05 July 2016

Resource Review: Roles for Music-Receiving in Addiction Treatment

“Music, like speech, is a product of both our biologies (e.g. gene polymorphic expressions) and our social interaction (e.g. environment). It has been correctly suggested that music is a necessary and integral dimension of human development; and that music may have played a central role in the evolution of the modern human mind” (Blum, et al, 2010).

As a musician relatively new to the counseling field, I am drawn to apply my old skills and passions to what feels like the “brave new world” of the caring professional. Each of my musical selves—performer, educator, composer, and attentive listener—has a stake in this quest for new territory. When we talk about “music,” we refer to vast, never fully-charted, waters comprising both participatory and non-participatory. But even these two sub-categories overlap, as we often find ourselves—physiologically, neurologically, psychologically—participants in the music made by others. Neither can we distinguish between music having therapeutic intention or some other intention. My strategy for whittling the topic down to a manageable size is to focus on the research that speaks to my composer-self, and attempt to filter out elements vying for the attention of my educator-self. I therefore seek the implications of research and contemporary practices for those who would create music.
Mindfully Musical

My topic, then, centers on the effects music listening or receiving—as opposed to music making—can have on those in addiction treatment. I will further limit my scope to enhancement of mindfulness through music, which overlaps enough with so-called “sound healing” approaches that I will discuss as well. Mindfulness has its place in addiction treatment as a tool to identify feelings and triggers that precede relapse. Alcoholics who were determined to have developed a certain degree of trait mindfulness—as determined through a questionnaire—were found to be less prone to relapse “cue reactivity” than their more high-strung peers (Garland, 2011). Given their history of seeking problem resolution through substance use, addicts will be vulnerable to relapse until they can address these problems through sober means—problems which include insomnia, physical pain, stress, somatic memories, loneliness, boredom, low self-esteem, post acute withdrawal syndrome (PAWS), emotional dysregulation, and mental disorders. A music intervention that improves functioning in any of these areas should therefore be considered for addiction treatment. Music-making activities will address some areas—certain social, cognitive, and emotional ones—while music-receiving will address others.
Privileged Treatment

Music and sound healing appears to be offered primarily at luxury addiction treatment centers such as Passages Malibu, where “sound therapy uses vibrations to affect cellular resonance in the body to help heal the cellular impact of depression, anxiety, and trauma” working with an in-house practitioner who utilizes “quartz crystal singing bowls, didgeridoos, Native American flutes, buffalo drums, and his own voice” (passagesmalibu.com). Behavioral Health of the Palm Beaches offers “healing sound therapy” in which:
patients are exposed to a variety of sounds at varying frequencies and intervals while they lie down with their eyes closed. During the session, they are encouraged to focus only on the different sounds in an effort to experience their potential healing properties. Differing sounds can include low-frequency pulses and high-pitch pings from various instruments. A human voice is also commonly used. Each part of the body has a resonant frequency and will respond to different pitches and sound-types (bhpalmbeach.com).
Although this last website distinguishes this intervention from music therapy, it in fact is music therapy—as we shall see below.

What is Music Therapy?

Many research studies seek to document the effects of Music Therapy on a variety of populations. What is meant by “Music Therapy” varies enough that it can be difficult to distinguish causal from correlational in research studies. Some interventions comprise a combination of active and passive music-related activities. To peruse job listings for music therapists one might picture the role as primarily one of bedside instrumentalist/vocalist. But the music therapists treating addicts described in Baker, et al (2007) and Lesiuk (2010) are leading discussion of song lyrics, song writing (or song parody, that is, substituting new words for an existing song), and relaxation training. Another intervention (Punkanen, 2005) involved clients choosing their own recordings of “anchor” music—associated with positive emotions, memories, or images—to bring them to homeostasis from an aroused state. None of these involve live music performed by the practitioner; though they do fit the general definition given at the AMTA website:
Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. . . The goals, objectives, and potential strategies of the music therapy services are appropriate for the client and setting. The music therapy interventions may include music improvisation, receptive music listening, song writing, lyric discussion, music and imagery, singing, music performance, learning through music, music combined with other arts, music-assisted relaxation, music-based patient education, electronic music technology, adapted music intervention, and movement to music (musictherapy.org).
Music’s Effect on the Brain

The effect in hearing a given music on the human brain varies significantly with the type of music and the context in which it is used. Daniel Levitin, a pioneer in quantifying the music listening experience, summarizes his findings in This is Your Brain on Music:
The story of your brain on music is the story of an exquisite orchestration of brain regions, involving the oldest and newest parts of the human brain, and regions as far apart as the cerebellum in the back of the heard and the frontal lobes just behind your eyes. It involves a precision choreography of neurochemical release and uptake between logical prediction systems and emotional reward systems. We love a piece of music, it reminds us of other music we have heard, and it activates memory traces of emotional times in our lives (Levitin, 2006).
He cites research attributing the “thrills and chills” resulting from music listening to the Reward Reinforcement Pathway—including a study showing that “the pleasure of music listening could be blocked by administering the drug naloxone, believed to interfere with dopamine in the nucleus accumbens” (Levitin, 2006). Of his own quantitative study—using Functional and Effective Connectivity Analysis—he says:
We found exactly what we had hoped. Listening to music caused a cascade of brain regions to become activated in a particular order: first, auditory cortex for initial processing of the components of the sound. Then the frontal regions . . . that we had previously identified as being involved in processing musical structure and expectations. Finally, a network of regions—the mesolimbic system—involved in arousal, pleasure, and the transmission of opioids and the production of dopamine, culminating in activation in the nucleus accumbens. And the cerebellum and basal ganglia were active throughout, presumably supporting the procession of rhythm and meter. The rewarding and reinforcing aspects of listening to music seem, then, to be mediated by increasing dopamine levels in the nucleus accumbens, and by the cerebellum's contribution to regulating emotion through its connections to the frontal lobe and the limbic system (Levitin, 2006).
This would appear to apply to active music listening, as opposed to subliminal—another pair of overlapping categories.

Subliminal Sonics

The music we intend to listen to, that holds our interest, will engage all the brain regions described above. What I will call subliminal music holds no particular interest and does not seek to engage our frontal cortex with its variety. Rather, it is designed to have a direct physiological outcome. When it is “music” and when it is simply a specifically-tailored noise is a philosophical matter. We may specify our musical taste by saying, at the conscious level, “I know what I like.” We may not know what our brain likes, however, at the subconscious level. It can be challenging to sort out all of the sound healing modalities that can be located on the internet.
Beginning with the least expensive, sleepgenius.com offers a $5 (smartphone) app to remedy insomnia. In a “white paper,” neuroscientist Seth S. Horowitz writes on the three methodologies the app is designed to evoke through earphones.
1]Complex, broadband sounds, particularly those with harmonic structure, are capable of synchronizing large populations of neurons in the brain from the brainstem through the cortex.
2] Binaural beating — structured stereo sounds that synchronize large regions of the cortex—can be used so that the beating frequency oscillates at the rates observed in different stages of sleep, simulating normal neural processes for maintaining sleep and driving the sleeper from one stage to another.
3] auditory-facilitated relaxation. This involves the use of calming sounds, such as low amplitude pink noise, convolved with cardiac and respiratory sound envelopes which decrease in repetition rate across a physiologically appropriate range, to lower the listener’s heart and breathing rates (Horowitz, 2013).
With an overall rating of 3 out of 5 stars, there does not appear to be a significant percentage of users who find the app successful in achieving the above. Perhaps some of these users would fare better with the separately sold SleepPhones (only available with a pre-loaded iPod for a total of $275), but it is still possible any one of us could have a 5-star experience.

Physioacoustics & Binaural Brain Beats

Binaural beats result from two sine waves, just a few Hz (cycles per second) apart, being each sounded through left and right headphone drivers. The difference between the two frequencies is said to create for the ear an “auditory illusion” of a third frequency equal to that difference. This third frequency is generally below the normal range of human pitch perception; what one hears is the rhythmic throb generated by interaction of the two pitches. Experiments related to this phenomena go back as far as the late 18th century. These low frequencies are said to affect brain waves through the process known as “entrainment”—in which two independently tuned oscillators seek to get in tune with each other. The term also applies to when we tap our foot in time to music without making the conscious choice to do so (as seen in the hilarious film The Full Monty when the clandestine dance company is standing on line to collect their “dole”). Whether entrainment, between external sound and brain waves, can actually occur at frequencies that the human ear is not capable of registering remains a point of controversy. Delta waves, for example—which are associated with deep sleep and whose activity has been shown to become severely limited through alcoholism—are lower than 4 Hz. The lowest a good ear can perceive is 20 Hz, which is, not coincidentally, the lowest frequency a pair of studio headphones reproduces.

Marko Punkanen describes his music therapy practice with addicts as comprising three components: the “anchor” music, described above, along with “the physioacoustic method,” and the sharing of these experiences with the therapist. His objective is the resolution of somatic memories—what Montgomery described as transforming “emotional memories into memories of emotions”—with the physioacoustic treatment having the goal of attaining an altered state. This involves utilization of a reclining chair or bed embedded with speakers. One such manufacturer is Next Wave in Finland; their
Physioacoustic Sound Wave Therapy System is a unique method of using low frequencies within the range of 27-113 Hz for therapeutic purposes. A group of Finnish experts spent 20 years developing a compact device that would precisely replicate and control low frequency sound vibrations. The result was a reclining chair housing a computer and six audio speakers. The computer creates and controls low frequency sinusoidal sound waves, which are broadcast through the speakers.
The chair seems to have primarily been designed for muscle relaxation, though lists among its applications “rehabilitation of drug and alcohol abuse” (nextwave.fi).

Another product targeting addiction treatment, The Biosound™ Therapy System is a vibrational platform constructed with memory foam and integrated with an audio/visual delivery system. The Biosound™ Therapy System utilizes precisely choreographed music that is synchronized with low frequency sine tones and binaural beats (biosoundhealing.com).

While “choreographed” would imply dance, this treatment takes place on a mattress where the patient wears a “meditation headband” (offered as a more comfortable alternative to earphones) and faces a computer screen providing biofeedback. In addition to binaural beats, the audio track provides spoken affirmations that reinforce addiction recovery. The biosoundhealing site appears to sell their system a la carte. There being no mattress listed among their products, one is led to assume that it is obtained through another company. The software alone goes for $3000. Addiction treatments centers offering this apparatus are shown on a U.S. map, with the highest concentrations being in Florida and greater Los Angeles.

Also rooted in binaural beats is the Neuro Programmer 3 offered by transparentcorp.com, a Windows software application that also offers “monaural beats” (two pitches beating against one another but mixed not in stereo) and “isochronic" tones (evenly spaced tone pulses) along with biofeedback. “Widely regarded as the most effective tone-based method, isochronic tones produce very strong cortical responses in the brain. Many people who do not respond well to binaural beats often respond very well to isochronic tones” (transparentcorp.com). An employee of Transparent Corporation authored “A Comprehensive Review of the Psychological Effects of Brainwave Entrainment” (Huang, Charyton, 2008) that compares 20 studies. The authors are able to verify from the research that brainwave entrainment can significantly affect cognitive functioning deficits, stress, pain, headache/migraines, PMS, and behavioral problems. An alternative to audio entrainment of low frequencies is visual, through the use of pulsating light. While the NP3 offers pulsating light from the computer screen, the manufacturer recommends getting “AudioStrobe glasses,” from an outside source, for the full effect. There is a large set of related features offered in this software package that is sold in $60 and $90 versions.

How can one recommend a computer-centered intervention when many experts advise against use of screen-technologies for the last two hours before bedtime due to their effect on the nervous system? (Goudreau, 2010). This would be a topic for further research. Singing bowls or Chinese gongs can be used as a more natural medium than synthesized sound waves with a similar, if less precise, intention of brainwave entrainment. It is important to remind ourselves, as well, that the therapeutic relationship trumps any particular technique.

This term was coined by Alfred Tomatis, who developed music-listening interventions based on equalization, or filtering, of the frequency spectrum—which he labels “electronic gating” or, humbly, “the Tomatis effect.”

Designed to establish a unique sound perception contrast, this effect causes the contraction and relaxation of the inner ear muscles. This to-and-fro movement is made possible by the sudden transition from lower, bass frequencies, which do not require any particular effort on the part of the ear, to higher, acute frequencies, which require the ear to make a special effort to accommodate. This activity is much like a gymnastic exercise for the ear, which, thanks to repeated activity and to the progressive mobilization of the ear, optimizes the transmission of the sensory sound message to the brain (tomatis.com).

CDs from the early 1990s based on this principal can still be found in my wife’s collection, dating from when she hoped to affect her sons’ brain disorders. The research offered at the Tomatis Method website claims to positively affect adult anxiety, childhood learning disorders and behavior problems, and auditory processing disorders. What may be heard on the CDs are chamber-music works, either in their original form or in transcription from orchestral works, from the classical and, sometimes, romantic periods. First one hears the piece presented much as on a standard professional recording (with most pieces newly recorded by session musicians) followed by a portion of the same piece with all but the highest frequencies filtered out—how it might sound over a tiny, tinny loudspeaker. Patients are prescribed (headphone) listening plans, such as three times per day, 15 minutes each. The theory goes that your brain will “work” to fill in the missing sonic information. There are enough facets to this method to justify four levels of professional training, offered internationally, of 3-4 days each. If the claims prove true, these sonic “calisthenics” could help an addict through PAWS at the very least. I would describe the musical selections offered in the CDs as ranging from the superficial to somewhat deep—depending on the composer. Another way to put it: some are fine viewing Watteau, while others may require Rembrandt to feel they got their money’s worth at the art museum.

Music-enhanced Interventions

Healing practices appropriate to addiction treatment that can benefit from the addition of music include meditation, massage, exercise, dance, yoga, and Tension & Trauma Releasing Exercises (TRE). Regarding meditation, results from a study of incarcerated individuals with substance use disorders indicate that after release from jail, participants in the VM (Vapassana Meditation) course, as compared with those in a treatment-as-usual control condition, showed significant reductions in alcohol, marijuana, and crack cocaine use. VM participants showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes (Bowen, Witkiewitz, Dillworth, Blume, Chawla, Simpson, Ostafin, 2006).

Young, DeLorenzi, and Cunningham (2011) describe five “curative factors in meditation” beneficial to the addict that can reduce symptoms related to relapse:
exposure—facing thoughts and feelings without judging them
cognitive change—realizing that labels given to thoughts and feelings may not be accurate
self-management—choosing the present over depressing or anxious thoughts
relaxation—an aid to stress-related disorders
acceptance—accepting, rather than fighting, urges to use (Young, et al, 2011)
The authors do not advise introduction of meditation until the middle or late stages of recovery as the mind remains too agitated in the early stage. Witkiewitz, et al (2012) suggested that “Mindfulness-Based Relapse Prevention (MBRP) may affect numerous brain systems and may reverse, repair, or compensate for the neuroadaptive changes associated with addiction and addictive-behavior relapse.”

While traditional forms of meditation do not typically involve music, there are newer forms that fully integrate music and meditation such as The Bonny Method of Guided Imagery and Music (GIM).
The selected music contains the great masterpieces of composers such as Beethoven, Brahms, Debussy, Mozart, Rachmaninov, and Vivaldi. The uniqueness of this method lies in the synchronicity of music and imaginative experiences. In this process, music plays the role of a strong co-therapist and active partner. It acts as a mirror and reflects ambivalences and both light and shadow. GIM encourages unresolved issues to surface and helps the traveler to find new levels of problem solving (gim-trainings.com). In a literature review, Corboy (1999) finds GIM to be “an effective addiction recovery modality.”

Music for its Own Sake

A research article (Blum, et al, 2009)—dedicated to saxophonist and addict Stan Getz—seeks to determine whether the “reward gene” (dopamine D2 receptor, or DRD2), associated with severe alcoholism, plays a role in the mesolimbic response to music, as described by Levitin on pages 3-4.
It is reasonable to assume that music is a strong indirect D2 agonist (by virtue of DA neuronal release in the NAc) and may have important therapeutic applicability in Reward Deficiency Syndrome (RDS) related behaviors including Substance Use Disorder (SUD). . . music therapy appears to be a novel motivational tool in a severely impaired inpatient sample of patients with co-occurring mental illness and addiction (Blum, et al, 2009).

The authors call for further research as to whether the same gene that predisposes great artists to be addicts also predisposes them to be great artists. Here, I believe, we are back to talking about being attentive to music that interests us, which may have some of the physiological-affecting qualities described above in addition to the aesthetic enjoyment it offers us. Seen from this perspective, we are in relation to the creator of the music. It could be postulated that we are mirroring his/her neurons, resonating with her/his ideas, entering the state out of which the music was composed. What distinguishes a “great” composer/improviser/performer is the integrity intrinsic to what has been created, how well it bears the passing of time and repeated listenings. Whether it be the soothing imitation of Renaissance polyphony, the graceful shaping in a Mozart melody, a terrifying Mahler crescendo, or an ecstatic Ella Fitzgerald scat, our neurons are being set off like fireworks. If a search for meaning drives addiction then that drive has the potential to be harnessed for healing, a healing enhanced by the neural integration possible through music-receiving.


Baker, Felicity A., Gleadhill, Libby M., Dingle, Genevieve A. (2007). Music therapy and emotional exploration: Exposing substance abuse clients to the experiences of non-drug-induced emotions. The Arts in Psychotherapy 34 (2007) 321–330.

Blum, K., Chen, T., Chen, A., Madigan, M., Downs, B.W., Waite, R., Braverman, E., Kerner, M., Bowirrat, A., Giordano, J., Henshaw, H., Gold, M. (2010). Do dopaminergic gene polymorphisms affect mesolimbic reward activation of music listening response? Therapeutic impact on Reward Deficiency Syndrome (RDS). Medical Hypotheses 74 (2010) 513–520.

Bowen, S., Witkiewitz, K., Dillworth, T.M., Blume, A., Chawla, N., Simpson, T.L., Ostafin, B.D. (2006). Mindfulness Meditation and Substance Use in an Incarcerated Population. Psychology of Addictive Behaviors 2006, Vol. 20, No. 3, 343–347.

Corboy, Patricia (1999). The transpersonal aspect of guided imagery and music and addiction recovery.  Dissertation retrieved from http://search.proquest.com/docview/194083072/
Garland, Eric L. Trait Mindfulness Predicts Attentional and Autonomic Regulation of Alcohol Cue-Reactivity. Journal of Psychophysiology 2011; Vol. 25(4):180–189

Goudreau, Jenna (2010). Do Computers Really Fry Your Brain? retrieved from http://www.forbes.com/2010/06/29/technology-computers-health-stress-forbes-woman-well-being-screen-time.html


Lesiuk, Teresa L (2010). A Rationale for Music-Based Cognitive Rehabilitation Toward Prevention of Relapse in Drug Addiction. Music Therapy Perspectives; 2010; 28, 2.

Levitin, D. (2006). This Is Your Brain on Music: The Science of a Human Obsession. New York: Dutton (Penguin Group).

Punkanen, Marko (2005). On a Journey to Somatic Memory: Theoretical and Clinical Approaches for the Treatment of Traumatic Memories in Music Therapy-Based Drug Rehabilitation; in Aldridge, David (Ed). Music and Altered States: Consciousness, Transcendence, Therapy and Addictions. Jessica Kingsley Publishers, Chapter 11.

Siverman, M. (2011). Effects of Music Therapy on Change Readiness and Craving in Patients on a Detoxification Unit. Journal of Music Therapy, 48, 4; 509-531.

Witkiewitz, K., Lustyk, M.K.B., Bowen, S. (2012). Retraining the Addicted Brain: A Review of Hypothesized Neurobiological Mechanisms of Mindfulness-Based Relapse Prevention. Psychology of Addictive Behaviors 2012, Vol. 26, No. 3.

Young, M.E., DeLorenzi, L.A., Cunningham, Laura (2011). Using Meditation in Addiction Counseling. Journal of Addictions & Offender Counseling, October 2011, Volume 32.