Canada is in the throes of an urgent public health crisis involving substance use , touching as many as one in five people across the nation , and music may be the unsung hero to this epidemic.

To begin, these substances, such as alcohol, drugs, or other chemicals, are referred to as ‘psychoactive’ substances because they alter the way the body or the mind functions. People use substances, such as alcohol or drugs, for many different reasons, including wanting to wind down and relax, for having fun, to experiment, or to cope with stressors in their life. Substance use becomes problematic or a “ substance use disorder (SUD )” when continued use of these substances start to interfere negatively with one’s everyday life, regular relationships, and general well-being. This problematic use of substances is associated with a variety of health, social, and economic disadvantages for the user.

It should be stressed that substance use disorder is not a character flaw or a sign of weakness. This disorder requires continuous support and treatment and cannot be overcome with sheer willpower. This is because substance abuse can create powerful changes in the brain that convince the user that becoming sober is impossible. Treatment programs for patients with SUD include body detoxification, pharmaceutical options, psychosocial treatment, and recovery management. Still, only as few as an estimated 10 per cent of those with SUD receive professional help , whereby the treatment completion rates remain low (47 per cent in the U.S.A. in 2006) and the relapse rates are high (40–60 per cent). In this way, there is a dire need for improvements in substance abuse treatment. The use of music, either through music therapy or musical-based interventions, represents an alternative avenue to mainstream care that may be able to better support those dealing with SUD.

The growing relationship between music and substance abuse treatment is both fascinating and promising. Emerging evidence suggests that music can provide a broad range of benefits for people dealing with SUDs, ranging from neurobiological to psychosocial benefits. On the neurobiological level, music may be stimulating neural systems relating to reward and emotions that are very similar to those pathways that are activated by substance abuse. By accessing these similar pathways, music may be able to promote more positive mood states, which is associated with beneficial effects on sleep and treatment completion. At the same time, by promoting positive mood states, music may be able to ‘prevent’ or buffer against the risk of relapse which is often associated with more negative mood states.

Even more, pleasurable music may be able to promote the release of a dopamine , a chemical messenger that carries signals between brain cells. Dopamine is important because it can positively affect the reward system, which is believed to be dysregulated in those with SUDs. At the same time, dopamine can inhibit activity in areas of the limbic system, a region of the brain involved in behavioural and emotional responses, to inhibit transmission of pain perception. This is important because pain is often a strong withdrawal symptom for some people who are recovering from substance abuse. Withdrawal symptoms are physical or physiological symptoms that occur upon abrupt discontinuation or decrease in intake of the substance, and for some people, they can be so serious that it hinders their recovery process. Therefore, the intentional use of music being able to challenge these withdrawal symptoms is very significant.

Finally, on a psychosocial note, music may help increase motivation to actively engage in treatment for people with SUDs. Lack of motivation is a driving issue in the low completion rates of treatment, and music appears to address this by empowering users to navigate and explore their feelings in a non-threatening way. Even more, music may be helpful in reducing social isolation in group music therapy sessions, which ultimately helps promote positive social and problem-solving skills. This is significant because many people with SUD have poor psychosocial skills, which music appears to increase over the course of musical-based interventions. Finally, through music, people can discuss lyrics of songs that are meaningful and relevant to their experience with substance use. Being able to safely explore their dynamics with the substance is thought to contribute to the development of more healthy coping strategies.

Overall, it appears that music holds a lot of potential in addressing the various complexities underlying substance abuse. A holistic tool, it seems that music allows people with SUD to explore and unpack their lived experiences in a productive and healthy setting, all the while facilitating neurobiological changes in the background that contribute to overall wellness. Unfortunately, many folks with SUD remain a disenfranchised community within the greater population, and thus more efforts into developing holistic and human care through music are needed.

This article was written by Mahrukh Aziz, and is part of a series provided by upper year health sciences students at McMaster University.

Room 217 has an extensive collection of articles and webinars about music and health in its reference library . If you want to learn how to incorporate music into your care practice, visit our Music Care Training page. We also have resources for use in a number of care settings.