essay on music addiction

• Health Conditions

Is ‘Music Addiction’ Really a Thing?

If you love music, you’re not alone. People throughout the world appreciate and use music every day, whether it’s to advertise, remember facts, exercise, or drift off to sleep. For many, music also plays a huge role in culture and identity.

Plus, music may also:

• reduce anxiety and stress
• help relieve pain
• improve your mood
• improve sleep quality

While there’s little fault to find with those effects, some question whether people can enjoy music a bit too much.

The short answer to this is no: Experts don’t formally recognize music addiction as a mental health diagnosis. Still, that doesn’t mean music habits can still sometimes become problematic.

Is it possible?

In short, not really.

Experts don’t formally recognize music addiction as a mental health diagnosis. Still, that doesn’t mean music habits can still sometimes become problematic.

If you have any familiarity with how addiction develops, you might know a little about the role dopamine plays.

Here’s the short version:

Substance use or certain behaviors trigger the release of dopamine in the brain’s reward system. Over time, the brain begins to rely on these substances or behaviors and naturally releases less dopamine. So, your brain becomes dependent on those dopamine triggers.

A 2011 study involving 10 people who experience chills when listening to music suggests that music can trigger a dopamine release when it produces an intensely positive emotional response — aka the chills.

In theory, the brain could potentially come to rely on music-triggered dopamine production, but there’s not much evidence to suggest this actually happens.

When music might become a problem

There’s no straight answer here, but we can look to things that health professionals generally check for when evaluating someone for a potential addiction:

• Can you control the behavior pattern?
• Does it cause problems in your daily life?
• Do you continue the behavior despite any negative consequences, because you feel unable to stop?
• Do you need the behavior more over time and experience withdrawal when you don’t engage in it?

It really comes down to this: Does listening to music affect you negatively?

Here are some more specific signs that you may want to take a closer look at your music habits.

You rely on music to manage your emotions

Music is often deeply emotional. It can convey an almost endless range of feeling.

It’s often used as a coping strategy for anxiety or stress. Many people report improvements in mood and motivation after listening to energizing music. It may even help you express emotions and find deeper insight.

Still, it won’t get to the heart of what’s causing your distress.

Keep in mind that listening to music that matches your mood can also intensify that mood — for better or worse. Sometimes this can help.

Sad breakup songs, for example, might help you work through your feelings after romantic disappointment. On the other hand, they might also have the opposite effect and prolong your feelings of sadness and grief.

You can’t function without music

Music can help make challenging or unpleasant tasks more tolerable. You might turn up the radio in bad traffic , jam out to high-energy songs while housecleaning, or listen to soothing music when you feel stressed.

Music isn’t appropriate in all situations, though.

For example, secretly listening to music during school lectures, meetings at work, or while someone’s trying to have a serious conversation with you isn’t a great idea.

If you feel distressed or find it difficult to function without music, it may be worth exploring why.

Music distracts you from important tasks

Getting lost in a song (or two) is pretty normal. Regularly losing track of time when listening to music could create challenges, however, especially when it keeps you from carrying out your responsibilities.

Maybe you wait for that 6-minute guitar solo to wrap up before you head out to pick your partner up from work. Or you get so in the zone that you’re suddenly way behind on making that dinner you promised you would.

Music plays a part in substance use

Substance use enhances the experience of listening to music for some people. Maybe a couple drinks helps you loosen up and dance at a live show. Or ecstasy makes you feel like you’re mentally synced up with the DJ.

Occasionally using substances while enjoying a deeper connection to music isn’t necessarily a problem, but it’s something to be mindful of.

According to 2015 research , 43 percent of 143 people receiving treatment for a substance use disorder linked a specific type of music with a greater desire to use substances.

Again, this doesn’t necessarily mean music is bad. In fact, most study participants also said music played an important part in their recovery.

But these findings do suggest music could potentially play a part in problematic substance use.

If you find yourself drawn to a specific type of music that also triggers a desire to use substances, consider taking a closer look at this connection.

How to cut back (if you feel like you need to)

Unless listening to music is having a negative impact on your life, there’s no reason to cut back.

If you’re looking to make some changes, though, consider these strategies.

Identify areas where you can go without music

Even if you want to listen to less music, you don’t have to go without it entirely. Instead, try choosing specific times of day or activities when avoiding music might be wise.

If you’ve identified specific areas of problem listening (during class lectures or at work when you’re supposed to focus on customers, for example), start cutting back there.

If you have the ability to listen to music nearly all day, every day, set aside some time when you could go without.

Sure, you can hang on to your workout tunes , but try giving your listening device a break when you go for a walk. Keep your ears open for the sounds of nature instead.

Break up your listening with other activities

If you listen to music pretty much nonstop, you may spend less time taking in other forms of media or interacting with others. Music has plenty of benefits, it’s true. But other media can offer benefits too.

Some things to try:

• Call a friend or loved one.
• Watch a favorite movie.
• Study a new language (free apps like Duolingo or audio CDs from your local library work great for this).

Listen to other things

Music is convenient because you can listen while doing other things. Background noise can keep you company at home or work if you don’t enjoy silence.

Music isn’t your only option, though.

Consider giving these different types of audio a try:

• National Public Radio (NPR). Google NPR followed by your city’s name for your local channel.
• Audiobooks. Many local libraries offer fiction and nonfiction options for checkout or streaming.
• Podcasts. No matter what you’re interested in, there’s probably a podcast about it.

Change how you listen to music

If your music listening is less of a problem than how you listen to music, making a few changes in your listening style could help:

• When you feel down and music makes it easier to wallow in gloom, try journaling, talking to a friend, or going for a walk.
• If loud music distracts you from work or studying, consider switching to music without lyrics when you need to focus .
• Consider lowering the volume or removing your headphones in situations when you need increased awareness, like at work or on the road.

Best practices to keep in mind

By this point, you may have realized you don’t have a problem with your music listening habits. Even so, keeping these tips in mind can help you get the most enjoyment and benefit from music — and protect your hearing at the same time.

Turn down the volume

The one major downside to listening to music? It can lead to hearing loss over time if it’s too loud.

You might not even realize just how high the volume is. People tend to play the music they love most at higher volumes, perhaps because they believe it’s not as loud as music they enjoy less — even when the volume is exactly the same.

So, if you really want to blast that one song, go for it, but then lower the volume. Your ears (and probably your neighbors) will thank you.

If you use headphones, remember the 60-60 rule : Only listen to up to 60 percent of maximum volume for 60 minutes a day.

Switch to over-ear headphones

If you’re concerned about hearing loss, experts recommend headphones that cover your ear as a safer option. Earbuds and wireless headphones may be fantastically convenient, but they can increase your chances of hearing loss.

Noise-canceling headphones can also block out background noise, making it easier to lower the volume without the unwanted consequence of external sound creeping in and disrupting your chill.

Match your music to the situation

You probably know what types of music energize you, but certain types of music can offer benefits in specific situations:

• Music with a slow, restrained tempo can promote relaxation and lower stress.
• Classical music can help increase focus, especially when studying.
• Your favorite music can help improve a bad mood.

When to get help

If you feel like you need to rework some of your habits around music but are having a hard time doing so, working with a therapist can be a big help.

A therapist can help you better understand what drives your behaviors around music and come up with healthier ways to address them.

Say you use music to relieve persistent anxiety, but your reliance on music is causing problems in your relationship. A therapist can help you address the causes of your anxiety and find other ways to cope with symptoms in the moment.

It’s also best to talk to a therapist if you notice symptoms of anxiety , depression , or other mental health concerns. Music can certainly help you feel better, but it’s not the same as treatment.

Our guide to therapy for every budget can help you get started.

The bottom line

Feel like you can’t live without music? It’s a pretty common feeling. For most people, music mostly has a positive impact, so listen away. Still, it never hurts to keep an eye (or ear) open for signs that music is causing problems in your life.

Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues.

How we reviewed this article:

• Dingle GA, et al. (2015). The influence of music on emotions and cravings in clients in addiction treatment: A study of two clinical samples. DOI: https://doi.org/10.1016/j.aip.2015.05.005
• Dosseville F, et al. (2012). Music during lectures: Will students learn better? DOI: https://doi.org/10.1016/j.lindif.2011.10.004
• Groarke JM, et al. (2019). Listening to self-chosen music regulates induced negative affect for both younger and older adults. DOI: https://doi.org/10.1371/journal.pone.0218017
• Is anyone listening? Monitoring your teen's headphone volume can help avoid hearing loss (n.d.). https://osteopathic.org/what-is-osteopathic-medicine/headphones-hearing-loss
• Salimpoor V, et al. (2011). Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. DOI: https://www.researchgate.net/deref/http%3A%2F%2Fdx.doi.org%2F10.1038%2Fnn.2726
• Schmuziger N, et al. (2012). Is there addiction to loud music? Findings in a group of non-professional pop/rock musicians. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630946/
• Stewart J, et al. (2019). Music use for mood regulation: Self-awareness and conscious listening choices in young people with tendencies to depression. DOI: https://dx.doi.org/10.3389%2Ffpsyg.2019.01199
• van der Zwaag MD, et al. (2011). The influence of music on mood and performance while driving. DOI: http://doi.org/10.1080/00140139.2011.638403
• Warren M. (2016). The impact of music therapy on mental health. https://www.nami.org/Blogs/NAMI-Blog/December-2016/The-Impact-of-Music-Therapy-on-Mental-Health
• What is addiction? (2017). https://www.psychiatry.org/patients-families/addiction/what-is-addiction

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Why is music so addictive? We have our ancestors to blame…

And addiction would appear to be exactly the right word to use. When we hear a song that we like, our bodies react by producing the neurotransmitter dopamine which engenders feelings of enjoyment. This chemical is also released when we drink a glass of water because we’re thirsty, or after we’ve had sex. In these situations, the body is rewarding actions that increase its chances of survival and reproduction so that our conscious selves will be more likely to repeat the action. So we are addicted to music, at least in the same sense that we are addicted to food, water and sex. But how then does listening to music increase the chances of our genes being passed on to the next generation?

If we were to examine modern society the answer would be that it doesn’t (unless you count the possibility that rock stars of the more promiscuous variety have had ample opportunity to “do a Genghis Khan”). The enjoyment we derive from music is now fixed not just in our genome but in our culture and natural selection have little influence. Instead, the earliest forms of music-making hold the key. An easy answer, as it were, is that musicality is a side-effect of being large brained and part of a learning culture. However this does not explain why it is chemically reinforced with dopamine.

Another theory refers to its roots in tribal settings, where music was often performed in groups and would help strengthen social bonds. Quality of life and technology would benefit from the harmony and groups devoting more time to musical activities might conceivably be in better condition or “fitter” than those groups that don’t. Problems arise, however, with this theory being evolutionary viable. For example, competition between hostile groups would more often than not have been a somewhat violent affair. Surely the early-hominids who spent less time banging sticks together and more time banging heads would win these skirmishes and so the Sinatras of the Stone Age would swiftly die out.

A more convincing argument defines music as an analogue of bird and whale song i.e. a method of communication; a signal. To be favoured by natural selection, a signal must manipulate the behaviour of its receiver in such a way that the benefit to the sender is greater than the cost of producing the signal in the first place. Some of the most elaborate signals in nature have evolved to display the quality of the individual and attract a mate. For example, the fantastical plumage and mating displays of male birds of paradise are only worthwhile if the female is persuaded to mate, the display does not attract predators or competing males, and the male does not just expire from exhaustion before he gets a chance to mate. So what message might early music have conveyed that was so beneficial to the “artist” to justify the time and energy spent perfecting their performance?

As brains became larger and more complex in primates and early-humans, thus it became more important to the survival and fitness of an individual. Growth and maintenance of the brain involves about half of all the genes in our genome, two-third of which are probably expressed no where else. Consequently, somehow conveying the quality of the brain to potential mates would be very informative and very rewarding to our large-noggined ancestors.

As a signal with the potential for immense complexity, music with both rhythm and melody requires fine motor control and a capacity for automating complex learned behaviours. A competent display not only betrays a well developed brain, but also indicates high quality in other traits too: a suitor with time enough to perfect his performance and feed himself is fit enough to provide for a family. Furthermore, as a signal of quality, music is hard to fake. This is fundamental if the signal is to stay the course of evolutionary time; on the whole, prospective mates will only attend to a signal that they can be sure is honest in its message.

And so follows sexual selection: competition between males for mates leads to more complex musical signals, whilst females evolve a preference for them. Perhaps then the dopamine response originally evolved to encourage mating and help them identify good quality signals over just average ones.

Over our evolutionary history music has become ingrained in culture rather than genetics. Grade 8 on the clarinet probably gives little indication of brain size and is, unfortunately, not much of a chat-up line. Yet French anthropologist Claude Levi-Strauss said that “the musical creator is a being comparable to the gods” and he is not wrong: the greatest musical icons are often the most admired and adored in society. How do we explain this? Well my cynical streak suspects that things have come full circle and now sex sells music, rather than the other way around…

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Going For a Song

Can listening to music be addictive.

Posted May 22, 2014

• What Is Addiction?
• Find a therapist to overcome addiction

“Music acts on our emotions and feelings. Drugs act on our emotions and feelings. We generally recognise that the feelings created by drugs are not ‘real’. Does the same apply to music? Is music a drug?” (Philip Dorrell, 2005; author of ‘What is Music? Solving a Scientific Mystery’ )

This opening quote from Philip Dorrell is something that I have pondered many times—especially because people that know me can vouch that I am a self-confessed music obsessive. This blog is based on an article that I had published in an issue of Record Collector magazine on music mania and addiction . Although most lists of manias include ‘musomania’ (i.e., an obsession with music), there is very little in the way of academic or clinical literature on the topic. Jillyn Smith in her 1989 book Senses and Sensibilities interviewed Michael Koss (at the time, the President of the Koss Stereo Headphone Corporation . He was quoted as saying:

“The excitement that people, especially teenagers , get from high-decibel music results from activation of the peripheral nervous system by low frequency sound waves beating against the body…people can get ‘high’ from this feeling, because it switches on the body’s fight or flight mechanism, bringing a rush of adrenalin (a reason for battle music)”

There are certainly anecdotal reports of people being obsessed and/or ‘addicted’ to music’. One notorious case, is a Swedish man in his forties (Roger Tullgren) who receives state benefits from the Employment Service because of his ‘addiction’ to heavy metal music. Tullgren (with the help of three occupational psychologists) campaigned for ten years to get his condition classed as a ‘handicap’ so that he would not be discriminated against. In 2006 he claimed to have attended almost 300 heavy metal gigs and constantly missed work as a consequence. He was then sacked from his job because of his continual inability to turn up for work. With the help of psychologists, his lifestyle was subsequently classed as a disability (which in turn meant he was entitled to wage supplements). He now works at a hotel washing up and has been given a special dispensation to listen to heavy metal while he works. Other Swedish psychologists have found the ruling strange. Quoted in a Swedish newspaper, The Local, one unnamed male psychologist was reported to have said:

"I think it's extremely strange. Unless there is an underlying diagnosis it is absolutely unbelievable that the job centre would pay out. If somebody has a gambling addiction, we don't send them down to the racetrack. We try to cure the addiction, not encourage it”.

Part of me can empathize with Tullgren as I too constantly play music while I am working, and I play my i-Pod whenever I am in transit. However, my love of music has never interfered with my job, and as far as I am concerned there are no negative detrimental effects as a consequence of my excessive listening to music. However, that doesn’t mean that some people may not be addicted to music. In an online essay, Philip Dorrell explored the question theoretically and noted:

“For drugs like heroin, the notion of addiction is relatively uncontroversial…For a not-quite-so-strong drug like cocaine, it becomes less clear as to where the boundary between regular use and addiction lies. Looking at the more popular alcohol, some people get addicted to it, and some don't…There is the weaker notion of "psychological dependence", which implies that you will miss not having something, but not to the extent that you would deem yourself to be suffering. I think that might be a fair description of many people's relationship with music…So, is music a drug? The short answer is ‘yes, sort of’”.

For Dorrell, the long answer to the question of whether music is a drug is that (theoretically) music could be considered “similar in the strength and nature of its effects to a mild recreational drug” because (i) it generates ‘false’ feelings, (ii) the maximum level of effect is roughly equivalent to a couple of ‘standard’ alcoholic drinks, (iii) it is not strictly addictive, but may cause psychological dependence, and (iv) excessive consumption can cause some health problems.

I have operationally defined addictive behaviour as any behaviour that features what I believe are the six core components of addiction (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict and relapse ). I argue that any behaviour (e.g., excessive listening to music) that fulfils these six criteria can be operationally defined as an addiction. Theoretically, and in relation to “music addiction”, the six components would therefore be:

• Salience – This occurs when music becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour). For instance, even if the person is not actually listening to music they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with music).

• Mood modification – This refers to the subjective experiences that people report as a consequence of listening to music and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).

• Tolerance – This is the process whereby increasing amounts of listening to music are required to achieve the former mood modifying effects. This basically means that for someone engaged in listening to music, they gradually build up the amount of the time they spend listening to music every day.

• Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to listen to music because they are without their i-Pod or have a painful ear infection.

• Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (work, social life , other hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time listening to music.

• Relapse – This is the tendency for repeated reversions to earlier patterns of excessive music listening to recur and for even the most extreme patterns typical of the height of excessive music listening to be quickly restored after periods of control.

I have also argued that the temporal dimension and context of the addiction needs to be taken into account. With regard to the temporal dimension, most people can think of periods in their lives when listening to music has taken over for a short time (e.g., listening to music 12- to 16-hour days for a month). This alone does not mean that such people are addicted to listening to music. To be genuinely addictive, the activity must be something that has been sustained and have been going on over a long period of time. The difference between a healthy excessive enthusiasm and an addiction is that healthy excessive enthusiams add to life whereas addiction takes away from it.

Most recently, a 2011 study published in Nature Neuroscience reported that on a neurochemical level, the pleasurable experience of listening to music releases the neurotransmitter dopamine that is important for the pleasures associated with rewards such as food, psychoactive drugs and money. This led to many headlines in newspapers along the lines of “people who say that they are ‘addicted’ to music are not lying ”.

In their study, Dr. Valorie Salimpoor and her colleagues (at Montreal’s McGill University in Canada), measured dopamine release in response to music that elicited "chills". Participants in their experiments were asked to listen to their favourite songs while their brains were being observed using a neuro-imaging technique known as Position Emission Tomography (PET). They found that changes in heart rate, skin conductance, temperature, and breathing, were correlated with how pleasurable the music was. Furthermore, their findings suggested that dopamine release was greater for pleasurable music when compared to “neutral” music. In newspaper interviews, Dr Salimpoor said:

“Dopamine is important because it makes us want to repeat behaviors. It’s the reason why addictions exist, whether positive or negative. In this case, the euphoric ‘highs’ from music are neurochemically reinforced by our brain so we keep coming back to them. It’s like drugs. It works on the same system as cocaine. It’s working on the same systems of addiction, which explain why we’re willing to spend so much time and money trying to achieve musical experiences. This is the first time that we’ve found dopamine release in response to an aesthetic stimulus. Aesthetic stimuli are largely cognitive in nature. It’s not the music that is giving us the ‘rush.' It’s the way we’re interpreting it”.

The team also reported that just the anticipation of pleasurable music led to increased dopamine release. Therefore, this helps explain why individuals (like myself) continually repeat songs or albums all the time as we want to re-experience those sensations repeatedly.

References and further reading

Dorrell, P. (2005). Is music a drug? 1729.com, July 3. Located at: http://www.1729.com/blog/IsMusicADrug.html

Dorrell, P. (2005). What is Music? Solving a Scientific Mystery. Located at: http://whatismusic.info/ .

Griffiths, M.D. (2012). Music addiction. Record Collector , 406 (October), p.20.

The Local (2007). Man gets sick benefits for heavy metal addiction. June 19. Located at: http://www.thelocal.se/7650/20070619/

Morrison, E. (2011). Researchers show why music is so addictive. Medhill Reports, January 21. Located at: http://news.medill.northwestern.edu/chicago/news.aspx?id=176870

Salimpoor, V.N., Benovoy, M., Larcher, K. Dagher, A. & Zatorre, R.J. (2011). Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nature Neuroscience, 14, 257–262.

Smith, J. (1989). Senses and Sensibilities. New York: Wiley.

Mark Griffiths, Ph.D., is a chartered psychologist and Director of the International Gaming Research Unit in the Psychology Division at Nottingham Trent University.

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Since 2006, two UCF professors — neuroscientist Kiminobu Sugaya and world-renowned violinist Ayako Yonetani — have been teaching one of the most popular courses in The Burnett Honors College. “Music and the Brain” explores how music impacts brain function and human behavior, including by reducing stress, pain and symptoms of depression as well as improving cognitive and motor skills, spatial-temporal learning and neurogenesis, which is the brain’s ability to produce neurons. Sugaya and Yonetani teach how people with neurodegenerative diseases such as Alzheimer’s and Parkinson’s also respond positively to music.

“Usually in the late stages, Alzheimer’s patients are unresponsive,” Sugaya says. “But once you put in the headphones that play [their favorite] music, their eyes light up. They start moving and sometimes singing. The effect lasts maybe 10 minutes or so even after you turn off the music.”

This can be seen on an MRI, where “lots of different parts of the brain light up,” he says. We sat down with the professors, who are also husband and wife, and asked them to explain which parts of the brain are activated by music.

How the Brain Responds to Music

Click on the region of the brain to the right to learn more about how it effects your perception of music.

• Frontal Lobe

Used in thinking, decision-making and planning

“The frontal lobe is the most important to being a human. We have a big frontal lobe compared to other animals. By listening to music, we can enhance its functions,” Sugaya says.

• Temporal Lobe

Processes what we hear

“We use the language center to appreciate music, which spans both sides of the brain, though language and words are interpreted in the left hemisphere while music and sounds are inerpreted in the right hemisphere,” Yonetani says.

• Broca’s Area

Enables us to produce speech

“We use this part of the brain to express music,” Yonetani says. “Playing an instrument may improve your ability to communicate better.”

• Wernicke’s Area

Comprehends written and spoken language

“We use this part of the brain to analyze and enjoy music,” Yonetani says.

• Occipital Lobe

Processes what we see

“Professional musicians use the occipital cortex, which is the visual cortex, when they listen to music, while laypersons, like me, use the temporal lobe — the auditory and language center. This suggests that [musicians] might visualize a music score when they are listening to music,” Sugaya says.

Coordinates movement and stores physical memory

“An Alzheimer’s patient, even if he doesn’t recognize his wife, could still play the piano if he learned it when he was young because playing has become a muscle memory. Those memories in the cerebellum never fade out,” Sugaya says.

• Nucleus Accumbens

Seeks pleasure and reward and plays a big role in addiction, as it releases the neurotransmitter dopamine

“Music can be a drug — a very addictive drug because it’s also acting on the same part of the brain as illegal drugs,” Sugaya says. “Music increases dopamine in the nucleus accumbens, similar to cocaine.”

Processes and triggers emotions

“Music can control your fear, make you ready to fight and increase pleasure,” Yonetani says. “When you feel shivers go down your spine, the amygdala is activated.”

• Hippocampus

Produces and retrieves memories, regulates emotional responses and helps us navigate. Considered the central processing unit of the brain, it’s one of the first regions of the brain to be affected by Alzheimer’s disease, leading to confusion and memory loss.

“Music may increase neurogenesis in the hippocampus, allowing production of new neurons and improving memory,” Yonetani says.

• Hypothalamus

Maintains the body’s status quo, links the endocrine and nervous systems, and produces and releases essential hormones and chemicals that regulate thirst, appetite, sleep, mood, heart rate, body temperature, metabolism, growth and sex drive — to name just a few

If you play Mozart, for example, “heart rate and blood pressure reduce,” Sugaya says.

• Corpus Callosum

Enables the left and right hemispheres to communicate, allowing for coordinated body movement as well as complex thoughts that require logic (left side) and intuition (right side)

“As a musician, you want to have the right-hand side and the left-hand side of the brain in coordination, so they talk to each other,” Sugaya says. This allows pianists, for example, to translate notes on a sheet to the keys their fingers hit to produce music.

Processes rhythm and regulates body movement and coordination

“Music can increase dopamine in this area, and music increases our response to rhythm,” Yonetani says. “By doing this, music temporarily stops the symptoms of Parkinson’s disease. Rhythmic music, for example, has been used to help Parkinson’s patients function, such as getting up and down and even walking because Parkinson’s patients need assistance in moving, and music can help them kind of like a cane. Unfortunately, after the music stops, the pathology comes back.”

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The Transformative Power of Music in Mental Well-Being

• August 01, 2023
• Healthy living for mental well-being, Patients and Families, Treatment

Music has always held a special place in our lives, forming an integral part of human culture for centuries. Whether we passively listen to our favorite songs or actively engage in music-making by singing or playing instruments, music can have a profound influence on our socio-emotional development and overall well-being.

Recent research suggests that music engagement not only shapes our personal and cultural identities but also plays a role in mood regulation. 1 A 2022 review and meta-analysis of music therapy found an overall beneficial effect on stress-related outcomes. Moreover, music can be used to help in addressing serious mental health and substance use disorders. 2 In addition to its healing potential, music can magnify the message of diversity and inclusion by introducing people to new cultures and amplifying the voice of marginalized communities, thereby enhancing our understanding and appreciation for diverse communities.

Healing Trauma and Building Resilience

Many historically excluded groups, such as racial/ethnic and sexual minorities and people with disabilities, face systemic injustices and traumatic experiences that can deeply impact their mental health. Research supports the idea that discrimination, a type of trauma, increases risk for mental health issues such as anxiety and depression. 3

Music therapy has shown promise in providing a safe and supportive environment for healing trauma and building resilience while decreasing anxiety levels and improving the functioning of depressed individuals. 4 Music therapy is an evidence-based therapeutic intervention using music to accomplish health and education goals, such as improving mental wellness, reducing stress and alleviating pain. Music therapy is offered in settings such as schools and hospitals. 1 Research supports that engaging in music-making activities, such as drumming circles, songwriting, or group singing, can facilitate emotional release, promote self-reflection, and create a sense of community. 5

Empowerment, Advocacy and Social Change

Music has a rich history of being used as a tool for social advocacy and change. Artists from marginalized communities often use music to shed light on social issues (.pdf) , challenge injustices, and inspire collective action. By addressing topics such as racial inequality, gender discrimination, and LGBTQ+ rights, music becomes a powerful medium for advocating for social justice and promoting inclusivity. Through music, individuals can express their unique experiences, struggles, and triumphs, forging connections with others who share similar backgrounds. Research has shown that exposure to diverse musical genres and artists can broaden perspectives, challenge stereotypes, and foster empathy among listeners especially when dancing together. 7

Genres such as hip-hop, reggae, jazz, blues, rhythm & blues and folk have historically served as platforms for marginalized voices, enabling them to reclaim their narratives and challenge societal norms. The impact of socially conscious music has been observed in movements such as civil rights, feminism, and LGBTQ+ rights, where songs have played a pivotal role in mobilizing communities and effecting change. Music artists who engage in activism can reach new supporters and help their fans feel more connected to issues and motivated to participate. 6

Fostering Social Connection and Support

Music can also serve as a catalyst for social connection and support, breaking down barriers and bridging divides. Emerging evidence indicates that music has the potential to enhance prosocial behavior, promote social connectedness, and develop emotional competence. 2 Communities can leverage music’s innate ability to connect people and foster a sense of belonging through music programs, choirs, and music education initiatives. These activities can create inclusive spaces where people from diverse backgrounds can come together, collaborate, and build relationships based on shared musical interests. These experiences promote social cohesion, combat loneliness, and provide a support network that can positively impact overall well-being.

Musicians and Normalizing Mental Health

Considering the healing effects of music, it may seem paradoxical that musicians may be at a higher risk of mental health disorders. 8 A recent survey of 1,500 independent musicians found that 73% have symptoms of mental illness. This could be due in part to the physical and psychological challenges of the profession. Researchers at the Max Planck Institute for Empirical Aesthetics in Germany found that musically active people have, on average, a higher genetic risk for depression and bipolar disorder.

Commendably, many artists such as Adele, Alanis Morrisette, Ariana Grande, Billie Eilish, Kendrick Lamar, Kid Cudi and Demi Lovato have spoken out about their mental health battles, from postpartum depression to suicidal ideation. Having high-profile artists and celebrities share their lived experiences has opened the conversation about the importance of mental wellness. This can help battle the stigma associated with seeking treatment and support.

Dr. Regina James (APA’s Chief of the Division of Diversity and Health Equity and Deputy Medical Director) notes “Share your story…share your song and let's help each other normalize the conversation around mental wellness through the influence of music. My go-to artist for relaxation is jazz saxophonist, “Grover Washington Jr” …what’s yours?” Submit to [email protected] to get featured!

More on Music Therapy

• Music Therapy Fact Sheets from the American Music Therapy Association
• Music Therapy Resources for Parents and Caregivers from Music Therapy Works

By Fátima Reynolds DJ and Music Producer Senior Program Manager, Division of Diversity and Health Equity American Psychiatric Association

• Gustavson, D.E., et al. Mental health and music engagement: review, framework, and guidelines for future studies. Transl Psychiatry 11, 370 (2021). https://doi.org/10.1038/s41398-021-01483-8
• Golden, T. L., et al. (2021). The use of music in the treatment and management of serious mental illness: A global scoping review of the literature. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.649840
• Schouler-Ocak, M., et al. (2021). Racism and mental health and the role of Mental Health Professionals. European Psychiatry, 64(1). https://doi.org/10.1192/j.eurpsy.2021.2216
•  Aalbers, S., et al. (2017). Music therapy for Depression. Cochrane Database of Systematic Reviews, 2017(11). https://doi.org/10.1002/14651858.cd004517.pub3
• Dingle, G. A., et al. (2021). How do music activities affect health and well-being? A scoping review of studies examining Psychosocial Mechanisms. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.713818
• Americans for the Arts. (n.d.). A Working Guide to the Landscape of Arts for Change. Animating Democracy. http://animatingdemocracy.org/sites/default/files/Potts%20Trend%20Paper.pdf
• Stupacher, J., Mikkelsen, J., Vuust, P. (2021). Higher empathy is associated with stronger social bonding when moving together with music. Psychology of Music, 50(5), 1511–1526. https://doi.org/10.1177/03057356211050681
• Wesseldijk, L.W., Ullén, F. & Mosing, M.A. The effects of playing music on mental health outcomes. Sci Rep 9, 12606 (2019). https://doi.org/10.1038/s41598-019-49099-9

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The link between drugs and music explained by science

Lecturer in mental health and addiction, University of York

Professor in Substance Use, Liverpool John Moores University

Lecturer, University of Liverpool

Disclosure statement

Ian Hamilton is affiliated with Alcohol research UK.

Harry Sumnall is an unpaid member of the UK Government Advisory Council on the Misuse of Drugs (ACMD); an unpaid Trustee of the drug and alcohol charity Mentor UK; and an unpaid Board Member of the European Society for Prevention Research. He receives grants for alcohol and other drug research. This piece represents his personal view only.

Suzi Gage receives or has reeived funding from CRUK, the MRC and the Wellcome Trust to conduct research in to links between recreational drugs and mental health.

University of Liverpool provides funding as a founding partner of The Conversation UK.

University of York and Liverpool John Moores University provide funding as members of The Conversation UK.

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For centuries, musicians have used drugs to enhance creativity and listeners have used drugs to heighten the pleasure created by music. And the two riff off each other, endlessly. The relationship between drugs and music is also reflected in lyrics and in the way these lyrics were composed by musicians , some of whom were undoubtedly influenced by the copious amounts of heroin, cocaine and “reefer” they consumed, as their songs sometimes reveal.

Acid rock would never have happened without LSD, and house music, with its repetitive 4/4 beats, would have remained a niche musical taste if it wasn’t for the wide availability of MDMA (ecstasy, molly) in the 1980s and 1990s.

And don’t be fooled by country music’s wholesome name. Country songs make more references to drugs than any other genre of popular music, including hip hop.

Under the influence

As every toker knows, listening to music while high can make it sound better. Recent research, however, suggests that not all types of cannabis produce the desired effect . The balance between two key compounds in cannabis, tetrahydrocannabinol and cannabidiols, influence the desire for music and its pleasure. Cannabis users reported that they experienced greater pleasure from music when they used cannabis containing cannabidiols than when these compounds were absent.

Listening to music – without the influence of drugs – is rewarding , can reduce stress (depending upon the type of music listened to) and improve feelings of belonging to a social group. But research suggests that some drugs change the experience of listening to music.

Clinical studies that have administered LSD to human volunteers have found that the drug enhances music-evoked emotion, with volunteers more likely to report feelings of wonder, transcendence, power and tenderness. Brain imaging studies also suggest that taking LSD while listening to music, affects a part of the brain leading to an increase in musically inspired complex visual imagery.

Pairing music and drugs

Certain styles of music match the effects of certain drugs. Amphetamine, for example, is often matched with fast, repetitive music, as it provides stimulation, enabling people to dance quickly. MDMA’s (ecstasy) tendency to produce repetitive movement and feelings of pleasure through movement and dance is also well known.

An ecstasy user describes the experience of being at a rave :

I understood why the stage lights were bright and flashing, and why trance music is repetitive; the music and the drug perfectly complemented one another. It was as if a veil had been lifted from my eyes and I could finally see what everyone else was seeing. It was wonderful.

There is a rich representation of drugs in popular music, and although studies have shown higher levels of drug use in listeners of some genres of music, the relationship is complex. Drug representations may serve to normalise use for some listeners, but drugs and music are powerful ways of strengthening social bonds. They both provide an identity and a sense of connection between people. Music and drugs can bring together people in a political way, too, as the response to attempts to close down illegal raves showed.

People tend to form peer groups with those who share their own cultural preferences, which may be symbolised through interlinked musical and substance choices. Although there are some obvious synergies between some music and specific drugs, such as electronic dance music and ecstasy, other links have developed in less obvious ways . Drugs are one, often minor, component of a broader identity and an important means of distinguishing the group from others.

Although it is important not to assume causality and overstate the links between some musical genres and different types of drug use, information about preferences is useful in targeting and tailoring interventions, such as harm reduction initiatives, at music festivals .

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Addiction to Music is as Real as Addiction to Drugs

The human response to music is widely recorded and integral to the well-being and identity of every culture throughout history. While we understand the importance of music, we don’t fully comprehend how music affects the brain, or to what degree it is actually addictive. A recent scientific study offers evidence that music addiction is as real as drug or sex addiction.

Why do humans love to listen to the same types of music, or even the same songs, over and over? A study by Valorie Salimpoor and Robert Zatorre, neuroscientists at McGill University, investigated the ways in which dopamine affects the brain while music is playing. They also measured body temperature and heart rate.

With their brains under observation via Position Emission Tomography (PET) subjects listened to their favorite music while scientists observed dopamine release. The subjects were instructed to press a button during times in the music when they felt chills or excitement. Researchers recorded an increase in dopamine when the subjects were anticipating certain parts of their favorite music. The brain’s limbic system, which governs its response to emotion, reacted to the peak moment when subjects pressed their buttons to signify that they were experiencing a music-induced high. Salimpoor notes, “the euphoric ‘highs’ from music are neuro-chemically reinforced by our brain so we keep coming back to them. It’s like drugs. It works on the same system as cocaine.”

The human response to music is well documented throughout history. Research into the physical effects of listening to familiar music and the topic of music addiction is fairly new, however. Dopamine release is commonly associated with a human response to the fulfillment of needs. This type of brain activity is a hard wired survival mechanism. The McGill University study shows us that music, an abstract stimulus, is worthy of further study, as is the human response to aesthetic stimulus. Humans are likely evolving to better process and enjoy this type of external stimulus, making it crucial to achieving a higher quality of life.

Humans go to great lengths and spend vast amounts of time, money, and effort, in order to experience the ideal musical experience. One modern example of a deep seated fan culture is the legendary Deadheads. This group of people followed the Grateful Dead all over North America throughout the 1970s, 1980s, and 1990s, in an effort to see as many shows as possible. This community eventually began using the term “X Factor” to express how their experiences at Grateful Dead shows became something more than just listening to music. Blair Jackson, Jerry Garcia’s biographer said, “for many Deadheads, the band was a medium that facilitated experiencing other planes of consciousness and tapping into deep, spiritual wells that were usually the province of organized religion ... [they] got people high whether those people were on drugs or not."  

The collective obsession with replicated music via high-end stereo systems and expensive portable electronics illustrates the overwhelming need to keep favorite music, including motivational or comforting playlists, close at hand. According to a recent Nielsen study, 40 percent of Americans claim 75 percent of music spending. Could the 40 percent be music addicts? This group of super-fans also indicate that they are willing to spend more. Premium services like pre-orders, limited editions, original lyric sheets from the artist, and other exclusive extras prompt them to open their wallets wider for a better music-buzz.

Thankfully, there is no conclusive research proving that our collective addictive response to music is harmful. In fact, dopamine release is vital to humanity’s survival and ongoing happiness. While addictive drugs may break down the human body in various ways, music only lifts spirits and encourages community.

SOURCES: 

Anatomically distinct dopamine release during anticipation and experience of peak emotion to music

http://www.nature.com/neuro/journal/v14/n2/abs/nn.2726.html

Addiction Watch: If Love is a Drug, Can Music be One Too?

http://newsfeed.time.com/2011/01/11/addiction-watch-if-love-is-a-drug-can-music-be-one-too/

Blair Jackson

http://www.blairjackson.com/about.htm

Nielson Study: Music fans could spend up to $2.6B more annually

http://www.nielsen.com/us/en/insights/news/2013/turn-it-up--music-fans-could-spend-up-to--2-6b-more-annually.html

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Effects of music therapy and music-based interventions in the treatment of substance use disorders: A systematic review

Louisa hohmann.

1 Department for Educational Sciences and Psychology, Freie Universität, Berlin, Germany

2 Department for Biological and Medical Psychology, University of Bergen, Bergen, Norway

3 Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, United States of America

Thomas Stegemann

4 Department of Music Therapy, University of Music and Performing Arts, Vienna, Austria

Stefan Koelsch

Associated data.

All relevant data are within the paper and its Supporting Information files. Our study is a systematic review so that there are no primary data sets. Our analyses are based on summaries of the primary studies. These are included in tables in the manuscript. Additionally, the supporting information file contains a Prisma Checklist.

Music therapy (MT) and music-based interventions (MBIs) are increasingly used for the treatment of substance use disorders (SUD). Previous reviews on the efficacy of MT emphasized the dearth of research evidence for this topic, although various positive effects were identified. Therefore, we conducted a systematic search on published articles examining effects of music, MT and MBIs and found 34 quantitative and six qualitative studies. There was a clear increase in the number of randomized controlled trials (RCTs) during the past few years. We had planned for a meta-analysis, but due to the diversity of the quantitative studies, effect sizes were not computed. Beneficial effects of MT/ MBI on emotional and motivational outcomes, participation, locus of control, and perceived helpfulness were reported, but results were inconsistent across studies. Furthermore, many RCTs focused on effects of single sessions. No published longitudinal trials could be found. The analysis of the qualitative studies revealed four themes: emotional expression, group interaction, development of skills, and improvement of quality of life. Considering these issues for quantitative research, there is a need to examine social and health variables in future studies. In conclusion, due to the heterogeneity of the studies, the efficacy of MT/ MBI in SUD treatment still remains unclear.

Introduction

The misuse of legal and illegal substances is a significant problem in modern societies. For example, in the United States, the estimated 12-months prevalence rates for addictions in 2014 were 3.0% for alcohol and 1.9% for illicit drugs [ 1 ]. Use and misuse of alcohol and drugs are associated with a variety of health, social, and economic disadvantages for the users themselves and others (e.g., family, friends, community, environment, and country [ 2 ]). Treatment programs for patients with substance use disorders (SUD) include body detoxification, pharmaceutical, psychosocial, and psychotherapeutic treatment, and recovery management [ 3 ]. Nevertheless, only a minority of people with SUD, i.e., about 10%, receives such professional help [ 4 ]. Moreover, the treatment completion rates are low (i.e., 47% in the USA in 2006 [ 5 ]) and the relapse rates are high (40–60% [ 6 ]). Thus, there is still need to improve addiction treatment.

Standard psychological treatments mostly consist of verbal therapies such as cognitive behavior therapy, motivational interviewing, and relapse prevention [ 7 ]. In addition, complementary and alternative medical therapies are utilized to allow for creative and expressive ways to address issues. Music therapy is one of such non-mainstream therapies [ 8 ]. According to the American Music Therapy Association [ 9 ], music therapy is defined as 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”. Therefore, in this review, the term music therapy (MT) is used only for studies where music therapists were involved in the delivery of the intervention; for studies where the intervention was delivered without participation of music therapists, or their participation remains unclear, we will use the term music-based intervention (MBI). Furthermore, we include studies examining the effect of music stimuli presentation without presence of persons therapeutically guiding the interventions, which are referred to as music presentation (MP) studies.

How can MT/ MBI help patients with SUD? Compared to commonly used verbal psychological therapies, MT and MBI provide different opportunities for self-expression, cooperative group activity, imagination, and synchronized sensorimotor experience [ 10 ]. In addition to that, there is evidence of beneficial impact of MT/ MBI on mood [ 11 , 12 ], stress [ 13 ], self-esteem [ 14 ], motivation [ 15 ], emotional expression [ 16 ], and social cohesion [ 17 ]. Furthermore, MT/ MBIs appear to address general challenges of SUD treatment: For instance, in a study with patients with SUD and comorbid severe mental illnesses MT appreciation was associated with benefits in global functioning and motivation [ 15 ]. For patients with non-organic mental disorders and low treatment motivation positive effects of an individual three month MT program on negative symptoms, global functioning, clinical global impressions, social avoidance and vitality were reported [ 18 ]. Furthermore, for subgroups of addicted patients with special needs (e.g., women and adolescents [ 8 ]) MT/ MBI led to improvements in anxiety [ 19 ] and internal locus of control [ 20 ].

To clarify the clinical efficacy of MT/ MBIs in addiction treatment, a summary of their effects is warranted. Although there are many reports about the effects of MT/ MBI in patients with SUD in single studies, no meta-analyses are yet available on this topic. In 2008, Mays, Clark, and Gordon [ 21 ] systematically reviewed the use of MT for patients with SUD and emphasized a lack of evidence. In their review, they included five quantitative studies that greatly varied in terms of treatment settings, frequency, duration, persons guiding the session, and outcome variables. Furthermore, outcomes like drug consumption or long-term abstinence were not assessed in these studies. Therefore, the treatment effects of MT were primarily related to participants’ attitudes and emotions. In line with that, most of the MT studies in SUD treatment met the criteria of lower levels of evidence according to evidence-based practice hierarchies, indicating that high-quality research has not been conducted [ 22 ].

In this paper, we aimed to address the research question of whether MT and MBIs are clinically effective for people with substance use disorders (SUD) by reviewing the current state of research regarding this topic. Because little is known about the key outcomes affected by MT/ MBIs in patients with SUD [ 21 ], we evaluated the existing evidence to summarize the benefits of music interventions for this population.

Criteria for considering studies for this review

Types of studies.

We included all types of studies with quantitative or qualitative data assessed in a systematic way, e.g., by at least semi-structured interviews, video-taping, or questionnaires. We decided not to limit our inclusion criteria to randomized controlled trials (RCTs), even though there are many scholars who recommend focusing on this type of study for systematic reviews and meta-analyses [ 22 , 23 ]. We based this decision on the following rationale: (1) Silverman [ 22 ] and Mays et al. [ 21 ] emphasized the lack of RCTs available for our research question, and this is still valid at present; (2) for rare conditions and difficult clinical investigations (such as music therapy in psychiatry) the inclusion of other study types (such as case studies or case-control studies) is recommended because they may be the only available evidence [ 24 ]; (3) Furthermore, qualitative studies are useful to examine perspectives and experiences [ 22 , 25 ].

We also included MP studies examining the effects of music stimuli presentation on people with SUD without the presence of a music therapist or other persons therapeutically guiding the music intervention.

Types of participants

We considered studies that included patients or clients with SUD, regardless of age, gender or comorbid disorders. Studies examining subgroups like women or adolescents were included as well. If it was unclear whether all participants suffered from SUD (e.g., a study on residents and staff members of a rehabilitation center [ 26 ]), those studies were excluded. If separate conclusions about patients with and without SUD were drawn, those studies were included.

Types of interventions

All studies examining MT, MBI or MP were included. Articles were excluded if combined programs with music and other complementary approaches were used (e.g., combinations of art, video, music, group therapy, and individual counseling [ 27 ]) as this would not allow for the identification of separate effects of MT/ MBI/ MP.

Types of outcome measures

Similar to Mays et al. [ 21 ], we included all outcomes. For a listing of the outcomes included in the study, see Table 1 .

Search methods for identification of studies

First, we identified articles by conducting a literature search in the electronic databases ISI Web of Knowledge and Scopus on 1 st April, 2016. We used the search term “(music therapy AND addiction) OR (music therapy AND substance use disorder) OR (music therapy AND substance abuse) OR (music therapy AND alcohol*) OR (music AND intervention AND addiction)) OR (music AND intervention AND substance use disorder) OR (music AND intervention AND substance abuse) OR (music AND intervention AND alcohol*) ”. After deleting duplicate studies, we scanned the abstracts to include only articles published in English, focusing on MT/ MBI or MP and participants with SUD. Additionally, the bibliographies of the remaining records were scanned for further studies. Articles without systematic data assessment were excluded. Remaining sources were further subdivided with respect to the type of music/ intervention that was examined: (1) studies examining effects of the presentation of music stimuli without application of MT/ MBI (MP studies), (2) studies investigating one session of MT/ MBI, and (3) studies examining more than one session of MT/ MBI. With respect to category (1), for example examinations of simple listening to music without the presence of therapists or other persons guiding the session or experiments were included.

Data collection and analysis

General preparing procedure.

A review protocol does not exist. All unique articles (i.e. duplicates removed) were listed in a table. After their abstracts were scanned, we indicated whether or not the studies met the inclusion criteria listed above. Full texts of studies that met the inclusion criteria were analyzed. The study characteristics and results were summarized in separate tables.

Many studies included similar outcomes but used different terminology. Outcomes that were very similar were clustered under one common outcome term. For example, the outcomes depression, depressiogenic thought frequency, and feeling depressed were clustered under the outcome “depression” (See Table 1 for labels and included variables). For all studies, we extracted design aspects as well as statistical data. Based on this data, we examined if meta-analytic calculations would be useful.

We used three different types of data summary: (1) a description of the effects of MT/ MBI for the quantitative studies separated by outcomes, (2) a summary of effects of MT/ MBI/ MP for the quantitative studies separated by study characteristics, (3) a summary of the topics and themes described in the qualitative studies.

We did not conduct a meta-analysis due to the following reasons. First, according to the Cochrane systematic review guidelines [ 23 ], combining studies that use different types of control conditions may lead to meaningless results. After separating the studies per type of control condition, there were too few studies per outcome to allow for meta-analysis. Second, predominantly including studies by the same authors in the same meta-analysis would violate the assumption of independence of study reports [ 28 ]. As most of the studies with similar comparison designs were conducted by Silverman [ 29 – 37 ], there was too much dependency on the hierarchical level. A more detailed description of reasons for not conducting a meta-analysis is provided in the Results section below.

Descriptive summaries

We aimed to give an overview of the efficacy of MT/ MBI per outcome in consideration of the quality of the studies. To this end, we created a categorization system (see Fig 1 ) based on an evidence-based practice (EBP) taxonomy by Melnyk and Fineout-Overholt [ 52 ] that was developed for the nursing profession. As MT and nursing contexts appear to be similarly diverse, Silverman [ 22 ] recommended the use of this taxonomy when examining EBP for MT. This hierarchy contains seven levels of evidence with (I) being the highest rank and (VII) being the lowest rank in research. The articles we collected for our review did not cover the whole range. Therefore, we refer to Melnyk and Fineout-Overholt’s following levels: (II) well-designed RCTs, (III) well-designed controlled trials without randomization, and (VI) single descriptive or qualitative study. Based on these levels, we developed four main categories for our categorization system: (1) studies without reporting all necessary statistical data to compute a meta-analysis (e.g., means, standard deviations, sample sizes), (2) studies without a control group (CG), (3) non-randomized studies with CG, and (4) RCTs. Categories (3) and (4) are further subdivided into (3a)/ (4a) studies that reported no beneficial treatment effects of MT/ MBI and (3b)/ (4b) studies that reported treatment benefits of MT/MBI compared to a CG. For an overview of the categorization procedure see Fig 1 . To draw conclusions about MT/ MBI efficacy, RCTs are necessary [ 25 ]. Thus, studies fitting in categories (4a) and (4b), which are matching level (II) of Melnyk and Fineout-Overholt’s taxonomy, are categorized as high level evidence of efficacy . Categories (3a) and (3b) match level (III) in the EBP taxonomy, and categories (1) and (2) match level (VI), i.e., lower levels of evidence. Thus, the categories (1), (2) and (3a)/(3b) are referred to as of low level evidence of efficacy . Nevertheless, it is important to note that research designs other than RCTs are useful for research as well [ 25 ], so that our taxonomy of low and high level of evidence of efficacy only refers to the assessment of MT/ MBI efficacy.

CG = control group.

For the descriptive summaries we used the following rules: We counted how many unique studies examined a certain outcome (cluster). For studies that included multiple measures (e.g. two different scales) per outcome, data from only one measure was included. This was to avoid artificially inflating the weight of single studies. Articles that reported results of two separate studies within a single publication were used more than once (e.g., [ 20 ]). If different raters (e.g. client ratings and therapist ratings) were included only client ratings were counted. Finally, for studies with repeated measures, only immediate post-intervention scores were used.

Summary of music and MT/ MBI effects

We created separate summaries for (1) MP studies, (2) studies that investigated only one session, and (3) studies that examined the effects of more than one session of MT/ MBI. For each of these three categories a separate table including study characteristics and results was created.

Summary of qualitative articles

Studies were read carefully, and described topics and themes were summarized in a separate table.

Description of the studies

The identification process is displayed in the flow diagram (adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 53 ]) in Fig 2 . Our database search resulted in 383 records (without duplicates), 50 of which met the inclusion criteria. The other records were excluded because (a) they were not written in English ( n = 44), (b) did not include MT/ MBI as single program or MP ( n = 250), or (c) did not primarily focus on SUD ( n = 39). One full-text could not be obtained [ 54 ], therefore it was excluded. Five of the initially included records turned out to be book reviews and conference abstracts, thus they were excluded. Full-texts were obtained for the remaining 44 articles and an additional 16 articles were found in their references lists, resulting in a total of 60 records. Twenty-one of them were descriptive articles without structured qualitative or quantitative data and were excluded.

Thirty-nine records with systematic data collection remained. One article included two quantitative studies [ 20 ], and one consisted of both qualitative and quantitative studies [ 55 ]. Two articles reported about the same dataset [ 16 , 56 ], so that these results were summarized as one study. Altogether, we identified 34 quantitative studies, which were further subdivided with respect to the type of music/ MT that was examined: (1) six studies examined effects of music stimuli presentation without application of MT/ MBI, (2) thirteen studies investigated only one session of MT/ MBI, and (3) fifteen studies examined more than one session of MT/ MBI. Six records included qualitative data obtained through semi-structured interviews, structured or video-taped observations or questionnaires.

Sample and setting characteristics

The characteristics of the studies are summarized in Table 2 for studies that examined the effects of music stimuli presentation, Tables ​ Tables3 3 and ​ and4 4 for quantitative studies about MT/ MBI, and Table 5 for qualitative studies about MT/ MBI. Sample settings and characteristics are presented separately in the following for (a) MT/ MBI studies with both qualitative and quantitative data, and (b) MP studies.

Studies examining the effects of music/ musical production, not including sessions of music therapy held by therapists or other conducting persons. Effect sizes are only listed when reported in the articles. Amp = amphetamines; BP = blood pressure; CC = Control condition; CG = Control group; EG = experimental group; fm = females; JC = Jymmin’ condition; HR = heart rate; HRVm = heart rate volume; m = males; MIP = mood induction procedure; pd = prescription drugs; SUD = substance use disorders

a Frequency counts

* p < .05.

** p < .01.

*** p < .001

All studies included one session only for data analysis. Effect sizes are only listed when reported in the articles. amp = amphetamines; CBMT = cognitive behavioral music therapy; CG = control group; DARTNA = Drum-Assisted Recovery Therapy for Native Americans; EG = experimental group; fm = females; GIM = Guided Imagery and Music therapy; m = males; MBI = music based intervention; MI = mental illness; MT = music therapy; pd = prescription drugs; SOCRATES = The Stages of Change Readiness and Treatment Eagerness Scale; SUD = substance use disorders

b N = 121 completed all measures

c N = 100 completed all measures

*p < .05.

Effect sizes are only listed when reported in the articles. For music-based intervention (MBI) studies, conducting persons are listed in brackets. BDI = Beck Depression Inventory; BSI = Brief Symptom Inventory; CG = control group; EG = experimental group; fm = female; m = male; MBI = music-based intervention; MI = Mental illness; MT = music therapy; pd = prescription drugs; SUD = substance use disorders

a Frequency counts.

b Results based on a criterion of clinical significance, i.e., changes by at least one standard deviation of the mean.

c Results based on scores from 36 participants.

For music-based intervention (MBI) studies, persons conducting the sessions are listed in brackets. MBI = music- based interventions; MT = music therapy.

MT/ MBI studies

For the majority of the studies, sessions were held in group settings, except a single-case study [ 40 ] and one study with individual application of the music-based program [ 41 ]. Most of the studies, i.e., three qualitative and 23 quantitative studies, were classified as “MT studies” (according to the music therapy definition provided in Introduction). With respect to MBIs, one study was conducted by vocal performance majors [ 57 ], one by different artists of the Council of Music [ 58 ], one by a cultural drumming teacher and a substance abuse counselor [ 48 ], one by a social worker [ 44 ], one by a counselor [ 41 ], and in three cases [ 15 , 40 , 55 ] the therapist’s background remained unclear.

Not considering the case study, sample size ranged from 8 participants [ 42 , 47 ] to 188 participants [ 49 ] for the quantitative studies, and from 3 participants [ 59 ] to 20 participants [ 55 ] for the qualitative studies. One quantitative [ 50 ] and one qualitative study [ 58 ] did not report sample sizes.

Six studies examined men only [ 40 , 45 , 50 , 55 , 59 , 60 ] and five women only [ 19 , 41 – 43 , 47 ].

Regarding the diagnosis, many samples included various drug addictions, i.e., polydrug abuse. Other studies only focused on chemical dependency [ 20 , 42 , 47 ], alcohol [ 45 , 50 , 60 ] or inhalant abuse [ 40 ].

With respect to the age of the participants, four studies investigated adolescents only with mean ages/ age ranges between 15 and 17 years [ 20 , 42 ] or as a single case study with a 14-year old boy [ 40 ]. For the other studies, mean age varied from 34.4 years [ 16 ] up to 52.5 years [ 48 ]. Eleven studies [ 16 , 19 , 39 , 43 , 47 , 50 , 51 , 55 , 57 , 58 , 60 ] did not report any measure of central tendency regarding age. In 16 cases [ 15 , 16 , 38 , 39 , 41 , 43 – 49 , 55 , 59 , 60 ] numeric age ranges were reported which varied from 21 years [ 44 ] (31–51 years) to 53 years [ 48 ] (19–71 years).

Music stimuli presentation studies

Sample sizes ranged from 19 participants [ 61 ] to 59 participants [ 62 ].

Two studies examined men only [ 55 , 62 ], and three investigated both men and women. One study did not report any information about gender [ 63 ].

Regarding the diagnosis, three studies focused on alcohol addiction [ 62 – 64 ], and the others included various drug addictions.

Regarding the age, mean age ranged from 31.1 years [ 61 ] to 43.1 years [ 64 ]. Two studies did not report any measures of central tendency [ 55 , 63 ] and one reported a median age of 46.4 years [ 62 ]. Age ranges (when reported) differed only slightly from 28 years [ 65 ] (20–47) to 33 years [ 64 ] (27–59).

Results of quantitative MT/ MBI studies separated by outcomes

For an overview of the efficacy of MT/ MBI per outcome (cluster) in consideration of the quality of the studies see Fig 3 . Studies were classified according to the categorization scheme presented in Fig 1 . None of the studies met the criteria of categories (3a) and (3b), i.e., studies with CG without randomization, so that these categories are not represented in Fig 3 . In the following section, we will describe the results in more detail.

Studies with effect or no effect compared to control group (CG) were classified as of high level evidence of efficacy (black and dark grey bars). Studies reporting insufficient statistical data to conduct meta-analyses and without CG were classified as of low level evidence of efficacy (light grey bars).

For the effect of MT/ MBI on variables related to this cluster (motivation, treatment eagerness, change readiness), 10 results were collected, and eight of them (80%) represent high level evidence of efficacy. For Silverman [ 32 , 34 ] who examined different motivational constructs within the same samples only motivation scores were used. All studies except one reported all statistical data and only one included pilot data without a CG [ 15 ]. In 37.5% of studies of high level evidence of efficacy (3/8), i.e. 30% of all studies (3/10), beneficial effects of MT/ MBI were found. All RCTs except one [ 38 ] were conducted by Silverman [ 29 , 31 – 36 ], and they differed widely with respect to CG designs and scales, so a meta-analysis was not conducted.

This outcome was examined in 11 studies including Howard [ 42 ] which reported on two separate samples. Five studies report insufficient statistical data and four were non-controlled studies, so that only 27% of the results (3/11) were categorized as of high level evidence of efficacy. None of the RCTs found benefits of MT/ MBI compared to CG. A meta-analysis was not conducted due to the different CG designs.

All three data sources of high level evidence of efficacy (i.e., 50% of all studies regarding this outcome) were reported by Silverman [ 29 , 31 , 32 ], so that we did not conduct a meta-analysis. Three further studies of low level evidence of efficacy [ 16 , 46 , 47 ] did not report all necessary statistical data. One out of three RCTs, i.e., 17% of all results (1/6), reported a positive effect of MT on enjoyment.

Withdrawal and craving

We decided to cluster these outcomes as the variables are closely linked. Patients in states of withdrawal often experience craving, and consumption of the substance may immediately and effectively reduce the symptoms [ 37 ]. Silverman [ 30 , 32 , 37 ] conducted three different RCTs examining craving and/or withdrawal in patients addicted to various drugs (e.g., alcohol, heroine, prescription drugs and cocaine). None of the studies showed beneficial effects of MT compared to different CG. A meta-analysis was not conducted because all results were reported by the same author.

MT helpfulness

Forty percent of the results (2/5) were of high level evidence of efficacy, comparing MT to group verbal therapy, and both RCTs were conducted by Silverman [ 31 , 32 ], so a meta-analysis was not appropriate. The lack of statistical details prohibited inclusion in meta-analysis for two further studies [ 44 , 47 ], and another study was a non-controlled study [ 15 ]. All in all, 50% of studies of high level evidence of efficacy, i.e., 20% of all studies (1/5) regarding helpfulness were in favor of MT/ MBI.

Locus of control (LOC)

All three studies considering LOC were RCTs, and two of them [ 20 ] (i.e., 67%) found positive effects of MBI/ MT. A meta-analysis was not conducted due to different CG designs.

Participation

For this category, many different constructs regarding the quantitative assessment of patients’ engagement and participation were subsumed, so six data sources were identified: Only one study included a CG [ 29 ] and did not identify benefits of MT. Furthermore, 50% of all data sources (3/6) did not report all statistical data [ 16 , 49 , 50 ] and 33% (2/6) were non-controlled studies [ 15 , 48 ].

Coping skills

Only one study out of three studies (33%) for this outcome, was of low level evidence of efficacy, i.e., a case study not including a CG [ 40 ]. None of the RCTs [ 36 , 38 ] found benefits of MT for coping skills.

Constructs examined without studies of high level evidence of efficacy

For five outcome clusters, namely anxiety , medical symptoms , anger , sadness , and stress , no RCTs could be identified, so conclusions about efficacy cannot be drawn.

Follow-up investigations

Only one RCT assessed follow-up scores regarding depression, enjoyment, perceived effectiveness and being clean [ 31 ] and did not identify differences between group verbal therapy and MT groups one month after intervention completion.

For at least eight categories of outcomes, studies of high level evidence of efficacy, i.e., RCTs, were identified. The descriptive summaries suggest that there is evidence for benefits of MT/ MBI compared to different control groups (CGs), especially for the variable locus of control (67% positive effects compared to CG). Additionally, regarding perceived helpfulness of the intervention, half of the RCTs reported higher values for MT compared to CG. For motivation and enjoyment there were inconsistent results, and more than half of the studies of high level evidence of efficacy did not identify statistically significant improvement for MT/ MBI participants. Regarding depression, withdrawal/ craving, participation, and coping skills none of the RCTs reported benefits for MT. Studies examining anxiety, medical symptoms, anger, sadness, and stress were all of low level evidence of efficacy, so that their results can only serve as a base for further research giving hints to constructs that should be evaluated with RCTs.

Results of quantitative studies separated by study characteristics

We now describe effects of MP, MT and MBI considering study characteristics according to the following categories: (1) effects of music in general, (2) effects of one session of MT/ MBI, and (3) effects of more than one session of MT/ MBI. Because most of the studies were not RCTs, conclusions about MT efficacy cannot be drawn. Thus, the summaries include descriptions of clinical effectiveness, i.e. the effects in clinical practice [ 67 ].

Studies comparing MT methods (e.g., lyric analysis and songwriting [ 46 ]) did not identify significant differences between the interventions, so that the methods are not differentiated in the following. With respect to the nomenclature, we noticed that regarding mood there is still no consensus, as mood , feelings , and emotions are often used interchangeably. For instance, Jones [ 46 ] refers to the terms “feelings and emotions” (p. 100), only to eventually assess “mood” using a visual analogue mood scale. Thus, due to the heterogeneity of the nomenclature used in the studies, it was not possible to differentiate these terms properly.

Effects of music presentation (MP)

Six studies examined the impact of music on patients with SUD without therapeutical involvement of an interventionist (see Table 2 ). The following effects of listening to music were reported: Short and Dingle [ 61 ] examined the impact of sad, happy, and relaxing songs on arousal in patients with SUD and a healthy control group (CG). Whereas the participants of the CG indicated different degrees of arousal and pleasantness for the three tracks, the SUD patients rated the three pieces of classical music equally arousing and pleasant. Furthermore, their degree of craving was linked to the personal relevance of songs: The patients reported increased craving after listening to a track associated with their substance use, whereas afterwards, listening to a track associated with abstinence resulted in decreased craving. These results indicate less emotional variations in SUD patients and a direct impact of music on relapse related variables. Furthermore, Fritz et al. [ 65 ] reported a strong context dependency of music effects. They conducted a musical feedback intervention with listening to a jointly self-produced music piece or a commercial track. Self-produced music showed positive effects on mood and locus of control (LOC) only when it was presented prior to the commercial music production. Jansma et al. [ 64 ] examined the effect of mood states on alcohol cue reactivity. They induced depressive mood by presentation of depressive music or distressed mood by negative feedback following a high performance task. Alcohol cue reactivity was present, but did not differ between negative or neutral mood states. Nevertheless, the patients were less irritated and more satisfied after depressive mood induction compared to distressing mood induction.

With respect to more abstract outcomes, patients with alcohol dependency perceived colors with greater intensity after listening to music compared to people (patients and staff of a therapeutic community) without exposure to music [ 63 ]. Similarly, music during LSD therapy was associated with colors, geometric designs, and past events. Between groups with and without music exposure, there was no difference in LSD experience. Nevertheless, only listening to familiar music appeared to have an effect on general music preference [ 62 ].

Additionally, there was experimental evidence for positive effects of music listening over a longer period of time. For members of a therapeutic community for drug users, music listening before falling asleep was related to increased sleep quality and mood on the following day as well as to decreased drop-out rate during a one-month-intervention [ 55 ].

Effects of one MT/ MBI session

MT/ MBIs typically include more methods than simply listening to music [ 68 ]. Effects of quantitative studies examining single MT sessions (mostly lyric analysis, songwriting or improvisation) are summarized in Table 3 . Most of them were conducted in detoxification centers with a short duration of stay between three and five days. Compared to a verbal therapy CG, MT participants showed similar measures of change readiness, depression, sobriety [ 31 ], client-rated working alliance [ 29 ], LOC [ 30 ], treatment eagerness, drug avoidance self-efficacy [ 34 ], craving [ 32 ], and withdrawal symptoms [ 30 ]. Silverman compared MT groups to wait-list CGs with pretest only, and found no differences regarding craving and withdrawal [ 37 ]. Positive effects of MT vs. group verbal therapy were found for therapist-rated working alliance [ 29 ], comfort [ 31 ], and motivational variables: MT participants had higher realization that aspects of change can be better than the status quo and more active changes [ 32 ]. In line with that, MT groups showed increased problem recognition, desire for help, treatment readiness, and total motivation compared to a wait-list CG with pretest only [ 33 , 35 ]. Furthermore, Silverman [ 36 ] found higher motivation to reach and maintain sobriety for participants of educational MT compared to patients receiving education without music or a music game. In the same study, treatment eagerness and knowledge of coping skills or triggers did not differ between groups. In three other studies, similar motivation scores between MT groups and verbal therapy or pretest CG were identified [ 29 , 32 , 34 ], indicating that the effects of single MT sessions on motivational aspects are not coherent. Regarding perceived enjoyment and helpfulness, the results were not consistent as well [ 29 , 31 , 32 ].

Other studies with single sessions for data analysis were conducted in an inpatient non-medical detoxification unit [ 46 ], an in- and outpatient rehabilitation unit [ 16 ], an inpatient dual diagnosis treatment unit [ 51 ] and an inpatient gender-specific residential program [ 19 ]. All these studies reported beneficial effects on mood: For instance, 65% of the participants showed a positive mood change [ 16 ]. More specifically, a great amount of the participants reported decreased anxiety [ 19 ], anger, and sadness [ 51 ], and or an increase in acceptance, enjoyment, happiness, and joy [ 46 ]. Furthermore, 87.5% of the participants used MT for mood regulation [ 16 ]. Nevertheless, one study found no differences between pre- and posttest regarding anxiety and depression [ 46 ].

Effects of multiple MT/ MBI sessions on mood

Effects of studies examining more than one session are summarized in Table 4 . Awareness, expression, and change of emotions are often mentioned as important intended therapy goals [ 50 ]. Therefore, five studies in inpatient settings [ 38 , 39 , 42 , 45 , 47 ] and five studies in outpatient settings [ 40 , 41 , 43 , 44 , 49 ] examined treatment effects on mood and emotions. Generally, MT participation was associated with positive mood changes [ 49 ], and the scores for perceived enjoyment and effectiveness of MT were almost at the maximum [ 47 ]. With respect to negative emotions, MT was linked to reduced anger, depression, stress, and anxiety [ 40 , 41 , 43 – 45 ]. Two RCTs identified beneficial effects of MT regarding therapist-reported, but not self-reported depression scores [ 38 , 39 ].

Effects of multiple MT/ MBI sessions on other outcomes

MT and MBI also affected other psychological variables: Adolescents with chemical dependency completing MT showed increased internal LOC compared to a wait-list CG engaging in alternative activities [ 20 ]. Results regarding motivation and coping skills were not clear: While in one RCT similar levels for both variables after standard treatment (CG) and additional Guided Imagery and Music (GIM) therapy were reported [ 38 ], a single case study found improved coping skills and motivation [ 40 ]. This patient had also reduced psychiatric symptoms after the MT intervention. In line with this finding, a cultural-based drumming treatment was associated with improved psychiatric and medical status in Native Americans [ 48 ]. In a non-randomized pilot study conducted in an inpatient treatment for dually diagnosed people with SUD and mental illness, Ross et al. [ 15 ] examined relationships between MT variables, psychiatric symptoms, general functioning, aftercare appointment, and motivation measured by the Stages of Change, Readiness and Treatment Eagerness Scale (SOCRATES). They found positive associations between MT appreciation and global functioning during hospital stay. Therapist appreciation was positively related to changes in global functioning and the Taking Steps subscale of SOCRATES measuring active changes. Furthermore, cross-sectional analyses at discharge revealed associations between MT appreciation and Taking Steps as well as between therapist appreciation and the Ambivalence and Taking Steps subscales of SOCRATES. Although MT variables did not directly predict improvement in psychiatric symptoms, the number of attended sessions was positively related to aftercare appointment in a following outpatient program within one week after hospital discharge. With regard to long-term effects beyond the hospital treatment, MT was also associated with sobriety and reduced substance use in another study [ 48 ]. As this pilot sample consisted of a small number of Native Americans not involved in inpatient settings, it remains unclear whether the results are transferrable to other populations. Nevertheless, MT was associated with beneficial behavioral aspects like high involvement, attendance and on-task behavior in several studies [ 42 , 49 , 50 ]. These findings suggest that MT and MBI may be important tools for recovery in line with the participants’ subjective evaluations of treatment effects and perceived helpfulness.

Qualitative studies

Six qualitative studies examined and described the participants’ reactions, attitudes, and subjective associations in the context of MT and MBI. In four studies, the patients’ behavior during the session was recorded using video-tapes [ 55 , 59 ] therapist’s notes [ 60 , 66 ] and lyric analysis [ 66 ]. Some authors conducted semi-structured interviews [ 57 , 59 ] or used questionnaires that were analyzed qualitatively [ 58 ]. Four general themes were identified: Firstly, music served as a tool for expression of thoughts and feelings. Secondly, in all qualitative studies the role of music and MT/ MBI for group interaction, cohesion, and relationships to others, including the therapist [ 60 ] was emphasized. Thirdly, MT/ MBI were related to the learning of skills regarding music [ 57 ], problem solving [ 66 ], and social interaction [ 59 ]. Finally, MT/ MBIs were associated with benefits for health and quality of life [ 59 ]. In line with the quantitative data, the behavioral observations revealed high engagement and involvement of the participants [ 55 , 59 , 66 ].

In order to address the research question whether music therapy (MT) and music-based interventions (MBIs) are clinically efficient for people with substance use disorders (SUD), we obtained a systematic collection of articles resulting in 34 quantitative and six qualitative studies. Regarding MT/MBI efficacy, we used a descriptive approach to summarize the efficacy evidence of quantitative studies. Furthermore, we summarized effects of exposure to music stimuli, MT and MBIs to describe findings regarding effectiveness. In the following, we discuss these effects, focusing on motivation and on findings regarding the four main themes identified in qualitative analyses. Furthermore, we discuss the quality of the studies. Taken together, the studies do not show clear common effects. Additionally, only few studies have assessed outcomes related to substance use even though such outcomes are critical for treatment success. Thus, variables such as long-term sobriety need to be examined in future studies. Possible mechanisms that may contribute to positive effects of MT/MBI remain to be investigated and specified as well.

Effects of music stimuli presentation

There is evidence for the direct impact of listening to music on emotions and craving without application of MT/ MBI [ 61 ]. In addition, frequent listening to relaxing tracks had a beneficial effect on sleep, mood, and treatment completion [ 55 ]. Neuro-imaging studies have demonstrated that music listening engages many brain structures important for cognitive, emotional, and sensorimotor processing [ 69 ], in particular the mesocorticolimbic system [ 70 , 71 ]. Positive short-term effects on variables like craving may reflect benefits for mental health even on a neurobiological level [ 72 ].

Short-term effects of single MT/ MBI sessions

Apart from the general impact of music stimuli presentation, participation in single MT sessions may result in additional short-term effects. Those are important to examine because many patients with SUD attend detoxification treatments with a low frequency of therapy sessions [ 3 ]. Single MT sessions appear to be as effective as single verbal therapy sessions for various psychological outcomes (e.g., withdrawal, LOC, craving, client-rated working alliance, and depression), and there were higher scores for MT for comfort [ 31 ], therapist-rated working alliance [ 29 ], and some aspects of change readiness [ 32 ]. These findings support the use of MT in short-term treatments for SUD. Results regarding enjoyment, helpfulness, and motivation differed between studies [ 29 , 31 , 32 ], although these aspects may be especially important in short-time interventions. As they may be related to positive therapeutic experiences, these factors may facilitate the participation in additional interventions. Importantly, the only RCT with follow-up assessment did not find any beneficial effects of single MT sessions on depression, enjoyment, perceived effectiveness and sobriety [ 31 ] after a one-month period. Additional longitudinal analyses of single session effects are necessary.

Effects of MT/ MBI on motivation

Lack of motivation is a crucial problem in the treatment of SUD [ 73 ], and beneficial effects of MT and MBI on motivation were commonly described [ 74 , 75 ]. Music itself is motivating and empowering for many people and it has been suggested that engagement in music making may lead to enhanced internal change motivation [ 76 ]. High rates for on-task behavior and engagement reported in qualitative and quantitative studies included in this review support this assumption [ 55 ]. Ten studies quantitatively assessed motivation, and eight of them were RCTs. Most of them investigated single sessions [ 29 – 36 ], and two included longer interventions [ 15 , 38 ]. Despite the positive qualitative reports of patients, not all of these studies identified significant benefits for MT/ MBI. Silverman reported higher treatment and sobriety motivation after MT compared to a wait-list CG with pretest only [ 33 , 35 ], whereas others identified no differences compared to verbal therapy or pretest [ 32 , 34 ]. Different results may be due to different study designs, comparisons or measurement instruments. For instance, a Likert scale for the assessment of motivation revealed similar ratings across groups, whereas the use of a multidimensional scale resulted in higher scores for experimental group than CG in the same sample [ 32 ]. In line with that, most studies with Likert scales did not identify benefits for MT groups [ 32 , 34 , 36 ], whereas the use of some multidimensional instruments revealed significant treatment effects [ 32 , 33 , 35 ]. There is actually no consistent definition for motivation in the context of research on addiction [ 77 ]. Therefore, it is difficult to find an adequate outcome measure capturing all relevant aspects and fitting to the treatment setting. For instance, Silverman [ 33 ] examined treatment motivation and readiness with the Circumstances, Motivation, and Readiness Scales for Substance Abuse Treatment [ 78 ] and did not identify benefits for MT. The use of this instrument as a clinical assessment tool is not recommended [ 77 ] because it was originally developed in the context of a therapeutic community. It is, at this point, not possible to claim that issues with instrument selection are related to incongruence of findings; however, this is certainly an issue worthy of further investigation in future studies.

Prochaska and DiClemente [ 79 ] argued that behavior change always occurs as process with different stages of change, so that differentiating aspects of motivation regarding these stages might be useful. Considering this, beneficial effects of MT on problem recognition, desire for help, treatment readiness, and overall motivation were reported [ 35 ]. Furthermore, there might be a benefit of therapeutic use of music compared to solely music engagement without therapeutic context as MT participants showed higher motivation scores than patients playing a music game instead [ 36 ]. Nevertheless, there were no differences for treatment eagerness in the same study, suggesting that there is need to differentiate between the motivational variables. More RCTs that use the same outcome measures and use the same control group interventions are needed to draw further conclusions.

Examining more than one session of MT, K. M. Murphy [ 38 ] did not identify benefits in motivation for patients with an additional GIM intervention compared to those with standard program only. Because this study did not include a sufficient amount of participants ( N = 16), long-term effects on motivation should be systematically examined in larger samples in more detail.

Effects of MT/ MBI on mood and emotions

In many studies, MT/ MBI had beneficial effects on mood and emotions, i.e., positive mood change, decreased negative emotions, e.g., anxiety, depression, and anger, and increased positive feelings, e.g., enjoyment and happiness. This is in line with the importance of MT for the expression and regulation of feelings, as identified in our qualitative analyses. MT provides opportunities for the exploration and expression of feelings without drugs and appears to be a non-threatening intervention [ 80 ]. Therapist-selected songs as well as songs written or selected by the participants themselves contain aspects related to feelings [ 33 ]. Many music therapy studies have demonstrated that songs may be used as a verbal and nonverbal tool for the exploration of feelings [ 12 , 16 , 46 , 81 , 82 ]. Jones reported that over the course of lyric analysis and songwriting interventions, emotional expression appears to increase, and suggests that positive mood changes may have a positive influence on further treatment-related variables such as therapeutic alliance [ 46 ]. Additionally, support by other group members may facilitate emotional expression [ 50 ]. Nevertheless, it should be noted that for many emotional variables (e.g., anxiety, anger, sadness) RCTs are needed to assess MT/ MBI efficacy.

Effects of MT/ MBI on skills and locus of control

Qualitative analyses suggested that MT/ MBI provide opportunities to learn in various areas. Many patients with SUD have poor psychosocial skills, which improved over the course of MT/ MBI [ 46 , 59 ]. M. Murphy [ 83 ] has suggested that music, as part of the participants’ everyday life, is adaptable to low levels of psychosocial functioning, and group interventions may be helpful in reducing social isolation. According to Ghetti [ 76 ], in group music therapy sessions, the therapist structures the active music making purposefully to enable group interaction in a non-threatening atmosphere. Successful group interactions in music making may help to develop social and problem solving skills. Furthermore, discussion of lyrics of popular songs can help enhance understanding of the individual’s dynamics regarding substance use and may lead to the development of more healthy coping strategies [ 76 ]. Only very few studies examined effects of MT/ MBI on cognitive abilities quantitatively. In contrast to the findings reported in qualitative studies, in RCTs no positive effects of MT on coping abilities could be identified [ 36 , 38 ], and also no effects of MBI on cognitive functioning were reported [ 48 ]. In contrast to that, a single case study showed enhanced coping after individual sessions [ 40 ]. However, these studies differed with respect to many variables, e.g., age, drugs, MT/ MBI methods, and duration so conclusions regarding treatment effect cannot be drawn at this time.

As internal change motivation is a critical aspect for the treatment of addictions, effects of MT/ MBI on locus of control (LOC) were examined as well. After a single session, MT participants did not differ regarding LOC compared to a verbal therapy group [ 30 ]. Furthermore, in an experimental setting examining effects of music stimuli presentation, increased internal LOC depended on the context [ 65 ], but after longer MT interventions, enhanced internal LOC was identified [ 20 ]. These results suggest that MT/ MBI may lead to increased internal LOC over time. When patients experience that their own abilities and actions determine what happens [ 84 ] during MT/ MBIs, this may be transferred to life outside the therapy setting and result in better outcomes of addictions’ therapy in the long term [ 85 ]. Typically in MT, music experiences are carefully structured and supported by the music therapist to enhance the potential for positive experiences by the patient [ 86 ]. This may lead to positive effects of MT on factors such as self-esteem [ 87 ] or self-efficacy [ 88 ]. However, it is important to acknowledge that asking patients to engage in music making may lead to some anxiety and insecurity as well for some patients, as has been reported in studies outside of the SUD population [ 89 ]. However, no studies to date have directly examined the relationship between mastery in music therapy and long-term treatment outcomes for patients with SUD. More research is necessary to explore this possible mechanism.

MT/ MBI effects on group interaction and relationships

Positive group dynamics were identified as important motivators in all qualitative studies. Over the course of the intervention, behavioral observations revealed increased exchange and cohesion [ 57 , 59 , 66 ]. Nevertheless, in their study with offenders in a substance abuse/mental illness treatment program, Gallagher and Steele [ 49 ] reported that 53% of their participants were “not sociable” (p. 121). For planning of the sessions, clinicians need to keep in mind that many patients with SUD have poor social skills. However, none of the quantitative studies in our review systematically examined group-related variables, so future research should examine social skills or aspects like group cohesion. Summarizing studies with respect to the outcome cluster, participation reveals a lack of studies of high level evidence of efficacy regarding this topic as well.

Regarding working alliance between therapist and patients, beneficial effects from the therapist’s perspective were identified quantitatively [ 29 ] as well as qualitatively [ 60 ]. By contrast, patients attending MT did not perceive a better working alliance compared to a verbal therapy CG [ 29 ]. This is in line with previous studies identifying weak reliability between therapist-rated and patient-rated working alliance in drug treatment [ 90 ]. Regarding the relationship between different perspectives of working alliance and therapeutic success, results are not consistent: Some studies found stronger relationships between the counsellor’s/ therapist’s view and success [ 90 – 94 ], whereas in other studies the patient’s view was identified as a more important predictor [ 95 ] or both measures were only weakly correlated with success [ 96 ]. Furthermore, levels of working alliance had different effects on outcome for different types of therapies [ 97 ]. These inconsistent results indicate that working alliance may be more complex and depend on many aspects. As most of the studies emphasized the importance of the therapist’s view, especially ratings at early time points after starting the therapy [ 98 ] as examined by Silverman [ 29 ], working alliance should be examined in further MT studies.

MT/ MBI effects on quality of life and health

In many studies, MT and MBI were associated with a great amount of perceived enjoyment and also reported to enhance quality of life and improve health [ 59 ]. In line with this, longer MBI were related to positive psychiatric and medical outcomes [ 40 , 48 ]. Nevertheless, these investigations were conducted in very specific settings, so that there is still a lack of studies examining health-related and long-term variables in common treatments for SUD. Especially, variables related to substance use are understudied. Furthermore, all studies examining medical symptoms were categorized as of low level evidence of efficacy in our descriptive summaries. Thus, high quality evidence has not been conducted.

Study quality and methodological recommendations

Our descriptive summaries considered the quality of the identified studies and revealed that in the last years, since the review of Mays et al. in 2008, more RCTs were conducted. Thus, for outcomes like motivation, depression, enjoyment, withdrawal and craving, perceived helpfulness, working alliance, and locus of control studies of high level evidence of efficacy already exist. Nevertheless, we did not calculate meta-analyses due to study heterogeneity or because similar variables were only examined by the same author. Furthermore, across all studies included in our descriptive approach, still only 38% (25/65) were RCTs, and especially for mood variables and long-term abstinence, high quality research has not been conducted. Due to the low quality of most of the studies, in the end, strong key outcomes cannot be substantiated.

It is important to consider that in studies that examine the impact of group interventions, the independence of observations, a common assumption for standard statistical tests, may have been violated because of interactions between group members. This may have resulted in biased standard errors and erroneous inference [ 99 ].

In Table 6 , methodological recommendations are summarized that are aimed at helping to overcome issues in future research. Most importantly, studies should investigate long-term outcomes such as abstinence and use randomized controlled trial designs. In order to reduce problems related to the independence of observations, hierarchical analyses taking into account the group structure of the data or cluster randomization should be applied. However, designing and executing of cluster randomized trials is difficult because for example larger sample sizes are needed or recruitment bias could occur [ 100 ].

If in the clinical context randomization is not possible, studies should at least include control groups as reference frameworks. In within subjects designs aimed at examining pre to post MT/MBI intervention improvements in functioning, one needs to consider that the statistical regression to the mean may be an explanation for the patients’ improvement. Including a control group may solve this issue. Studies of low level evidence of efficacy can be useful for generating hypotheses, getting information about subjective experiences, exploring effects on individual levels, or assessing the ecological validity of treatments [ 25 ]. Thus, we also included them in our review, but in 50% of these non-RCT studies (20/40), the results were reported without sufficient statistical information. Furthermore, across all studies, reports about characteristics of intervention, studies and participants varied widely, so that giving a transparent overview and comparing the studies regarding these aspects was difficult. In addition to that, only few studies reported standardized effect sizes [ 31 – 37 , 39 , 41 ], so the effects of MT/ MBI could hardly be interpreted and compared across studies. Therefore, we recommend the inclusion of reports that clearly describe characteristics of intervention, studies and participants, including diagnostic criteria, transparent information about statistical procedures, and all necessary statistical data (including effect sizes) according to the guidelines of the Task Force on Statistical Inference [ 101 ] in the articles. In addition to that, as described in the paragraphs above, high-quality research for outcomes related to skills, group interaction and relationships has not been conducted although these aspects are important topics mentioned in qualitative research. Thus, future studies should investigate variables such as cognitive abilities, group cohesion or medical symptoms among others. Measurement instruments for the same outcomes widely varied across studies (e.g., Likert scales vs. standardized tests) and they mostly captured different aspects, so comparisons were difficult. Therefore, in future research authors should use the same standardized measurement instruments that are suitable for the addiction and music therapy context. Furthermore, the researcher often acted also as music therapist and collected the data which may lead to procedural bias (such as Rosenthal effect [ 102 ]) or response bias in the data. It also remains unclear whether effects are due to the music therapy or the person of the music therapist. To reduce these tendencies, we recommend the inclusion of external researchers for data collection and analysis.

Conclusions

There is still no consensus regarding the effects of music therapy (MT) and music-based interventions (MBI) for patients with substance use disorders (SUD). Previous reviews [ 21 , 22 ] highlighted the need for more randomized controlled trials (RCTs) regarding long-term outcomes like maintenance of sobriety. The current literature includes additional RCTs, but most of them focused on short-term effects after single sessions in detoxification units. One RCT examined sobriety after a one-month period without significant differences between a single session of MT or group verbal therapy [ 31 ]. The only study examining abstinence after more than one session was conducted with one specific ethnic group without inpatient participants [ 48 ]. Therefore, future studies should include long-term investigations and follow-up measurements, in particular regarding variables related to substance use. Due to the great fluctuation in SUD treatments, planning of these studies may be a challenge. However, reduction of substance use and abstinence are critical aspects regarding the success of addictions’ treatment, so evaluations of treatment effects for these outcomes are necessary for future investigations. MT/ MBI appeared to be effective in the regulation of emotions and subjective outcomes, as also indicated by qualitative analyses. Nevertheless, the quantitative studies in our review were very diverse which was one important reason for not conducting meta-analyses. As MT/ MBI are commonly and specifically used in the treatment of groups and subgroups with SUD, e.g., women or adolescents [ 8 ], it is important to examine its efficacy and effectiveness in these specific populations as well. However, these results may not be generalizable across general SUD settings. Additionally, it is important to be aware that music can also trigger relapse (e.g. if the music is associated with substance abuse [ 61 ]), and that, therefore, music has to be used with great care in SUD patients.

Regarding limitations of the current review it must be noted that collecting the characteristics of the studies was particularly difficult because of missing information. We did not consider the patients’ additional diagnoses and treatment options, methods or specific therapy goals. These topics could be included in future reviews to provide additional insights in characteristics of effective MT/ MBI/ MP. Due to the small number of MT studies, separations regarding these aspects are currently not useful. Whereas this systematic review summarizes the available evidence in terms of treatment efficacy, it does not provide information about potential mechanisms of action of MT/ MBI for SUD. Furthermore, a methodological review of MT/ MBI/ MP and SUD studies may be warranted in the future. For example, studies could be codified regarding methodological strengths and weaknesses to make further methodological recommendations with respect to the investigation of concrete outcomes.

From a methodological point of view, future studies examining the efficacy of MT/ MBI/ MP for patients with SUD should include RCTs, so that meta-analytic calculations will be possible. Regarding content and outcome variables, future studies should consider including outcomes related to the qualitative findings as well as variables related to substance abuse so that a comprehensive picture of the efficacy of MT/ MBI/ MP can be drawn. In addition, we urgently need mechanistic studies that identify and examine the impact of potential treatment mediators and moderators. Additionally, the effects on problem solving, cognitive, and coping abilities and the role of MT/ MBI/ MP for different stages of motivation should be clarified. Furthermore, effects of the interventions on long-term medical and psychiatric outcomes, treatment retention and completion should be examined, while considering additional moderating and mediating variables like MT appreciation. Based on these findings, implications for future MT/ MBI as independent or adjunctive treatment programs for SUD can be developed. As individual preferences regarding music and MT as well as group dynamics appeared to be important for the success of MT [ 21 ], careful group composition and selection of materials are necessary. All in all, due to its high acceptance, flexibility, easy accessibility and low costs, MT/ MBI provide opportunities for SUD treatment for various groups in various settings. Nevertheless, its efficacy and effectiveness have to be evaluated more systematically and should focus on further long-term outcomes.

Supporting information

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The authors received no specific funding for this work.

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The Woes of Being Addicted to Streaming

I feel unsettled when I stream music on Spotify. Maybe you feel that way, too. Even though it has all the music I’ve ever wanted, none of it feels necessarily rewarding, emotional, or personal. I pay a nominal fee for this privilege, knowing that essentially none of it will reach the artists I am listening to. I have unfettered access to an abundance of songs I genuinely love, along with an abundance of great songs I’ve never heard before, but I can’t shake the eerie feeling that the options before me are almost too perfect. I have personalized my experience enough to feel like this is my music, but I know that’s not really true—it’s simply a fabricated reality meant to replace the random contours of life outside the app.

The truth is that if you’re using Spotify, Apple Music, Tidal, or any other streaming service, you’re not paying for music so much as the opportunity to witness the potential of music. Music becomes an advertisement for the streaming service, and the more time and attention you give it, the more it benefits the tech company, not necessarily the music ecosystem. In Spotify, each song’s play count is prominently displayed, in effect gamifying the music industry so that tracks tacitly compete against one another inside the app. They even go so far as to turn the amount of time you spend in their app into a badge of honor during their annual year-end promotional campaigns. So you’re in the top percentile of Big Thief listeners? That’s not just a measure of your love for an artist’s music , but also a reflection of the time spent enriching the value of a company.

In addition to co-opting corporate social media strategies to benefit from the attention economy, tech companies have inherently made songs fleeting, cheap, and sometimes intrusive , corrupting the cultural exchange between artist and listener. Music is now leased to you through a secret system that you don’t understand, by a company with which you should have no emotional connection. Instead of simply buying a physical product or even pirating music from Napster—both of which created uniquely personal libraries of songs that helped define the identities of a generation—millions of users now sit side by side at the ledge of one great big trough of recorded music for the monthly price of a Chipotle burrito.

There have been many passionate and excoriating essays written about how streaming services have short-changed artists with minuscule payouts. But as the reviews editor of this music publication, I find myself asking: What does a platform like Spotify afford the most engaged music fans and what are the lingering effects of its use? As the independent musician and writer Damon Krukowski once wrote, there are alternative and radical solutions to combat the upstreaming of profits and homogenization of sound that the streaming era has come to stand for. But as one of nearly half a billion people who pay a small fee to rent the vast majority of the history of recorded music—not to mention the 2 billion people per month who use YouTube for free—I have found that, after more than a decade under the influence, it has begun to reshape my relationship with music. I’m addicted to a relationship that I know is very bad for me.

I know I am addicted to Spotify the same way I was addicted to nicotine or Twitter. It makes me happy, aggrieved, needlessly defensive. Oh, you boycott Spotify and only buy CDs on Bandcamp? Good for you. I use Spotify every day for hours on end, when I’m working, at the gym, running, when I want to put some music on while making dinner, when I go to sleep.

I write off part of my Spotify use as a hazard of my job, but I just can’t get enough of that sweet streaming asbestos outside of work, too. Even though I buy a fair amount of records every year, Spotify is my main delivery system for music. It’s like being hooked on rolling papers or the yellowed smell of a casino—not the actual vice itself. The ease, the look, the familiarity—I’m addicted to the emotional labor it does for me when its “Radio” feature instantly creates a playlist of songs that kind of sound like, say, “Breakdown” by Tom Petty and the Heartbreakers while I’m sitting outside on a nice afternoon. It loosely organizes what I love and what I might love and, for the most part, it’s absolutely correct.

I’ve sometimes rationalized that it is not an unhealthy addiction: I use Spotify in a way that reflects who I am, I bend it to my whims. For the last 10 years, I have kept playlists of favorite songs—both old and new—I discovered each year, a living record of growth and change in taste. I listen to weekly playlists that are made by friends and colleagues and artists, silently connecting with their interests. I’m going beyond the algorithm, operating at a higher frequency, clipping between the walls that cannot contain my taste profile.

The seeds of this addiction were planted in the late 2000s, when the music industry was struggling to adapt to the new digital era, unsure of how to wrap a tourniquet around the vast hemorrhaging of money caused by such a fast-moving paradigm shift. The streaming era as we know it began in an unlikely place, with good intentions: On October 10, 2007, Radiohead released In Rainbows and allowed fans to pay what they wanted for its digital files. After 1.2 million downloads, the average price paid per album was $2.26. Case studies in setting a new market price don’t come in a tidier package than this.

But as free-market and egalitarian as it was, the experiment was meant to motivate fans to go out and buy an actual physical copy of the album. Devised by Radiohead’s managers Bryce Edge and Chris Hufford while they were “a bit stoned,” the pay-what-you-want stunt was a means to an end: “If we didn’t believe that when people hear the music, they will want to buy the CD, we wouldn’t do what we are doing,” Edge said at the time. A lot of Radiohead fans did buy the album when it came out—it sold 122,000 copies in America alone in its first week—but by then, the downloaders outnumbered them by a wide margin. So even though Thom Yorke later described Spotify as “the last desperate fart of a dying corpse,” his band all but invented the model of what would become the streaming era: turning music into an ad that you pay very little for, with no real incentive to go and buy what it is advertising.

Another important shift was happening in 2007. Seeing the writing on the wall, several high-profile artists were abandoning their longtime major labels to find other avenues of distribution: Madonna left Warner to sign with touring giant Live Nation, a bellwether of where the real money was being made in the industry. (JAY-Z would make a similar move the following year.) Nine Inch Nails left music mogul Jimmy Iovine’s label Interscope and independently put out an instrumental album, Ghosts I-IV ; by Trent Reznor’s estimation, the collection made millions more than it would have had they released it with the label.

Into this stew of major label woes—which included the lingering piracy boogeyman—came Spotify. Launched in 2008, the streaming start-up was a direct attempt to both stem piracy and circumvent anti-piracy laws in its native Sweden. In addition to offering a way for online listeners to legally play music, Spotify acquired its user base in markets around the globe because of how easy it was to use. No more paying per song on iTunes, no more navigating the murky waters of P2P servers, no more waiting for albums to download. Here, finally, was a solution: legal music, a lot of it, right now, for cheap.

After officially launching in the U.S. in 2011, Spotify quickly turned into a potential panacea for everything that was ailing the music industry. Two years later, newspapers were asking: Can Spotify Save the Music Industry? A race to market dominance ensued. By 2014, Reznor had mended fences with Iovine and became the chief creative officer of Iovine’s new streaming platform, Beats Music, which wanted to set itself apart from competitors like Spotify and Pandora. Instead of an algorithmic platform that served you what you wanted, its team of curators would provide you with a more human experience. Iovine saw that, through artist and influencer-created playlists, you could confer taste, status, and criticism—the stuff that the former record-buying public supposedly pined for. One of Iovine’s maxims at the time: Access is average; curation is everything. Seeing the promise of a more bespoke streaming experience, Apple bought Beats for $3 billion and relaunched the service as Apple Music in 2015.

That same year, JAY-Z stood on a stage with Madonna, Rihanna, Daft Punk, Kanye West, and several other A-list musicians to announce the artist-majority-owned service Tidal, with “a mission to re-establish the value of music.” Touting hi-fi streaming and better payouts for artists, Tidal seemed like a much-needed counterweight to Apple Music and Spotify. Finally, here was a platform not funded by Silicon Valley VCs but by (admittedly already wealthy) musicians who understood the art and work that goes into the process of creation. But since its launch, its growth has lagged dramatically behind its competitors. Last year, JAY-Z sold the majority of Tidal to Square, a mobile payment company owned by Twitter founder Jack Dorsey.

Each successive introduction of a new tech company into the streaming era sought to solve a problem created by the digital era: pirating, the devaluation of music, and the lack of human connections music once relied upon. At this point, music piracy has generally been on the decline for five years. Major labels have plugged the holes in their coffers by licensing the vast majority of their music to streaming services and meting out payouts to their signees. The exception has always been the independent-minded Bandcamp, which includes a Radiohead-style pay-what-you-want option at a record’s point of sale, and fosters holistic connection between musicians and listeners through hubs run by labels and artists. Earlier this year, Bandcamp was acquired by the software company Epic Games.

Much like social media, the streaming era has created a simulation of real life. Each company uses its technology to digitize and replace the analog practice of buying, listening, and connecting to music, all while capitalizing on the nostalgia of those activities. The seamlessness of the experience—the ease with which one song bleeds into the next, and the buffet of decisions laid before you on Spotify’s home screen—creates an artificial scarcity out of vast abundance. For me, it has caused a kind of nagging depersonalization, an experience so divergent from, say, holding an album in my hands, or being in a record store, that I feel like a little bit of a hack every time I open the app. But I also understand that for the majority of subscribers, this simulation of a beautiful, vibrant, limitless music industry is possibly all they could ever want.

Let’s say there are three general categories of music listeners: Passive, Auxiliary, and Intentional. Most of the world falls into the Passive category, absorbing music like inhaling oxygen: without much thought at all. For them, there is either music playing, or maybe it’s not music playing, who can be sure? There is perhaps little to no interrogation into why any sound is floating down from the speakers at the grocery store; it simply exists at the same megahertz as the shopping cart and the fluorescent lights and the cereal selection. Songs are liked and not liked, if they are thought about at all, and the whole relationship is pure and elegant.

The second is the Auxiliary listener, someone for whom music enhances a primary experience to make it more interesting. Common forms of auxiliary listening involve music accompanying a visual stimulus, like film scores or needle drops in movies, music videos or their modern-day equivalent: a song snippet looped in a TikTok. But the Auxiliary listener chiefly uses music as a utility: to relax, to work, to go to the gym, to get drunk, to do drugs, to have sex, to dance, to fall asleep. Music is not your life, but what was playing while you lived it.

The last is the Intentional listener, someone who chooses to listen to music for the pleasure of it in and of itself. This is admittedly the tiniest category of people, a subset that spends a remarkable amount of time listening to albums, mixtapes, DJ sets, and playlists without distraction. They are purposeful about what they select and why—for them, there is a pleasure to be found in the flow of listening to music and the emotional, intellectual, and biographical response that it creates untethered to anything but the chemical responses in the brain. Some of these people use drugs to enhance this connection, but not all of them. Music, for these people, is life.

It’s important to make these distinctions because I believe that, for Passive and Auxiliary listeners—again, the vast majority of people in the world —Spotify and the streaming era writ large have achieved an ideal compromise. The technology has made accessible what had previously been difficult or kept behind the gates of record stores or music criticism. For an older generation, there is a sudden and overwhelming pleasure in being able to listen to all the music from your life instantly, retracing the decades through a digital library.

The cognitive dissonance occurs when people in the Intentional group—people like me—try to tell people in the Passive and Auxiliary groups how to listen to music. I know the global financial devaluation of music is irreversible, and there are only a small percentage of total music listeners for whom the phrases “buy from brick-and-mortar stores” or “support Bandcamp Fridays” means anything. But what I fear is that the streaming era is actually writing the same listening histories for those who can’t be bothered with Intentional listening–all exclusively based on proprietary algorithms that seem like a way to discover music but, in fact, act more like a feedback loop.

A close friend, an Auxiliary listener, recently sent me a Spotify link to an album by classic rock revivalists Greta Van Fleet, noting that it would be good music for the gym. This sent me into a bit of a panic spiral for three reasons. One is that I wondered why I neglected to share my professional life with him: In 2018, my pan of their debut album drew the attention of those beyond Pitchfork’s usual purview, with Barstool Sports suggesting that the band must have “fucked my girlfriend,” and GVF fans threatening to “TP” my house via homemade signs they held up at concerts. The second is that I realized I am but a tiny little dust mite in the universe, and my own opinion on Greta Van Fleet is largely irrelevant beyond the scope of a few thousand music snobs and select GVF fans, and what’s actually important in the world is the bond close friends have despite these relationship glitches. Third is that Spotify knows me better than my close friend.

The more time I spend on Spotify, the more it pushes me away from the outer edges of the platform and toward the mushy middle. This is where everyone is serviced the same songs simply because that is what’s popular. Four years ago, while the app’s algorithmic autoplay feature was on, I was served the Pavement song “Harness Your Hopes,” a wordy and melodic—and by all accounts obscure—B-side from the beloved indie band. As of this writing, the song has over 72 million streams, more than twice as much as their actual college rock hit from the ’90s, “Cut Your Hair,” the one Pavement song your average Gen X’er might actually recognize. How did this happen? In 2020, Stereogum investigated the mystery but came up empty-handed from a technological perspective, though the answer seems obvious to me: Whereas many Pavement songs are oblique, rangy, and noisy, “Harness Your Hopes” is among the most pleasant and inoffensive songs in the band’s catalog. It is now, in the altered reality of Spotify, the quintessential Pavement song. When frontman Stephen Malkmus was asked about this anomaly, he sounded blithely defeated: “At this point we take what we can get, even in a debased form. Because what’s left?”

The whole “Harness Your Hopes” situation is in part a result of what’s called “cumulative advantage.” It’s the idea that if something—a song, a person, an idea—happens to be slightly more popular than something else at just the right point, it will tend to become more popular still. (On the other hand, something that does not catch on will usually recede in popularity, regardless of quality.) This is the metric of how most social recommendation algorithms work—on Facebook, the more “likes” an article has, the better odds a user will read it. But when this is applied to what songs are sent to which people, Spotify can engineer its own market of popularity as well as what song defines a band. Popular songs on Spotify are popular within the app because they are what most people are listening to. So from both a behavioral psychology and business perspective, it makes sense for Spotify to assume that you want to listen to what other people are listening to. The chances of the average listener staying on the app longer are much higher if Spotify curates songs that have had a similar effect on people whose taste matches theirs.

This is one of the main addictive chemicals of most streaming services: Recommend a handful songs—out of millions!—that feel uniquely personal but in fact are just what everyone else is hearing, too. If a Passive or Auxiliary listener lets the algorithmic Spotify Radio play songs based on Tom Petty’s “Breakdown,” the results are almost purely based on chronology, tempo, and feel. Gone are the filigrees and the autobiography of the song and how it existed in the world to you , the listener. Instead, everyone’s experience is now the same.

For instance, Spotify’s radio station for Ludacris’ “What’s Your Fantasy” doesn’t link to any OutKast songs, even though I watched Ludacris open for André 3000 and Big Boi when that song was released in 2000, and both acts are from Atlanta. Is Spotify aware that Big Boi is a huge Kate Bush fan? Does Spotify know that singer-songwriter John Darnielle of the Mountain Goats is a metal head? If you have seen Darnielle cover metal bands from Dio to Gorguts to Nightwish, or are familiar with one of his most popular songs, “The Best Ever Death Metal Band Out of Denton,” you know that he loves some sick riffs and moonward barks. But all of that intimate (and publicly available) knowledge is lost to machine learning. Tuning into Spotify’s Mountain Goats’ Radio won’t turn up any Dio at all—just literate and mostly acoustic indie rock songs that sound similar to the Mountain Goats. Left to a streaming service, these kinds of textured and unique connections are smoothed over or erased entirely.

I have committed my personal and professional life to making sense of music, of finding connections and context within songs to create a critical framework that allows me to organize everything I listen into an ornately chaotic web. If I started a Fugazi radio playlist, maybe I would throw some Red Hot Chili Peppers on there—you’ll hear it. If I started a Pavement radio playlist, how could I not include the Louisiana rapper Young Bleed’s song “How Ya Do Dat,” where he calls himself “ slanted and enchanted ”? I would argue that Prince’s “When Doves Cry” and Parquet Courts’ “Instant Disassembly” both utilize a stilted, inverted grammatical style in their lyrics and are absolutely in conversation with each other.

When music is so abundant and our attention is scarce, there’s power in adding more intention to your listening diet, more chaos, more risk. The thrill in finding music that is wired to your singular life is not that thousands of other people have found the same thing. It’s that the music becomes something confounding and unique, a true reflection of where you are and where you’ve been. The beauty of the algorithm of your mind is that it makes perfect sense to no one but yourself.

This week, we’re exploring how music and technology intersect, and what today’s trends and innovations might mean for the future. Read more here .

Essay on Addiction

Students are often asked to write an essay on Addiction in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Addiction

Understanding addiction.

Addiction is a strong desire to do something repeatedly, even if it’s harmful. It’s like a brain disease. People can get addicted to different things like drugs, alcohol, or even activities like gambling.

Why People Get Addicted

People can get addicted for many reasons. Some may feel good when they do something, so they repeat it. Others may want to escape from problems or stress. Sometimes, it’s because of peer pressure or trying to fit in.

Effects of Addiction

Addiction can harm a person’s health. It can lead to diseases, mental problems, and even death. It can also ruin relationships and cause problems at work or school.

Overcoming Addiction

Overcoming addiction is hard, but possible. It needs strong willpower and often help from doctors or therapists. Support from family and friends is also important. Remember, it’s okay to ask for help.

Preventing Addiction

250 words essay on addiction, what is addiction.

Addiction is when a person can’t stop doing something, even if it’s harmful. It can be about drugs, alcohol, games, or even food. The person knows it’s bad but can’t stop. It’s like a strong pull that keeps them going back.

How Does it Start?

Addiction often starts with trying something new. This could be a friend offering a cigarette, or playing a new video game. At first, it seems fun and exciting. But over time, the person starts needing it more and more. It becomes a need, not just a want.

The Impact of Addiction

Addiction can hurt a person in many ways. It can make them sick, or cause problems at school or work. It can also hurt their relationships with family and friends. They may lie or steal to keep doing what they’re addicted to. This can lead to feelings of guilt and shame.

Fighting Addiction

Fighting addiction is hard, but not impossible. It starts with admitting there’s a problem. Then, the person needs help from professionals like doctors or counselors. They can give advice, medicine, or therapy to help the person quit. Support from family and friends is also important.

Remember, it’s okay to ask for help. Everyone struggles with something at some point. With the right help and support, anyone can overcome addiction.

500 Words Essay on Addiction

Addiction is a serious issue that affects many people around the world. It is a state where a person cannot stop using a substance or engaging in a behavior, even if it is harmful. The person becomes dependent on the substance or the activity to feel good or normal.

Types of Addiction

Addiction can be of two types: substance addiction and behavioral addiction. Substance addiction involves drugs, alcohol, nicotine, or other substances. Behavioral addiction involves activities like gambling, eating, or using the internet.

Causes of Addiction

Addiction has a negative impact on a person’s health, relationships, and daily life. It can lead to physical health problems like heart disease or mental health issues like depression. Addiction can also strain relationships with family and friends and make it hard for the person to perform well at school or work.

Overcoming addiction is not easy, but it is possible with the right help and support. This can include professional treatment like therapy or medication, as well as support from loved ones. It is important for the person to learn healthy ways to cope with stress and other triggers that may lead to addictive behavior.

In conclusion, addiction is a complex issue that requires understanding, support, and prevention efforts. It is important for everyone to be aware of the signs of addiction and to seek help if they or someone they know is struggling. Remember, overcoming addiction is possible with the right help and support.

That’s it! I hope the essay helped you.

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Essay on Addiction for Students and Children

500 words essay on addiction.

As we all know that excess of anything can be very dangerous, the same way, addiction of any kind can hamper the life quality of an individual. The phrase states that addiction is a family disease as one person uses and the whole family suffers. The above statement stands true in all its essence as the addict does not merely suffer but the people around him suffer greatly too. However, that does not mean they can’t be helped. Addiction is curable and we must not give up on the person who is addicted, rather help them out for a better life.

Cost of Addiction

Addiction comes at a great cost and we need to be able to recognize its harmful consequences to not let ourselves or anyone become an addict. Firstly, addiction has major health hazards. Intake of anything is bad for our body , and it does not matter what type of addiction it is, it will always impact the mental and physical health of a person.

For instance, if you are addicted to drugs or food, you will get various diseases and illnesses. Similarly, if you are addicted to video games, your mental health will also suffer along with physical health.

Moreover, people who are addicts usually face monetary issues. As they use that thing in excess, they spend loads of money on it. People become obsessed with spending all their fortunes on that one thing to satisfy their addiction. Thus, all these addictions of drugs , alcohol , gambling, and more drain the finances of a person and they usually end up in debt or even worse.

Furthermore, the personal and professional relationships of addicts suffer the most. They end up doing things or making decisions that do not work in their favor. This constraint the relationships of people and they drift apart.

Moreover, it also hampers their studies or work life. When you are spending all your money and time on your addiction, naturally your concentration levels in other things will drop. However, all this is not impossible to beat. There are many ways through which one can beat their addiction.

Get the huge list of more than 500 Essay Topics and Ideas

Beat Your Addiction

It is best to work towards beating your addiction rather than getting beat by it. One can try many ways to do so. Firstly, recognize and identify that you have an addiction problem. That is the first step to getting cured. You need to take some time and understand the symptoms in order to treat them. Motivate yourself to do better.

After that, understand that the journey will be long but worthwhile. Identify the triggers in your life and try to stay away from them as far as possible. There is no shame in asking for professional help. Always remember that professionals can always help you get better. Enroll yourself in rehabilitation programs and try to make the most out of them.

Most importantly, do not be hesitant in talking to your loved ones. Approach them and talk it out as they care most about you. They will surely help you get on the right path and help you in beating addiction for better health and life.

Q.1 What are the consequences of addiction?

A.1 Addiction has very severe consequences. Some of them are health hazards, monetary issues, relationship problems, adverse problems on studies and work of a person. It seriously hampers the quality of life of a person.

Q.2 How can one get rid of addiction?

A.2 A little help can go a long way. One can get rid of addiction by enrolling in rehabilitation programs and opening up about their struggle. Try to take professional help and talk with your close ones to become better.

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