Music in Addiction Treatment: Physiology, Applications and Overall Health Benefits

At Recovery Unplugged, we always say “music is medicine” and now we’re getting into the “nitty-gritty” of what that means. Check out this article from guest blogger, mental health expert and Recovery Unplugged Clinical Consultant Hilary Curtis, PhD, LMHC, CCATP, CAIMHP illustrating the physiological and behavioral benefits of music in addiction treatment. 

Music has been used in addiction treatment and recovery for a long time in varying applications.  Our brains fully respond to music in personal and transformative ways.  Things happen when we like the sounds we are hearing: our eyes dilate, our pulse changes, our body releases dopamine. Music is closely connected to our emotions, the regulation of affect, social interactions, and psychological processes.  Our culture reflects this by embedding music in our educational, religious, patriotic, and ancestral expressions.  Music can calm us, create feelings of safety, bring us together with others, define a sense of self.  Music is indeed our medicine.  We have a physiological reaction to the music that is involuntary, exhilarating, invigorating, and often enjoyable.  For example, we often feel better when we listen to our favorite song or have a strong positive memory attached to a song from childhood.  Music even motivates us to work out and adopt other healthy behaviors.

Replacing the High of Drugs and Alcohol with Music in Addiction Treatment

People generally use mind-altering substances because they want to change the way they feel.  The use of mind-altering substances can cause relaxation and altered perception, increased heart rate, lower blood pressure, and make the user feel relaxed and happy; however, they can also cause lethargy, anxiety, paranoia, and psychosis.  Regular use of mind-altering substances can severely impact how our brains work, damaging our ability to concentrate, learn, and retain information.  What may start as an act to self-regulate one’s emotions or mood can escalate into a spiral of out-of-control harmful use that we see when people try to stop using.

Developmental theories of addiction suggest that emotion regulation is an important risk factor for substance use disorders.  Stephen W. Porges, PhD, proposed the Polyvagal Theory in 1994, which links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological state in the expression of behavioral problems and psychiatric disorders.  Music connects instantly with our autonomic nervous system and affects our emotional state. Bridging music, the nervous system and mental health outcomes is a lot more than just playing a song. We can harness the power of music with evidence-based practices if we consider the power of the brain, our deep need to self-regulate our emotions as well as our natural love for music, itself.

Addiction is a disorder of the brain’s reward system. When the brain is exposed to an addictive substance or behavior, nerve cells in the area of the brain involved in planning and executing tasks start communicating in ways that link liking something with wanting it, and in turn, driving us to go after it.  When substances are used repeatedly, our willpower, which involves the executive planning in the brain, is functionally steam rolled over by primal urges.  Instead of willpower, our primal urges are now in the decision-making “driver’s seat” of the brain.

Knowing how music impacts brain function and human behavior allows us to use it to reduce stress, reduce pain, reduce symptoms of depression, learn new skills, improve cognitive and motor skills, enhance spatial-temporal learning and the rebuilding of neurons in the brain.  When our physiological state is balanced and regulated, it can accelerate and enhance learning.  We know that recovery from addiction involves our mind and our body.  When we have bodily feelings, we generate a personal narrative, and that narrative makes sense to us.  For example, we may tell ourselves: “I feel anxious, there must be something going on that is making me anxious, I better get out of here.” In recovery, we change the neurological narrative and build new skills to continue change.

Neurologically Informed treatment planning uses a holistic model to understand the brain’s system of emotional regulation with biological, psychological, and social influences.  The brain specializes in the processing of life experiences, including trauma.  Life experiences are meaningful with regard to the needs that are embedded within the brain structures of each human being. Neurologically informed treatment strives to teach skills to help shift the brain into a state that enables these basic needs to be fully satisfied.

Through repeated exercises and independent efforts,, we can learn to take some voluntary control over brains’ circuits that represent cognitive distortions and maladaptive behaviors, which had been strengthened by conditioning from our history of thinking and behavior, as well as the ways we were taught to think and behave by parents and other important people in our lives.

Music, Addiction Treatment and the Brain: What’s the Connection?

Neuroscience explains how music enters the brain, and triggers dopamine that travels to the pleasure center.  You can watch the brain “light up” on an MRI as the neurotransmitters fly through neural networks of cognition, memory, primal fears, perception, and movement. These realities can help us to better understand music in addiction treatment.

Music and the Brain

• The Frontal lobe is needed for decision making and planning; it can listen to music, recognize patterns and harmonies, and improve functioning.
• The Temporal lobe (processing what we hear) activates both the left and right hemisphere with words, language as well as sounds.
• Broca’s area (involved with speech) helps us express ourselves with music, playing an instrument can be communication.
• Wernicke’s area (comprehension of language) can analyze and enjoy music.
• The Occipital lobe processes what we see and might visualize music while listening.
• The Cerebellum coordinates movement and physical memory; Alzheimer’s patients who cannot remember their loved ones are still able to play the piano.
• The Nucleus Accumbens, which plays a huge role in addiction, increases dopamine and urges us to replay that favorite song and memorize the words so we can immerse our self in becoming part of the experience.
• The Amygdala processes and triggers emotions including fear and the drive to fight or seek pleasure; it can be shivers down our spine when we recognize sounds paired with trauma or joy.
• The Hippocampus regulates memories and emotional responses. Central processing plays a key role in identifying experiences we seek or avoid; we can hear the first few notes of a favorite song and recognize the next notes without thinking or we can remember the dopamine rush of a mind-altering substance and seek it like a reflex.  Music can also increase neurogenesis (creating new neurons and healing) in the hippocampus and improve memory so we can remember every word of the alphabet song or use the same tune to sing twinkle, twinkle little star.
• The Hypothalamus maintains body functioning like thirst, appetite, sleep, mood, heart rate, body temperature, metabolism, growth and sex drive; music can regulate heart rate and blood pressure and bring the body into a state of balance to improve sleep, feeling calm, and optimally balance for our bodies to function.
• The Corpus Collosum allows the right and left hemisphere to communicate, translate music on a song sheet into finger movements on a piano and allow us to dance and sing.
• The Putamen processes rhythm, body movement and coordination and music can increase dopamine in this brain region; music has been used to treat Parkinson’s disease patients by interacting with the body’s response to rhythm.

Connecting the Dots between Music and Addiction Treatment

For many people, Recovery becomes a process of connecting (and re-connecting) the dots, like building a song from different notes.  No single treatment is appropriate for everyone and effective treatments address the diverse needs of the individual, not just their addiction.  People who recover from addiction connect dots between their health, experiences (including trauma), relationships, family, emotions, beliefs, purpose and goals, culture, identity, and their social world. These parts do not heal or change in isolation from one another.  These parts interact and influence each other in ways we recognize, as well as ways of which we are unaware.

Recovery is self-directed and can take many pathways.  The metaphor of peeling back layers of an onion is an expression often used in psychotherapy for what takes place during the process of self-discovery and change.  When discovered in this way, we are able to allow the layers to slowly peel back in order re-examine the many parts of ourselves with their strengths, barriers, and adaptations.  Recovery Unplugged works to heal all parts of the person and take an interactive and holistic view of change as a process.

SAMHSA uses a working definition of recovery as: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”  Best practice treatments for substance use disorders (SUD) tell us that successful treatment is system of care that addresses physical, psychological, social, and neurobiological issues.  A successful treatment system also removes the stigma and myths about addiction that have been roadblocks to lasting recovery.  When we facilitate safe engagement, collaborative trust, positive expectations, and agreement on treatment goals, positive outcomes are more likely to follow.

The “Top-Down” and the “Bottom-Up” Approach to Change

There are literally over a thousand different treatment models for psychotherapy and change.  Treatments for SUD and mental health problems are continually evolving and, in the past few decades, researchers have turned increasingly to neurobiology to direct best-practice models that show evidence that they work.  Cognitive behavioral therapy (CBT) for substance use disorders has demonstrated success used alone as well as in combination with other treatment strategies.

CBT is a “top-down” approach because it focuses on ways our thoughts influence our feelings.  CBT works with the belief that many dysfunctional behaviors, such as substance use disorders or psychological disorders like depression, can be created in an irrational and dysfunctional belief system.  Helping clients learn to change their thoughts rather than their selves lays the groundwork to feel less blame, less shame and promote engagement and hope.

Learning new cognitive skills requires integrating emotional functioning that is also capable of being modified. Just as we teach how thoughts lead to emotions, we need to teach how emotions lead to thoughts (a bottom-up approach).  With both approaches, we can better understand our experiences, tolerate stress, and create new ways to understand the self and engage in recovery. Treatments like EMDR, mindfulness practices, and somatic therapies, engage with our senses and automatic response sensations to shift and connect with our own biology and nervous systems towards balance, being safe in the present, and learning skills to let emotional pain to pass and live more freely.

Our brains respond to sound and music in powerful physical ways that research has only just begun to document.  Music can attend to the psyche (mind) and soma (body) and has a direct effect on the human mind and body.  Music can also efficiently shift and “retune” our physiological and mental state to promote health, growth, and restoration with ourselves and others.

When we have better emotional control, we can be more socially engaged (feeling trust and connection) and more open to therapy (learning and change) which improves the therapeutic alliance and positive expectations for feeling better.  Improved social engagement and therapeutic alliance improve therapeutic outcomes through better trust, collaboration, and agreement on treatment goals (more so than other client demographics). When the client’s physiological state is regulated and in balance, this can accelerate or enhance learning and change through subsequent therapy.

Neuroplasticity concepts help people focus on recovery triggers as opposed to relapse triggers.  Neuroplasticity is the ability of the brain to change and reorganize structures (thoughts and beliefs) in patterns of responding in the world (behaviors and emotions).  Neural pathways in the brain are strengthened with repetition. Canadian neuropsychologist Donald Hebb encapsulated this process with the commonly repeated statement:  “the neurons that fire together, wire together.” Constant repetition of an experience leads to changes within the brain’s structure and how the neurons process that experience. The more consistent this experience is, the stronger these neurons bond.

Music and Neuroplasticity

If you learned to play the guitar, you had to practice, and practice, and practice, before you were eventually able to think less about where your fingers needed to be for chords; your fingers started to know without you thinking about it  and your body remembered.  Not all emotional reactions are mediated by cognitive processes (thoughts), and music engages clients emotionally, spiritually, mindfully and with empowerment to accept  change.

Relapse triggers represent old patterns of response to emotional dysregulation.  At Recovery Unplugged, music and songs become linked as recovery triggers for change, recovery, improved functioning and achieving future goals. Recovery Triggers create easily accessible, internalized cognitive and emotional representations of ways to change behaviors that can be practiced in the now and in the future.  Beyond teaching clients cognitive behavioral, emotional and relational strategies to avoid maladaptive responses, we want to encourage them to find out what will personally empower them to internalize their recovery.  This can lead to lasting changes that can be sustained with daily practice and in sustained recovery.

With musical engagement as an enhancement of a comprehensive system of evidence-based treatment, the person in treatment  can learn concrete ways to be begin creating and strengthening new neural pathways that allow the client to experience themselves and their relationship to the world in healthy and adaptive ways.  When we understand the neurophysiological reactions (cravings, urges) that are wired into our system, we are empowered to shift and change our narrative so that we no longer blame our body for responding with cravings and urges and self-compassion is increased.

By engaging with personally meaningful songs that mark significant memories and emotions,  a person’s  recovery triggers are available in the moment and in real life.  With an understanding of our emotions, we create self-compassion.  Self-compassion is like kindness, which stimulates a down-regulation (calming) of our stress response and the release of “feel good” hormones such as oxytocin. With music, we can facilitate learning to down-regulate and become more open and receptive to new information. It is in this state that clients are optimally primed to learn and grow and benefit from treatment.

Further Integrating Music into Treatment

Clinicians can improve outcomes when treatment gives clients  a vehicle for retaining/internalizing the necessary skill sets, perceptions and behaviors needed for long-term recovery. The best thing about using music for these purposes is that it is something the clients already want to do when they leave treatment and that is play music.  The brain is a powerful tool and we can help clients identify ways to make it work for them.  Small positive changes that can be repeated over and over can literally rewire the brain.  Small steps and small achievable goals lead to improved expectancy and new ways to respond to real life stressors.

Hilary Curtis, PhD, LMHC, CCATP, CAIMHP

Recovery Unplugged Clinical Consultant