Treating Addiction with Tunes:

A Systematic Review of Music Therapy for the

Treatment of Patients with Addictions
Kara L. Mays, BS
David L. Clark, BS
Adam J. Gordon, MD, MPH

ABSTRACT. Music therapy is the use of musical interventions in a therapeutic setting to accomplish
health-related goals. Descriptions of music therapy exist in the peer-reviewed literature and indicate
potential use of music therapy in treatment of patients with addiction disorders. This systematic review
describes and compares the types of music therapy demonstrated in the literature and evaluates the
evidence that music therapy improves outcomes of patients with addictions. A search and critical
review of all the existing published literature on music therapy for the treatment of addictions was
conducted using online databases and secondary search strategies. Few studies quantitatively assess
the use of music therapy in the treatment of patients with addictions. Music listening provided by
music therapists is commonly studied. Music therapy sessions reported were additive, not independent,
treatment modalities. In the literature, no consensus exists regarding of the efficacy of music therapy
as treatment for patients with addictions.

KEYWORDS. Addictions, music therapy, treatment

INTRODUCTION definition is that music therapy is a systematic

Music therapy has been variably applied as
both a primary and accessory treatment for
persons with addictions to alcohol, tobacco,
and other drugs of abuse. Although varying
definitions of music therapy exist, a common
application of music administered by trained
music therapists to achieve improvements in
the emotional and/or physical health of persons
(1). The American Music Therapy Association
further defines music therapy as “the clinical
and evidence-based use of music interventions

Kara L. Mays is affiliated with VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC),
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
David L. Clark is affiliated with First Aid Treatment for Humanity, Monaca, Pennsylvania, USA.
Adam J. Gordon is affiliated with VISN 4 Mental Illness Research, Education, and Clinical Center
(MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA; Center for Health Equity
Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA; and University
of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania, USA.
Address correspondence to: Adam J. Gordon, MD, MPH, FACP, Mental Illness Research, Education,
and Clinical Center, VISN 4, VA Pittsburgh Healthcare System, Mailcode 151C-H, 7180 Highland Drive,
Pittsburgh, PA 15206, USA (E-mail: adam.gordon@va.gov).
This project was funded by infrastructure support funding from the VISN 4 Mental Illness Research,
Education, and Clinical Center (MIRECC, Director: D. Oslin; Co-Director: G. Haas), VA Pittsburgh
Healthcare System..
Substance Abuse, Vol. 29(4) 2008
Available online at http://www.haworthpress.com


C 2008 by The Haworth Press. All rights reserved.
doi: 10.1080/08897070802418485 51
52 SUBSTANCE ABUSE
to accomplish individualized goals within a
therapeutic relationship by a credentialed pro-
fessional who has completed an approved music
therapy program” (2).
Music therapy has been used to improve the
health and welfare of patients with a variety
of disorders, including Alzheimer’s disease,
autism, multiple sclerosis, and chronic pain (3).
In addition, music therapy has been described as
an adjunct to traditional medical treatment plans
to help individuals with psychiatric illnesses,
including those who have addictions (4,5). In
patients with addiction disorders, music therapy
is thought to evoke positive responses with its lis-
teners by increasing self-esteem and motivation,
enhancing socialization and communication,
improving expression of emotions, improving
transference of information related to relaxation,
enhancing physical and emotional healing, and
improving the ability to identify learning styles
used for coping and self-expression (6). Through
a general improvement of the behavioral, emo-
tional, and social facets of the addicted patient,
music therapy can be a unique treatment mode as
a part of an overall treatment plan, particularly
in treatment settings where little variability
of treatment (e.g., counseling, group therapy,
pharmacotherapy) exist.
Unfortunately, ambiguity exists in defining
the characteristics of music therapy that make
it effective, how music therapy is delivered, and
what outcomes can be expected in patients with
addictions. Several authors have attempted to
identify the components of music therapy that
make it effective for patient outcomes. Bonny
described five key features that enhance the
ability of music therapy to produce positive
outcomes. For Bonny, the music must (1) be
nonverbal, (2) evoke emotions, (3) produce
physiological responses, (4) promote symbolic
images, and (5) increase the experience of the
other senses, including enhancing touch, taste,
and vision sensations (1).
Traditionally, music therapy is conducted by
music therapists to individual patients or groups
and often combined with other types of care,
including regular counseling, primary or mental
health care, or educational sessions (7). How-
ever, some residential addiction programs apply
music therapy without a music therapist and
allow patients leeway regarding mode of music.
Bednarz and Nikkel categorized music therapy
into several modes of delivery. They describe
music therapy as either (1) music discussion, (2)
music instruction, (3) group participatory music,
(4) music listening, and (5) expressive music
interventions (8). Music discussion includes
talking about the role of music in life and its
relationship to occurrences and events. Music
instruction consists of learning musical skills.
Group participatory music consists of partici-
pants playing music together. Music listening is
the act of listening to recorded or live music
during a structured activity. Expressive music
focuses on feelings and emotions, and generally
includes activities such as composing songs.
Because of the ambiguity of what music
therapy is and how it is to be administered,
an evidence-based consensus has not been
established on what types of music therapy
best improve patient outcomes in patients with
addiction disorders. In part, this ambiguity is due
to the little literature that exists regarding the
types of music therapy and quality and nature
of the outcomes presented in that literature.
Although music therapy has been described to
improve the health of many conditions, the
types of outcomes for music therapy as an
independent or adjunct treatment for addictions
are relatively unknown. Unfortunately, there has
been little examination of the outcome that
clinicians should expect of patients who use
music therapy as a treatment for addiction.
The purpose of this systematic review is to
describe and compare the approaches to music
therapy documented in the published literature
and evaluate the existing evidence that music
therapy, as an independent or additive treatment
modality, can improve outcomes of patients
with addictions. This critical examination of
the types and outcomes of music therapy may
help addiction treatment providers to initiate or
standardize music therapy as a treatment for
patients with addictions.
METHODS
The authors conducted a search of the
published literature for any mention of music
therapy for the treatment of addictions by means
of primary and secondary search strategies. In
 Mays, Clark, and Gordon
the primary search strategy, the authors searched
the online database MEDLINE and PsycINFO
from 1967 to December 1, 2006, for all publi-
cations using the keywords “addiction,” “sub-
stance related disorders,” “substance abuse,”
“music,” and “music therapy” in the title, subject
headings, or abstracts. After identification, each
abstract was assessed based on whether music
therapy was evaluated or described for the treat-
ment of addictions. These publications could
include general information on music therapy for
addiction treatment, literature reviews regarding
music therapy, general descriptions of music
therapy programs for patients with addictions,
or studies (with reported outcomes) of music
therapy as a treatment modality for addictions.
After the primary search was conducted, a
secondary search strategy was performed to
identify additional sources of reports of music
therapy for the treatment of addictions. First,
additional publications were identified and col-
lected through the review of the references of
the publications found in the primary search
strategy. Second, known and available journals
in the English language focusing on music ther-
apy were hand-searched for articles describing
music therapy for the treatment of addictions
and references of all manuscripts in the journals
were searched for possible additional papers.
Hand-searched journals included the Journal of
Music Therapy (years 1991 to 2004) and Music
Therapy Perspectives (1982 to 1984). Third,
several books on music therapy were examined
to evaluate for additional descriptions, studies,
and reviews of music therapy (3,4). Studies
and manuscripts referenced within these books
regarding music therapy for the treatment of
addictions were collected. Finally, a Web-based
search was conducted using the search terms
above to find any additional references regarding
music therapy used to treat addictions.
For the purposes of this study, the authors
assigned descriptions to the papers that were
collected. Papers or publications that described
music therapy programs or program models
were termed “music therapy descriptions.” Pub-
lished journal articles that evaluated music
therapy activities with measurable outcomes that
quantified results were termed “music therapy
studies.” Finally, book-published music therapy
descriptions, studies, or reviews were termed
53
“book-published music therapy descriptions.”
The quality of the individual research article was
not evaluated nor was the nature or process of
the analytic evaluation of the published articles.
For each music therapy study, characteristics
of the therapy, program, and/or settings were
described and compared. This comparison in-
cluded the specific treatment setting, the resi-
dential nature of the program (inpatient versus
outpatient program), the drugs used by clients
undergoing music therapy, and the voluntary
nature of the program (involuntary versus vol-
untary) where the music therapy was performed.
Furthermore, of the music therapy studies, the
modality of music therapy used in each study
was described and compared. Characteristics
included the type of music therapy, whether
the therapy was an additive or independent
treatment modality for the clients with addiction,
how frequently and over what duration the
therapy was performed, whether the therapy was
performed and/or received by an individual or a
group, and whether the therapy was performed in
conjunction with a religious program or religious
therapy. When categorizing the type of music
therapy performed, the authors used Bednarz’s
classifications of music therapy that included
(1) music discussion, (2) music instruction, (3)
group participatory music, (4) music listening,
or (5) expressive music interventions (8).
RESULTS
Results of the primary search are summarized
in Figure 1. Based on the search terms “addic-
tion,” “substance related disorders,” “substance
abuse,” “music,” and “music therapy” in the title,
subject headings, or abstracts, music therapy
(n = 10,181) and addiction articles (n =
44,088) were identified. Of these, 83 articles
were identified that mutually mentioned music
therapy and addiction. Of these articles, 19
either described music therapy (n = 14) or
were music therapy studies (n = 5). Of the
combined music therapy and addiction articles
that were obtained, 64 articles did not describe
the treatment of addictions using any mode of
music therapy. Several of the excluded articles
described relationships between drug use and
music preference or explored the effect of music
on persons under the influence of drugs. In the
54 SUBSTANCE ABUSE

FIGURE 1. Music therapy articles in the published literature discovered upon search of online
literature databases.

“MUSIC “ADDICTION”
THERAPY” ARTICLES
ARTICLES

(n = 10,181) (n = 44,088)

MUSIC
THERAPY &
ADDICTION
ARTICLES
IDENTIFIED

(n = 83)
ARTICLES
EXCLUDED

(n = 64)

ARTICLES
INCLUDED

(n = 19)

MUSIC MUSIC
THERAPY THERAPY
DESCRIPTION STUDY

(n = 14) (n = 5)

secondary search strategy, the authors identified
several books related to music therapy and two
were reviewed for book-published descriptions
of music therapy as treatment for addiction (3,9).
One additional music therapy study was found
in this secondary search. No additional studies
were identified by Web-based searches.
Table 1 compares characteristics of the pro-
grams where music therapy studies were evalu-
ated. Two were conducted in outpatient settings
(10,11) and three were conducted in inpatient
settings (5,12,13). All studies were conducted
with clients who had various drug addictions, ex-
cept for that by Dougherty (12), who investigated
music therapy on patients with primary alcohol
dependence. Each study included music therapy
sessions consisting of music listening, whereas
several of the studies had additional music
interventions. All music therapy sessions were
conducted by a credentialed music therapist,
except for those conducted by a social worker
(11). The frequency of sessions was variable
among the studies. All of the music therapy
studies had group music therapy, admission was
voluntary, and all were adjunctive treatments to
existing program treatments.
 TABLE 1. Characteristics of Music Therapy Studies Identified in the Published Literature

Frequency of Professional Leading

Music Therapy Study Setting Music Therapy Mode Duration of Therapy Therapy Therapy

Dougherty (12) Inpatient alcoholic Music listening Unspecified mandatory 1 per week for Music therapist
rehabilitation Group participatory music session + optional 4 weeks
30-minute sessions
Gallagher (10) Outpatient counseling Music listening 45 minutes Unspecified Music therapist
Group participatory music frequency over
9 months
Gallant (11) Outpatient recovery Music listening 2 hours 4 over 2 weeks Social worker
Jones (13) Inpatient nonmedical Music listening Unspecified 4 days per week Music therapist
detoxification Expressive music interventions while in
treatment
Silverman (5) Inpatient chemical Music listening Unspecified 1 per week over Music therapist
dependency Expressive music interventions 8 weeks
treatment
55
56 SUBSTANCE ABUSE
Table 2 summarizes the measured variable,
results, and authors’ conclusions of the music
therapy studies that were identified. The studies
were not consistent with the type of variables
assessed and, therefore, the results published
were not consistent among the studies. In
general, the studies described music therapy
participation numbers and attitudes of music
therapy treatments. No study assessed drug or
alcohol consumption patterns before or after
music therapy or association of music therapy
participation on the maintenance of drug or
alcohol sobriety.
Several music therapy descriptions were
found (6,14–16). These descriptions lacked
any formal assessment of the music therapy
employed. Winkelman reviewed and examined
several music therapy programs implementing
drumming activities and presented descriptions
of each program (17). For example, he described
Mikenas, who used group drumming for patients
recovering from substance abuse, and Eshowsky,
who employed shamanic drumming programs
with adolescents and reported a reduction in
crack cocaine and marijuana use. In a manner
similar to Winkelman, Soshensky conducted a
series of three case studies in which patients
undergoing music therapy sessions undertook
the task of improvisation. Each patient was
later able to relate their song to their addiction,
helping to facilitate the healing (18).
DISCUSSION
In an extensive review of the published
literature, few descriptions of music therapies,
and fewer studies reporting outcomes of music
therapies, for the treatment of patients with ad-
dictions exist. Of the five music therapy studies
identified, all examined music listening as a
mode of therapy with two studies having group
participatory or expressive music interventions
as an additional modality. The duration and
frequency of music therapy described in studies
in the literature was variable or unspecified.
Most music therapy was conducted by a music
therapist.
There was no consensus in the published
literature regarding the effects of music therapy
on outcomes for patients with addictions. No
study investigated reduction of drug or alcohol
consumption or the ability of music therapy to
maintain abstinence for sober individuals. The
authors’ conclusions regarding music therapy
as a treatment of addictions were largely based
on participation and positive feelings of the
participants undergoing therapy.
To be effective as a primary or adjunct
treatment for addictions, music therapy must
be assessed as improving defined outcomes for
patients with addictions by means of a controlled
investigation. Based on this review, quantitative
evidence-based literature is lacking to support
music therapy as a treatment for patients with
addictions. This review found no formal efficacy
or effectiveness studies, or studies that compared
music therapy to other modes of addiction
treatment. However, this paucity of published
research may be secondary to the wide variety of
modes, types of delivery, and outcomes expected
from music therapy in the treatment of patients
with addictions.
Based on this critical examination of the
music therapy peer-reviewed literature, it is clear
that a need exists to conduct controlled studies in
which the goal is to show that music therapy has
an independent effect on outcomes of patients
with addictions. Essential aspects of such studies
would include having a group receiving music
therapy and a control group, with both having
a designated sample size. This would enable
investigators to compare the two groups and
explicitly portray outcomes of music therapy
interventions. Furthermore, group assignments
should be random, and both the duration and
frequency of music therapy sessions must be
noted. After the execution of controlled studies
utilizing music therapy as a treatment modality,
it may be possible to develop a program that is
successful in patients with addictions.
There exist hypothetical reasons as to why
music therapy may be effective in clinical
practice for the treatment of patients with addic-
tions. It may be that music therapy sessions in
structured drug and alcohol treatment programs
provide a conduit for expression and recreation
outside of more standard individual or group
counseling. The literature describes music ther-
apy as a stimulus for release of the participants’
 TABLE 2. Measured Variables, Results, and Authors’ Conclusions of Music Therapy Studies in the Published Literature

Music Therapy Study Variables Assessed Results Presented Authors’ Conclusions

Dougherty (12) Attendance 80–90% session attendance “Feedback from clients and staff, in
addition to statistics showing an
80% to 90% attendance at any
given time, indicates that this is a
successful method.”
Gallagher (10) Participation (assessed by therapist) From 188 patients: 91% actively participated, “Documentation of the responses of
Rogers’ Happy/Sad Faces Assessment 82% expressed thoughts and feelings,68% 188 clients during this time period
Tool (24) exhibited positive mood change. indicated that the majority actively
participated (91%), independently
expressed thoughts and feelings
related to the topic (82%), and
had a positive change in affect
(68%).”
Gallant (11) Client Attitudes Five of the six participants rated the music “The data in this study pointed
20-Item Hudson therapy as being “very helpful”. On average, clearly to the fact that: 1) the
Psychosocial Screening Instrument (9) clients reported being less anxious, feeling structured groups were effective,
less depressed, and as having fewer 2) the social work generalist
relationship problems. model had application for such
use and 3) music intervention
impacted significantly on these
couples.”
Jones (13) Visual Analog Mood Scale (25–27) Participants of the song-writing group reported “The music therapy interventions of
Significant moments in treatment greater changes in mood than the lyric songwriting and lyric analysis with
questionnaire analysis sessions for 10 of the 11 variables. persons in treatment for chemical
75% of 24 participants viewed it as a significant dependency were successful in
tool in recovery evoking emotional changes within
a single session. Music therapy
significantly reduced fear and
guilt while increasing acceptance
and joy.”
Silverman (5) Client attitudes toward treatment Participants found the music therapy sessions to “The data revealed that participants
groups be effective, with no significant differentiation enjoyed music therapy and found
Visual Analog Scale between the delivery methods. 50% rated it to be therapeutically effective,
music therapy as more effective and more no matter what particular type of
enjoyable than the other therapeutic groups. intervention was used. Half of the
surveyed participants rated music
therapy as the most enjoyable and
therapeutically effective group.”
57
58 SUBSTANCE ABUSE
emotions. This emotional release may bridge
the gap that addiction creates between the
mind, body, and emotion (19). Allowing patients
with addictions the opportunity to feel emotion
may encourage them to surpass denial, an
important aspect of addiction treatment in many
treatment programs (20). Group music therapy
may foster new relationships that can replace
the participants’ relationship with a substance,
which may effectively decrease the seclusion
often associated with addictive disorders (21).
The effects of a group presence of music
therapy may be analogous to the successes of
12-step approaches, where group dynamics and
participation are the primary means that improve
alcohol and drug outcomes (22,23).
There are several consistencies in the music
therapy programs available that could poten-
tially serve as the defining characteristics of
effective music therapy. In most programs, there
is evidence of a structured environment, both
group and individual involvement, freedom of
expression through music and responses to
music, emotional expression, and perhaps the
most important characteristic, a group bond
between participants resulting in positive so-
cial interactions. In addition, several studies
indicated positive results for participants that
generally enjoyed music or displayed an interest
in music (10,11,18). Thus, music therapy could
work best with clients who prefer music therapy
as a method of treatment and may have a large
capacity for impact because acceptance and
enjoyment of music is widespread. It is uncertain
in the descriptions and studies examined whether
certain patient characteristics (e.g., willingness
to play an instrument, preferences toward cer-
tain music) predicted better participation and
outcomes after the music therapy sessions.
Several limitations of this systematic review
must be noted. In general, interpretation of
the characteristics and outcomes of the music
therapy descriptions or studies was difficult.
Several assumptions were made in describing
the music therapy studies. For example, although
some studies mentioned the frequency of the
music therapy sessions in their programs, it
was assumed that sessions were administered
throughout the average length of client participa-
tion in the drug program. All studies appeared to
report positive, rather than negative, outcomes,
potentially introducing publication bias; music
therapy papers with negative outcomes may not
have been submitted or accepted for publication.
The outcomes described were often scant and
few articles fully described data variables and
data collection procedures, limiting the ability of
the reviewers to assess the quality of the studies.
Although the primary and secondary reviews
were extensive, there may be additional music
therapy studies that have been published. For
example, the authors did not examine published
graduate theses or studies in non-English lan-
guage journals.
Despite these limitations, this systematic
review of music therapy literature and programs
evokes several implications for future imple-
mentation of music therapy as a primary or
adjunct therapy for patients with addictions.
Additional research should be conducted to
test the efficacy of music therapy to improve
various outcomes of patients with addictions.
Research should examine the comparable ef-
fectiveness of music therapy within the con-
text of nonpharmacologic and pharmacologic
addiction treatment. Finally, research should
examine the effectiveness of different modes
of music therapy and what characteristics of
the leader/professional conducting the therapy
improve patient outcomes.
In summary, this systematic review found that
a paucity of music therapy literature is published.
Although not formally assessed in this review,
the lack of information and outcomes of the
therapy described in the literature implicates the
quality of the investigations. Although music
therapy has been implicated in the treatment of
many medical conditions and described in the
treatment of addictions, further research should
be conducted before wide acceptance of this
mode of treatment.
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