Music therapy in substance use treatment: the Cochrane review

Music therapy uses music, guided by a trained therapist, to work toward health goals. In substance use treatment it is offered as an add-on to standard care. Of the arts-based and activity-based approaches covered on this site, it has the largest body of trial evidence, which makes it a useful case for seeing both what has been shown and what has not.

What music therapy is

The American Music Therapy Association defines music therapy as the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship, delivered by a credentialed professional who has completed an approved music therapy program. It lists goals such as promoting wellness, managing stress, expressing feelings and improving communication.

The Cochrane review discussed below adds that music therapists use specific music interventions to help people manage emotions, cope with triggers, experience a sense of mastery and form healthy relationships. This is different from simply listening to music for pleasure, or from a recreational music activity without a therapist.

How it works in outline

The association says that after assessing a person's strengths and needs, the qualified music therapist provides treatment that can include creating, singing, moving to or listening to music, with the abilities built in sessions then carried over into other parts of life. The Cochrane authors describe a range of active and receptive forms of musical engagement, and propose that these can support neurobiological, psychological and social processes that promote health. These are descriptions of how the approach is meant to work, and the review itself does not test the mechanisms.

What sessions can look like

Session content depends on the therapist and the setting. Active forms can involve creating, singing or moving to music, while receptive forms involve listening to it. In the Cochrane review's trials, music therapy was given in detoxification units or longer-term treatment facilities, as an addition to the usual program. Treatment lasting longer than a single session was linked to greater reductions in craving, although the review notes it is not known whether the number of sessions affects other outcomes or whether one form of music therapy works better than another.

What the research says

The main source is a 2022 Cochrane systematic review by Ghetti and colleagues, with searches current to February 2021. It included 21 randomized trials with 1,984 people, all of whom had a substance use disorder; 52 percent reported alcohol as their main substance. Two studies involved people with co-occurring mental health diagnoses.

For music therapy added to standard care, compared with standard care alone, the review found:

• Substance craving: a medium reduction, rated moderate-certainty evidence (three studies, 254 participants).
• Motivation for treatment or change: a small-to-medium improvement (five studies, 408 participants).
• Depression and anxiety: no clear evidence of benefit, and the authors say they are uncertain about the results.
• Motivation to stay sober: no clear evidence of benefit.
• Staying in treatment: no meaningful difference.

When music therapy was compared with another active intervention, such as verbal therapy, motivation for treatment may have improved more, but there was no clear evidence of an effect on craving, depression or substance use at one month. The review found no data on adverse effects, so safety is not established by these trials either way.

The authors state low-to-moderate confidence in their findings. Most of the included studies were done by the same researcher in the same detoxification unit, which limits how far the results can be applied to other settings. Outcomes were also downgraded for small sample sizes. The National Center for Complementary and Integrative Health (NCCIH) summarizes the review as showing moderate reductions in craving and improved motivation in detoxification and short-term rehabilitation settings, and cites a 2017 systematic review of 34 quantitative and 6 qualitative studies that found benefits on emotional and motivational outcomes but inconsistent results, concluding that efficacy remained unclear.

A separate 2018 review in The Arts in Psychotherapy by Megranahan and Lynskey looked at all creative arts therapies and found only five randomized trials that met its criteria, all about music. It reported positive effects on contemplation, treatment readiness, motivation and craving, but called the evidence low in quality and its own conclusions inconclusive because of the small number of studies. It found no trial with reduced substance use as the main outcome.

Limits and who it may not suit

Taken together, the evidence supports music therapy as a possible add-on for craving and motivation during detoxification and short-term rehabilitation. It does not show that music therapy reduces substance use by itself, helps with depression or anxiety, or improves long-term outcomes. Whether it works as well outside the detoxification and short-term settings studied is not known from these trials.

It is not a substitute for medical care. Anyone going through withdrawal should read about withdrawal and detox and the importance of medical supervision, and the role of medication is covered under medications used in treatment. For related options, see art therapy, mindfulness-based approaches and the overview of holistic and complementary approaches.

Questions to ask a clinician

• Is the music therapist credentialed, and how is the work tied to my treatment goals?
• Would sessions be active (making music), receptive (listening), or both?
• How many sessions are offered, given that more than one seems to matter for craving?
• How would this fit alongside my medication and counseling?