MUSIC THERAPY IN ADDICTIONS TREATMENT

Susan C. Gardstrom, PhD, MT-BC

I sit in a small, unadorned room with ten other women—all residents of an addictions treatment facility in Dayton, Ohio. Samia’s hands rest casually on the tubano drum, positioned on the floor in front of her. “This is how I feel right here, right now,” she states assuredly. Then, making a fist, she forcefully pounds the drumhead once, twice, three times. She explains: “I feel powerful today; that’s a new feeling for me!” The other women spontaneously applaud. Samia smiles and passes the drum to the woman on her left. “I’m Josie,” she mumbles,” and this is how I feel right here, right now.” Josie creates loud, chaotic bursts of sound. Eventually, these expressions give way to a quiet, repeated rhythm that fades to silence. Josie looks up tearily and rallies to speak: “I thought I was angry, but the drum brought out the sadness under-neath. That’s what I need to face…the grief that drives me to use.” This is Josie’s first public admission that her addictive trajectory was set in motion by sorrow—most likely from the death of her infant son. I sug-gest that she start her griefwork by listening to “Lullaby” (Dixie Chicks), with the physical and emotional support of the stout women around her. She agrees, and we all plunge into (and eventually emerge from) this tempest. The song both spurs and contains the raw expression of Josie’s anguish, and the other residents, many of whom have experi-enced similar losses, and are able to empathize deeply.

I am a volunteer at this facility and a board-certified music therapist. Music therapy is a creative arts therapy whose aim is to promote health and well-being using music experiences and the powerful relationships that develop through them. Certified therapists are found in a host of educational, medical, and rehabilitative settings.

The women and men I meet vary widely in age, identities, and life histories, yet they have much in common. All have spent the better part of their teen and adult years seeking drugs and alcohol as a way to anesthetize undesirable feelings, such as isolation, shame, regret, anger, fear, and hopelessness. Most have co-occurring physical and psychiatric disorders and struggle on a daily basis with poor self-esteem. All are desperate to break the potentially fatal addictive cycle once and for all. Music, when skillfully and compassionately intro-duced, can help them to claim personal agency, engage in authentic self-expression, and develop meaningful and supportive connections with other group members toward sustained recovery.

Group sessions typically last anywhere from 60 to 90 minutes. Ini-tially, I work to promote a positive working alliance and decrease potential anxiety about the process, assuring the residents that they need not have musical talent to profit from music therapy and es-tablishing the session as a “no judgment zone.” As depicted above, a brief emotional check-in often leads to the “core” music experi-ence, wherein the bulk of therapeutic work occurs.

Four types of music experiences and multiple variations of each are available to support therapeutic processes:

1. Listening – The clients take in recorded or live music and respond in some fashion.
• Music-assisted Relaxation
• Music-assisted Imagery
• Song Discussion

Example: The residents experience opioid withdrawal-related agitation—unrest so severe that it interferes with their ability to focus. The need to decrease agitation is obvious and insistent. Accordingly, I select a recorded instrumental piece to support deep, regular breathing. I overlay a guided imagery script. Afterward, several residents in attendance report increased physical relaxation and diminished racing thoughts. Guided music listening has positively impacted the autonomic nervous system.

2. Composition – The clients create original lyrics, music, and compilations.

  • Song Transformation and Song Writing
  •  Instrumental Composition
  • Musical Collage

Example: The theme of ‘Friendship’ arises during the check-in. I suggest that this co-ed group write original lyrics about friendship using “Lean on Me” (Bill Withers) as a basis. They work in teams of 2-3, first discussing what it means to be a true friend to another in recovery, and then folding these ideas into the song structure. The residents re-convene to agree on the finished product and rehearse the song transformation. They then proudly perform it for the staff, singing the bridge with particular zeal:

You just call on your sponsor when you need a friend We all need an “old timer” to lean on
They just might have an answer that saves your rear end We all need an “old timer” to lean on

The process of composition has allowed for the healthy exploration of an important therapeutic theme and resulted in a sense of musical accomplishment.

3. Improvisation – The clients create sounds and music spontaneously with the voice and instruments.
• Instrumental Improvisation
• Vocal Improvisation
• Mixed Media Improvisation

Example: The men report a need to “let go of anger and frustration” related to interpersonal strain on the unit. I offer instrumental improvisation as an option for the release of these unwanted emotions. The men explore percussion instruments and each chooses one. I “lay down” a consistent pulse and encourage free expression. Playing is tentative at first, but soon the men assert their “voices,” and scowls give way to smiles. Many are observed interacting musically with others. After several minutes, one of the players begins a rumble, and the rest of us join in, building to a synchronized and decisive conclusion and followed by a burst of laughter. Rhythm has energized and organized individual players’ expressions, and tension and divisiveness has been replaced by healthy playfulness and a sense of unity.

4. Re-creation – The clients learn and perform existing music.
• Instrumental Re-creation
• Vocal Re-creation
• Musical Productions

Example: It is a rainy day, and the women report low energy and loneliness. I match their emotional tenor, singing a contemplative chant about the importance of sheltering one another from the storms of life. After multiple repetitions, some of the women begin to sing with me. I move seamlessly into another song, accompanying on guitar. Now almost everyone is singing. I distribute binders with lyrics for 40 popular songs of various styles, and the women take turns requesting favorites—some old and some new, some forlorn and some frivolous, but all conjuring meaningful memories and associations. To end the session, someone suggests “Fight Song” (Rachel Platten), and the residents sing with gusto. The women have experienced a few of the many documented therapeutic benefits of singing (especially singing with others), such as decreased depression and increased sense of personal empowerment through self-expression.  

These examples show some of the many ways that music is used toward healthy reflection, expression, and interaction among peo-ple with addictions. As a unique and powerful complement to more traditional therapies, music therapy promotes the bio-physical, psycho-emotional, and psycho-spiritual healing that is viewed as a necessary aspect of recovery.

References Provided Upon Request
Susan C. Gardstrom is Professor and Coordinator of Music Therapy at the University of Dayton. Clientele served include adjudicated adolescents, children with physical disabilities and autism, and adults with addictions.