Music therapy, as defined by the American Music Therapy Association, is the “use of music interventions to accomplish individualized goals within a therapeutic relationship.” In substance dependence disorder treatment, music therapy is used to address the cognitive and emotional aspects of the disorder, without targeting the biological aspects associated with it. However, because music targets specific neurotransmitters and certain regions within the brain in ways similar to alcohol and other substances, music therapy is an effective alternative treatment option for those struggling with substance dependence and should be used more often as the primary source of treatment.
Substances work by affecting the structures and the neurotransmitters within the brain. For example, noticeable changes in limbic and cortical areas within the brain are present when alcoholics are presented with alcohol. Alcohol, cocaine, opiates and nicotine act by directly affecting levels of neurotransmitters such as dopamine , acting on important brain regions such as the ventral striatum, cingulate gyrus, the orbital cortex, the nucleus accumbens (NAc), and the insula [2,3].Repeated activation of certain regions and neurotransmitters within the brain makes people crave reactivation to avoid negative withdrawal symptoms.
Substances also affect many other neurotransmitters  such as glutamate, the neurotransmitter associated with conditioned learning .When substances that increase the level of neurotransmitters GABAergic neuron activity are present,  a process called glutamatergic firing occurs in the brain, and glutamate levels increase. Although the interaction between glutamatergic afferents and the amygdala, which is associated with emotion and motivation, are not entirely understood, a clear association between the two has been established .The widespread effects of drug use on brain structures and neurotransmitters motivates addicts to continue their substance use due to biological, cognitive, and emotional withdrawal symptoms.
Substance dependence disorders exist in a cyclic pattern, primarily involving intoxication and withdrawal. Intoxication varies with each substance, but generally consists of distorted perception and emotions. Withdrawal symptoms follow intoxication with various substances, the final stage in which substance effects begin to diminish and users begin to experience negative emotional and physical symptoms. This physical discomfort and emotional negativity result in a person seeking the substance to alleviate these symptoms .
Current substance use disorder treatments are varied, consisting primarily of juxtaposed psychological and biological approaches. The psychological treatment method addresses the cognitive and emotional aspects of substance use disorders through the implementation of groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) and other psychological treatment methods.
Current biological treatments incorporate the use of additional drugs to substitute, block, or discourage the use of substances. Agonists are drugs with similar effects as an addictive drug, providing a less harmful proxy for body to crave until he or she is weaned off. Antagonistic prevention includes drugs that block certain neurotransmitter receptors within the NAc and drugs that counteract the effects of drugs on the body, such as naloxone, which is used to treat narcotic drug overdoses. Partial agonists act to equilibrate the levels of certain neurotransmitters within the brain, eliminating excess or deficiency, both of which can increase addicts’ desire to seek, obtain, and take the substance to which they are addicted. And finally, aversive drugs such as Disulfiram cause physical discomfort for the user upon the consumption of alcohol or other target substances .
Music therapy is a treatment method utilized to address the cognitive and emotional aspects of substance use disorders, which also has the potential to address the biological factors. According to the American Music Therapy Association (AMTA), music therapy is “an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals.”
Music therapy incorporates listening, relaxation, discussion, and analysis phases to address different problems associated with substance abuse and dependence disorders. Specific music-related tasks, such as songwriting, allow people to express their feelings and enable people to feel a sense of empowerment and achievement upon completing their lyrics. Performance helps to encourage feelings of solidarity and helps to achieve group empowerment. Drumming is a preferred group treatment method because it “helps a group develop cohesion, connectedness, and a sense of community” .Currently, music therapy implementation is used to target the cognitive and emotional factors of substance use treatment therapies, not the biological factors.
Music also has the ability to affect the brain in a manner very similar to that of substances, giving it the potential to be incorporated into biological treatment methods. Music has the ability to affect dopamine activity in the NAc, the VTA, the amygdala, and the hippocampus regions in the brain, all of which are largely associated with the reward and motivational system . Dopamine is also the neurotransmitter in the reward response generated in the brain in response to many stimuli associated with addictions, including sex, food, and substances. Music also affects the interplay of the NAc and the amygdala and the hippocampus, suggesting that this interaction decreases the productivity of both the amygdala and the hippocampus, regions associated with fear and negative emotions. Decreased productivity in these regions may decrease the likelihood of an addict returning to substances, because very often addicts relapse due to negative emotions and physical symptoms [3,4].Therefore, music has the capability to affect the brain and certain neurotransmitters in ways similar to addictive substances such as alcohol, heroine, opiates, etc., allowing it to act as effectively as biological treatment methods.
Because relapse is common among substance abusers due to cognitive, emotional, and physical symptoms, it is necessary to find a treatment that addresses all of these components. To simultaneously address all of the issues, a combination of biological and psychological treatments are often prescribed at the same time. Music therapy offers a treatment method consisting of only one component, which addresses cognitions, emotions, and biological factors, eliminating inconsistency in the length of treatment programs and discrepancy in treatment modalities. Additionally, music therapy can be continued even after sessions with a therapist have ended, whereas pharmaceutical treatments cannot be continued.
Because music has such a large impact on all aspects associated with substance abuse and dependence and could potentially lower relapse rates, it is a treatment method that needs to be explored more thoroughly and more seriously. It offers a safe alternative to modern medicinal practices targeted at substance use disorders, and has the potential to change the treatment practices associated with these disorders. With more funding, more research, and more respect from medical practitioners as well as from the general society, music therapy has the potential to be an effective alternative to dangerous and/ or semi-effective ‘mainstream’ treatment methods used today.
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