers, this simulation of a beautiful, vibrant, limitless music industry is possibly all they could ever want.

Let’s say there are three general categories of music listeners: Passive, Auxiliary, and Intentional. Most of the world falls into the Passive category, absorbing music like inhaling oxygen: without much thought at all. For them, there is either music playing, or maybe it’s not music playing, who can be sure? There is perhaps little to no interrogation into why any sound is floating down from the speakers at the grocery store; it simply exists at the same megahertz as the shopping cart and the fluorescent lights and the cereal selection. Songs are liked and not liked, if they are thought about at all, and the whole relationship is pure and elegant.

The second is the Auxiliary listener, someone for whom music enhances a primary experience to make it more interesting. Common forms of auxiliary listening involve music accompanying a visual stimulus, like film scores or needle drops in movies, music videos or their modern-day equivalent: a song snippet looped in a TikTok. But the Auxiliary listener chiefly uses music as a utility: to relax, to work, to go to the gym, to get drunk, to do drugs, to have sex, to dance, to fall asleep. Music is not your life, but what was playing while you lived it.

The last is the Intentional listener, someone who chooses to listen to music for the pleasure of it in and of itself. This is admittedly the tiniest category of people, a subset that spends a remarkable amount of time listening to albums, mixtapes, DJ sets, and playlists without distraction. They are purposeful about what they select and why—for them, there is a pleasure to be found in the flow of listening to music and the emotional, intellectual, and biographical response that it creates untethered to anything but the chemical responses in the brain. Some of these people use drugs to enhance this connection, but not all of them. Music, for these people, is life.

It’s important to make these distinctions because I believe that, for Passive and Auxiliary listeners—again, the vast majority of people in the world —Spotify and the streaming era writ large have achieved an ideal compromise. The technology has made accessible what had previously been difficult or kept behind the gates of record stores or music criticism. For an older generation, there is a sudden and overwhelming pleasure in being able to listen to all the music from your life instantly, retracing the decades through a digital library.

The cognitive dissonance occurs when people in the Intentional group—people like me—try to tell people in the Passive and Auxiliary groups how to listen to music. I know the global financial devaluation of music is irreversible, and there are only a small percentage of total music listeners for whom the phrases “buy from brick-and-mortar stores” or “support Bandcamp Fridays” means anything. But what I fear is that the streaming era is actually writing the same listening histories for those who can’t be bothered with Intentional listening–all exclusively based on proprietary algorithms that seem like a way to discover music but, in fact, act more like a feedback loop.

A close friend, an Auxiliary listener, recently sent me a Spotify link to an album by classic rock revivalists Greta Van Fleet, noting that it would be good music for the gym. This sent me into a bit of a panic spiral for three reasons. One is that I wondered why I neglected to share my professional life with him: In 2018, my pan of their debut album drew the attention of those beyond Pitchfork’s usual purview, with Barstool Sports suggesting that the band must have “fucked my girlfriend,” and GVF fans threatening to “TP” my house via homemade signs they held up at concerts. The second is that I realized I am but a tiny little dust mite in the universe, and my own opinion on Greta Van Fleet is largely irrelevant beyond the scope of a few thousand music snobs and select GVF fans, and what’s actually important in the world is the bond close friends have despite these relationship glitches. Third is that Spotify knows me better than my close friend.

The more time I spend on Spotify, the more it pushes me away from the outer edges of the platform and toward the mushy middle. This is where everyone is serviced the same songs simply because that is what’s popular. Four years ago, while the app’s algorithmic autoplay feature was on, I was served the Pavement song “Harness Your Hopes,” a wordy and melodic—and by all accounts obscure—B-side from the beloved indie band. As of this writing, the song has over 72 million streams, more than twice as much as their actual college rock hit from the ’90s, “Cut Your Hair,” the one Pavement song your average Gen X’er might actually recognize. How did this happen? In 2020, Stereogum investigated the mystery but came up empty-handed from a technological perspective, though the answer seems obvious to me: Whereas many Pavement songs are oblique, rangy, and noisy, “Harness Your Hopes” is among the most pleasant and inoffensive songs in the band’s catalog. It is now, in the altered reality of Spotify, the quintessential Pavement song. When frontman Stephen Malkmus was asked about this anomaly, he sounded blithely defeated: “At this point we take what we can get, even in a debased form. Because what’s left?”

The whole “Harness Your Hopes” situation is in part a result of what’s called “cumulative advantage.” It’s the idea that if something—a song, a person, an idea—happens to be slightly more popular than something else at just the right point, it will tend to become more popular still. (On the other hand, something that does not catch on will usually recede in popularity, regardless of quality.) This is the metric of how most social recommendation algorithms work—on Facebook, the more “likes” an article has, the better odds a user will read it. But when this is applied to what songs are sent to which people, Spotify can engineer its own market of popularity as well as what song defines a band. Popular songs on Spotify are popular within the app because they are what most people are listening to. So from both a behavioral psychology and business perspective, it makes sense for Spotify to assume that you want to listen to what other people are listening to. The chances of the average listener staying on the app longer are much higher if Spotify curates songs that have had a similar effect on people whose taste matches theirs.

This is one of the main addictive chemicals of most streaming services: Recommend a handful songs—out of millions!—that feel uniquely personal but in fact are just what everyone else is hearing, too. If a Passive or Auxiliary listener lets the algorithmic Spotify Radio play songs based on Tom Petty’s “Breakdown,” the results are almost purely based on chronology, tempo, and feel. Gone are the filigrees and the autobiography of the song and how it existed in the world to you , the listener. Instead, everyone’s experience is now the same.

For instance, Spotify’s radio station for Ludacris’ “What’s Your Fantasy” doesn’t link to any OutKast songs, even though I watched Ludacris open for André 3000 and Big Boi when that song was released in 2000, and both acts are from Atlanta. Is Spotify aware that Big Boi is a huge Kate Bush fan? Does Spotify know that singer-songwriter John Darnielle of the Mountain Goats is a metal head? If you have seen Darnielle cover metal bands from Dio to Gorguts to Nightwish, or are familiar with one of his most popular songs, “The Best Ever Death Metal Band Out of Denton,” you know that he loves some sick riffs and moonward barks. But all of that intimate (and publicly available) knowledge is lost to machine learning. Tuning into Spotify’s Mountain Goats’ Radio won’t turn up any Dio at all—just literate and mostly acoustic indie rock songs that sound similar to the Mountain Goats. Left to a streaming service, these kinds of textured and unique connections are smoothed over or erased entirely.

I have committed my personal and professional life to making sense of music, of finding connections and context within songs to create a critical framework that allows me to organize everything I listen into an ornately chaotic web. If I started a Fugazi radio playlist, maybe I would throw some Red Hot Chili Peppers on there—you’ll hear it. If I started a Pavement radio playlist, how could I not include the Louisiana rapper Young Bleed’s song “How Ya Do Dat,” where he calls himself “ slanted and enchanted ”? I would argue that Prince’s “When Doves Cry” and Parquet Courts’ “Instant Disassembly” both utilize a stilted, inverted grammatical style in their lyrics and are absolutely in conversation with each other.

When music is so abundant and our attention is scarce, there’s power in adding more intention to your listening diet, more chaos, more risk. The thrill in finding music that is wired to your singular life is not that thousands of other people have found the same thing. It’s that the music becomes something confounding and unique, a true reflection of where you are and where you’ve been. The beauty of the algorithm of your mind is that it makes perfect sense to no one but yourself.

This week, we’re exploring how music and technology intersect, and what today’s trends and innovations might mean for the future. Read more here .

By Matthew Strauss

By Madison Bloom

By Nina Corcoran

By Jazz Monroe

Essay on Addiction for Students and Children

500 words essay on addiction.

As we all know that excess of anything can be very dangerous, the same way, addiction of any kind can hamper the life quality of an individual. The phrase states that addiction is a family disease as one person uses and the whole family suffers. The above statement stands true in all its essence as the addict does not merely suffer but the people around him suffer greatly too. However, that does not mean they can’t be helped. Addiction is curable and we must not give up on the person who is addicted, rather help them out for a better life.

Cost of Addiction

Addiction comes at a great cost and we need to be able to recognize its harmful consequences to not let ourselves or anyone become an addict. Firstly, addiction has major health hazards. Intake of anything is bad for our body , and it does not matter what type of addiction it is, it will always impact the mental and physical health of a person.

For instance, if you are addicted to drugs or food, you will get various diseases and illnesses. Similarly, if you are addicted to video games, your mental health will also suffer along with physical health.

Moreover, people who are addicts usually face monetary issues. As they use that thing in excess, they spend loads of money on it. People become obsessed with spending all their fortunes on that one thing to satisfy their addiction. Thus, all these addictions of drugs , alcohol , gambling, and more drain the finances of a person and they usually end up in debt or even worse.

Furthermore, the personal and professional relationships of addicts suffer the most. They end up doing things or making decisions that do not work in their favor. This constraint the relationships of people and they drift apart.

Moreover, it also hampers their studies or work life. When you are spending all your money and time on your addiction, naturally your concentration levels in other things will drop. However, all this is not impossible to beat. There are many ways through which one can beat their addiction.

Get the huge list of more than 500 Essay Topics and Ideas

Beat Your Addiction

It is best to work towards beating your addiction rather than getting beat by it. One can try many ways to do so. Firstly, recognize and identify that you have an addiction problem. That is the first step to getting cured. You need to take some time and understand the symptoms in order to treat them. Motivate yourself to do better.

After that, understand that the journey will be long but worthwhile. Identify the triggers in your life and try to stay away from them as far as possible. There is no shame in asking for professional help. Always remember that professionals can always help you get better. Enroll yourself in rehabilitation programs and try to make the most out of them.

Most importantly, do not be hesitant in talking to your loved ones. Approach them and talk it out as they care most about you. They will surely help you get on the right path and help you in beating addiction for better health and life.

Q.1 What are the consequences of addiction?

A.1 Addiction has very severe consequences. Some of them are health hazards, monetary issues, relationship problems, adverse problems on studies and work of a person. It seriously hampers the quality of life of a person.

Q.2 How can one get rid of addiction?

A.2 A little help can go a long way. One can get rid of addiction by enrolling in rehabilitation programs and opening up about their struggle. Try to take professional help and talk with your close ones to become better.

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