What was the aim of this review?
We aimed to assess if music therapy given in addition to standard care was effective for people with substance use disorders, in terms of impacting substance craving, motivation for treatment, and motivation for staying sober/clean. We were also interested in evidence about effects on depression and anxiety, as these are risk factors for relapse.
Music therapy as 'add on' treatment to standard care likely reduces substance craving and increases motivation for treatment for adults in detoxification and rehabilitation settings. Music therapy lasting longer than a single session is associated with greater reductions in substance craving. There is no evidence of an effect on depressive symptoms, anxiety, motivation to stay sober/clean, or retention in treatment. There were no data on adverse events.
Why is it important to do this review?
This review can help determine if music therapy has a beneficial impact on certain aspects of problematic substance use and motivation for treatment.
What did this review study?
Substance use disorder is the continued use of drugs, both illegal drugs and prescription medicines, with or without alcohol, even when these substances cause health problems or negatively affect social functioning. Approximately 35 million people worldwide engage in problematic drug use, and more than three million deaths each year are attributed to the harmful consumption of alcohol. Music therapy addresses the mental and physical needs of people undergoing substance use treatment, through use of a range of active and receptive forms of musical engagement that enable various health-promoting neurobiological, psychological, and social processes. Music therapists are health professionals who use specific music interventions to help their clients manage emotions, cope with triggers, experience mastery, and form healthy interpersonal relationships.
What were the main results of the review?
We included 21 studies with 1984 people. All participants were diagnosed with substance use disorder, with 52% reporting alcohol as their substance of choice. In two studies, participants had co-occurring mental health diagnoses. All studies were completed in either detoxification settings or longer-term substance use treatment facilities. Studies compared music therapy added to standard care to standard care alone or to other types of intervention that would be a typical part of treatment for substance use, such as verbal therapy. The quality of the performed trials and the reported results varied, which affected our confidence in the results.
Our findings suggest that music therapy added to standard care likely reduces substance craving when compared to standard care alone for people with substance use disorders receiving treatment in detoxification and short-term rehabilitation settings. Music therapy intervention lasting longer than a single session is associated with greater reduction in craving. Furthermore, music therapy likely improves motivation for treatment/change more than standard care alone, and may improve motivation for treatment/change more than other active treatments. We found no evidence of an effect of music therapy on depressive symptoms, anxiety, and motivation to stay sober/clean.
We have low-to-moderate confidence in our findings, and caution that it might be difficult to transfer our findings to other settings, since most included studies were conducted by the same researcher in the same detoxification unit.
We know that substance craving is diminished better when there is more than one session of music therapy, but we do not know if the number of music therapy sessions received impacts other outcomes. Additionally, we do not know if one form of music therapy works better than others for these outcomes.
Only one study reported a source of funding (National Key R&D Program of China, primary funder).
How up-to-date is this review?
This evidence is current to 1 February 2021.
Results from this review suggest that MT as 'add on' treatment to standard care can lead to moderate reductions in substance craving and can increase motivation for treatment/change for people with SUDs receiving treatment in detoxification and short-term rehabilitation settings. Greater reduction in craving is associated with MT lasting longer than a single session. We have moderate-to-low confidence in our findings as the included studies were downgraded in certainty due to imprecision, and most included studies were conducted by the same researcher in the same detoxification unit, which considerably impacts the transferability of findings.
Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving.
To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober.
We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews.
We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD.
We used standard Cochrane methodology.
We included 21 trials involving 1984 people. We found moderate-certainty evidence of a medium effect favouring MT plus standard care over standard care alone for substance craving (standardised mean difference (SMD) –0.66, 95% confidence interval (CI) –1.23 to –0.10; 3 studies, 254 participants), with significant subgroup differences indicating greater reduction in craving for MT intervention lasting one to three months; and small-to-medium effect favouring MT for motivation for treatment/change (SMD 0.41, 95% CI 0.21 to 0.61; 5 studies, 408 participants). We found no clear evidence of a beneficial effect on depression (SMD –0.33, 95% CI –0.72 to 0.07; 3 studies, 100 participants), or motivation to stay sober/clean (SMD 0.22, 95% CI –0.02 to 0.47; 3 studies, 269 participants), though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result. There was no evidence of beneficial effect on anxiety (mean difference (MD) –0.17, 95% CI –4.39 to 4.05; 1 study, 60 participants), though we are uncertain about the result. There was no meaningful effect for retention in treatment for participants receiving MT plus standard care as compared to standard care alone (risk ratio (RR) 0.99, 95% 0.93 to 1.05; 6 studies, 199 participants).
There was a moderate effect on motivation for treatment/change when comparing MT plus standard care to another active intervention plus standard care (SMD 0.46, 95% CI –0.00 to 0.93; 5 studies, 411 participants), and certainty in the result was moderate. We found no clear evidence of an effect of MT on motivation to stay sober/clean when compared to active intervention, though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result (MD 0.34, 95% CI –0.11 to 0.78; 3 studies, 258 participants). There was no clear evidence of effect on substance craving (SMD –0.04, 95% CI –0.56 to 0.48; 3 studies, 232 participants), depression (MD –1.49, 95% CI –4.98 to 2.00; 1 study, 110 participants), or substance use (RR 1.05, 95% CI 0.85 to 1.29; 1 study, 140 participants) at one-month follow-up when comparing MT plus standard care to active intervention plus standard care. There were no data on adverse effects.
Unclear risk of selection bias applied to most studies due to incomplete description of processes of randomisation and allocation concealment. All studies were at unclear risk of detection bias due to lack of blinding of outcome assessors for subjective outcomes (mostly self-report). We judged that bias arising from such lack of blinding would not differ between groups. Similarly, it is not possible to blind participants and providers to MT. We consider knowledge of receiving this type of therapy as part of the therapeutic effect itself, and thus all studies were at low risk of performance bias for subjective outcomes.
We downgraded all outcomes one level for imprecision due to optimal information size not being met, and two levels for outcomes with very low sample size.