Music therapy in substance use services

Guidelines

The use of music therapy in substance use services is recommended in two of the Norwegian Directorate of Health's national clinical guidelines:

• National Guideline for Treatment and Rehabilitation of Substance Use Problems and Addiction (2016):
  “It is recommended that music therapy be made available to patients/service users who wish to receive it” (p. 32). Music therapy is highlighted as relevant across specialist health services, correctional services, and municipal services. The guideline also emphasises that music therapy must be provided by practitioners with an approved qualification in music therapy.
• National Guideline for Detoxification from Substances and Addictive Medication (2016, IS-2211):
  Music therapy is described as a potential adjunctive treatment.

The following guideline is also relevant:

National Guideline for the Assessment, Treatment and Follow-up of People with Psychotic Disorders (2013)

• Music therapy is recommended with the highest possible recommendation grade, and the evidence base is assessed at the highest level of evidence.
• “Music therapy promotes recovery, and treatment should start as early as possible in order to reduce negative symptoms. Treatment must be provided by therapists with an approved qualification in music therapy” (p. 70).
• Music therapy is highlighted as being equally relevant in municipal services and specialist health-care services.

Summary

According to a recent Cochrane review synthesising evidence from outcome studies, music therapy reduces substance cravings and increases motivation for continued treatment and changes in substance use (Ghetti, Chen, Brenner, Hakvoort, Lien, Fachner & Gold, 2022).

This systematic review found a reduction in substance cravings after just a single music therapy session, with stronger effects observed when music therapy was offered over a period of one to three months. Increased motivation for further treatment and changes in substance use was also greater among participants receiving music therapy compared with those receiving other forms of therapy (Ghetti et al., 2022).

Most outcome studies in the substance use field have been single-session studies conducted in detoxification settings (see, for example, Silverman, 2015; 2017). Some studies examining the effects of multiple music therapy sessions on psychological symptoms and substance cravings have shown promising results, although further research is needed.

Earlier systematic reviews of music therapy research in substance use services included studies using a broader range of research methods but did not conduct meta-analyses of quantitative outcomes. These reviews reported positive effects of music therapy beyond those identified in the Cochrane review, while also noting some inconsistency across studies (Carter & Panisch, 2021; Hohmann et al., 2017; Mays, 2008).

Studies reporting significant findings suggest that music therapy may have a positive impact on clients’ emotional well-being and treatment motivation (Ross, 2008; Gardstrom, Bartkowski, Willenbrink & Diestelkamp, 2013). Research has also demonstrated significant reductions in psychological symptoms such as anxiety (Gardstrom & Diestelkamp, 2013), depression (Albornoz, 2011), and interpersonal difficulties (Heiderscheit, 2017). One study also reported a statistically significant improvement in sleep quality (Ross, 2008).

Findings from substance use services are supported by strong evidence from related areas, such as music therapy in mental health care for adults. A Cochrane review of music therapy for people with schizophrenia and schizophrenia-like disorders found significant effects, including improvements in negative symptoms (Geretsegger et al., 2017). These findings contribute to the strong recommendation of music therapy in the Norwegian psychosis guidelines.

Research in music therapy and mental health has also demonstrated a strong correlation between the number of music therapy sessions received and recovery outcomes, as well as the importance of treatment being delivered by qualified music therapists (Gold, Solli, Krüger & Lie, 2009).

Music therapy has been shown to have the following significant effects:

• Improved engagement with and motivation for continued treatment
• Increased motivation for changes in substance use
• Reduced substance cravings

Some individual studies have also demonstrated reductions in anxiety and depression.

Selected outcome studies and systematic reviews

• Albornoz, Y. (2011). The effects of group improvisational music therapy on depression in adolescents and adults with substance abuse: A randomized controlled trial. Nordic Journal of Music Therapy, 20 (3), 208-224. 
• Aurlien, K. (2015). Musikkterapi med personer med rusmiddelproblemer: Hva sier forskningen? [Masteroppgave]. Universitetet i Bergen, Bergen. 
• Carter, T. E., & Panisch, L. S. (2021). A systematic review of music therapy for psychosocial outcomes of substance use clients. International Journal of Mental Health and Addiction, 19(5), 1551-1568. doi: 10.1007/s11469-020-00246-8 
• Gardstrom, S. C. & Diestelkamp, W.S. (2013). Women with addictions report reduced anxiety after group music therapy: A quasi-experimental study. Voices, 13 (2). doi:10.15845/voices.v13i2.681 
• Gardstrom, S.C., Bartkowski, J., Willenbrink, J. & Diestelkamp, W.S. (2013). The impact of group music therapy on negative affect of people with co-occurring substance use disorders and mental illnesses. Music Therapy Perspectives, 31, 116-126. 
• Geretsegger, M., Mössler, K.A., Bieleninik, Ł., Chen, X., Heldal, T. & Gold, C. (2017). Music therapy for people with schizophrenia and schizophrenia-like disorders. Cochrane Database of Systematic Reviews, (5). doi:10.1002/14651858.CD004025.pub4 
• Ghetti, C., Chen, X.-J., Brenner, A.K., Hakvoort, L.G., Lien, L., Fachner, J., & Gold, C. (2022). Music therapy for people with substance use disorders (REVIEW). Cochrane Database of Systematic Reviews. Issue 5. Art. No.: CD012576. doi: 10.1002/14651858.CD012576.pub3 
• Gold, C., Solli, H.P., Krüger, V. & Lie, S.A. (2009). Dose-response relationship in music therapy for people with serious mental disorders: Systematic review and metaanalysis. Clinical Psychology Review, 29 (3), 193-207. 
• Heiderscheit, A. (2017). The effects of the Bonny Method of Guided Imagery and Music (GIM) on interpersonal problems, sense of coherence, and salivary immunoglobin A of adults in chemical dependency treatment. Music and Medicine, 9 (1), 24-36. 
• Hohmann, L., Bradt, J., Stegemann, T. & Koelsch, S. (2017). Effects of music therapy and music-based interventions in the treatment of substance use disorders: A systematic review. PLoS ONE, 12(11): e0187363. 
• Mays, K.L., Clark, D.L. & Gordon, A.J. (2008). Treating addiction with tunes: A systematic review of music therapy for the treatment of patients with addictions. Substance Abuse, 29, (4), 51-59. 
• Ross, S., Cidambi, I., Dermatis, H. Weinstein, J., Ziedonis, D., Roth, S. & Galanter, M. (2008). Music therapy: A novel motivational approach for dually diagnosed patients. Journal of Addictive Diseases, 27 (1), 41-53. 
• Silverman, M.J. (2012). Effects of group songwriting on motivation and readiness for treatment on patients in detoxification: A randomized wait-list effectiveness study. Journal of Music Therapy, 49 (4), 414-429. 
• Silverman, M.J. (2015). Effects of lyric analysis interventions on treatment motivation in patients on a detoxification unit: A randomized effectiveness study. Journal of Music Therapy, 52 (1), 117-134.  
• Silverman, M.J. (2017). Effects of group-based educational songwriting on craving in patients on a detoxification unit: A cluster-randomized effectiveness study. Psychology of Music, Advance online publication, 1-14.  

Studies of service users’ experiences with music therapy in Norway have been conducted both in municipal substance use services (Kielland, 2015; Kielland & Taihaugen, 2017; Taihaugen, 2017) and in specialist interdisciplinary substance use treatment services (TSB) (Dale, 2014, 2019).

People receiving substance use treatment describe music therapy as a valuable resource in their recovery processes (Dale, Kielland, Trondalen & Stige, 2015; Moe, 2007; Trondalen, Stige, Dale & Kielland, 2016). Music therapy is experienced as meaningful, providing opportunities for mastery and achievement that may foster hope and motivation for treatment, while also offering relief from difficult thoughts (Gardstrom, Klemm & Murphy, 2017; Ghetti et al., 2024; Kristiansen, 2013; Overå, 2013). Users also describe music therapy as supporting recovery from substance use problems (Dale et al., 2015; Trondalen et al., 2016).

Many service users highlight the importance of the social connections that emerge through musical interaction, as well as music’s role in helping them express and regulate emotions (Gardstrom, Klemm & Murphy, 2017; Ghetti et al., 2024; Hedigan, 2010; Moe, 2007; Overå, 2013; Trondalen et al., 2016). Such social connectedness may be particularly valuable for individuals experiencing co-occurring challenges related to attention, restlessness, and substance use problems (Ghetti et al., 2024).

Some clients also point out that music therapy can evoke both positive and difficult experiences and memories (Hedigan, 2010; Horesh, 2010). Qualified music therapists are trained to recognise and address this, helping clients become aware of and constructively manage potentially distressing or substance use-triggering memories.

User perspectives on music therapy

• Dale, R., Kielland, T., Trondalen, G. & Stige, B. (2015). Musikkterapi, rus og psykisk helse – brukererfaringer. Rusfag, 2, 18-23. 
• Gardstrom, S.C., Klemm, A. & Murphy, K.M. (2017). Women’s perceptions of the usefulness of group music therapy in addictions recovery. Nordic Journal of Music Therapy, 26(4), 338-358. 
• Ghetti, C.M., Hjelmbrekke, S., Morken, K., Dahl, T., & Stige, B.  (2024). Steering the energy with music: Hermeneutic phenomenological study of user perspectives of music and music therapy for co-occurring ADHD and substance use problems. Substance Abuse Treatment, Prevention, and Policy. https://doi.org/10.1186/s13011-024-00594-x 
• Hedigan, J.P. (2010). Authenticity and intimacy: The experience of group music therapy for substance dependent adults living in a therapeutic community. I D. Aldrige & J. Fachner (Red.) Music therapy and addictions (s.35-56). London: Jessica Kingsley Publishers. 
• Horesh, T. (2010). Drug addicts and their music: A story of a complex relationship. I D. Aldrige & J. Fachner (Red.) Music therapy and addictions (s.57-74). London: Jessica Kingsley Publishers. 
• Kristiansen, D.L. (2013). Nye muligheter. En eksplorativ studie av deltageres opplevelse i musikkterapigruppe innen rusbehandling [Masteroppgave]. Norges Musikkhøgskole, Oslo. 
• Moe, T. (2007). Receptiv musikterapi med misbrugspatienter – et pilotprosjekt. Psyke og Logos, 28, 478-498. 
• Næsheim, D. (2021). Huset imellom verdener. Et samarbeid mellom en musikkterapistudent og deltakere ved et rusfritt lavterskeltilbud om å utvikle en samspillsgruppe [Masteroppgave]. Norges Musikkhøgskole, Oslo. 
• Overå, M. (2013). Hekta på musikk. Oslo: NMH-publikasjoner. 
• Trondalen, G., Stige, B., Dale, R. & Kielland, T. (2016). Musikkterapi i rusbehandling. Psykisk Helse og Rus, 2 (27), 20-26. 
• Trydal, I. (2022). Bedre enn rus? En mixed methods-syntese av syv rapporter om deltakernes erfaring og tilfredshet med musikkterapi som en del av behandlingstilbudet innen rusomsorgen [Masteroppgave]. Norges Musikkhøgskole, Oslo. 
• Trzebinski, M. & Tuastad, L. (2022). En mangesidig recoveryprosess: En metasyntese av evalueringsrapporter om musikkterapi i psykisk helse- og rusfeltet. Musikkterapi (1). 

Evaluation reports

• Dale, R. (2014). Evaluering av prosjekt ”musikkterapi” ved Stiftelsen Bergensklinikkene. Rapport. Bergen: Stiftelsen Bergensklinikkene KoRus vest Bergen. 
• Dale, R. (2019). Brukarerfaringer – Evaluering av musikkterapi ved Bergensklinikken. Rapport. Bergen: Kompetansesenter rus vest Bergen. 
• Johansson, K. (2019). Musikkterapi som del av oppsøkende og forebyggende arbeid med utsatt ungdom og unge voksne. Rapport om musikkterapitilbudet i Uteseksjonen i Oslo. Rapport. Oslo: Norges musikkhøgskole. 
• Kielland, T. (2015). Musikkterapi i kommunalt rusarbeid. Rapport. Brumunddal: Sykehuset innlandet HF, Divisjon Psykisk Helsevern, Kompetansesenter rus – region øst. 
• Kielland, T. & Taihaugen, M. (2017). Musikkterapi i kommunalt rusarbeid. Rapport. Brumunddal: Sykehuset innlandet HF, Divisjon Psykisk Helsevern, Kompetansesenter rus – region øst. 
• Kielland, T. & Selbekk, A.S. (2019). Musikkterapi: Gir meg en sånn positiv følelse inne i meg at jeg kan. Rapport. Oslo/Stavanger: Fagrådet – Rusfeltets hovedorganisasjon og KoRus Vest Stavanger. 
• Taihaugen, M. (2017). Musikkterapi i kommunalt rusarbeid – et musikalsk tilbud tilpasset alle. Rapport. Brumunddal: Sykehuset innlandet HF, Divisjon Psykisk Helsevern, Kompetansesenter rus – region øst. 
• Taihaugen, M. (2021). Erfaringsrapport fra musikkterapitilbudet ved Sagatun Brukerstyrt Senter 2020. Rapport. Brumunddal: Sykehuset innlandet HF, Divisjon Psykisk Helsevern, Kompetansesenter rus – region øst. 

Music therapy practice in substance use services

Music therapy practice in substance use services in Norway is recovery-oriented and draws on resource-oriented and community music therapy approaches. These approaches emphasise recognising and promoting clients’ strengths, quality of life, health, and recovery processes. Practice is grounded in humanistic and sociocultural traditions, while also incorporating elements from psychodynamic and neurobiological perspectives, as well as cognitive rehabilitation.

In music therapy, clients engage in a range of musical activities and interactions. These may include improvisation, ensemble playing and performance, composition and songwriting, as well as listening to and discussing music. Music therapy in substance use services can be provided both individually and in groups.

Music therapists are trained to facilitate meaningful musical experiences and therapeutic processes for clients with varying levels of previous musical experience, from those with extensive musical backgrounds to those with little or no prior experience.

Music therapists in substance use services work across a variety of settings, including interdisciplinary specialist substance use treatment services (TSB), encompassing inpatient, day-treatment, and outpatient services, as well as municipal services and correctional facilities. Their work may also involve controlled-use approaches, prevention, aftercare, and low-threshold community-based initiatives such as bands, music cafés, and choirs. In some clinical settings, music therapists may be delegated responsibility for treatment planning and follow-up.

Interdisciplinary collaboration is a central component of music therapy practice. Opportunities to participate in treatment meetings and collaborate with other community and service providers are therefore important.

Case descriptions and clinical methods

• Borling, J. (2011). Music therapy and addiction: Addressing essential components of the recovery process. I A. Meadows (Red.) Developments in music therapy practice: Case study perspectives. (s.334-349). Gilsum NH: Barcelona Publishers.
• Gardstrom, S.C., Carlini, M., Josefczyk, J. & Love, A. (2013). Women with addictions: Music therapy clinical postures and interventions. Music Therapy Perspectives, 31, 95-104.
• Kristiansen, D.L. (2016) Å dele av seg selv. Om sangdeling som musikkterapeutisk metode i arbeid med rusmiddelavhengighet. I Stensæth, K., Krüger, V. & Fuglestad, S. (Red). I transitt – mellom til og fra: om musikk og deltagelse i barnevern. (s.211-230). Oslo: NHM-publikasjoner.
• McFerran, K. (2011). Moving out of your comfort zone: Group music therapy with adolescents who have misused drugs. I A. Meadows (Red.) Developments in music therapy practice: Case study perspectives. (s.248-267). Gilsum NH: Barcelona Publishers.
• Murphy, K.M. (2015). Music therapy in addictions treatment. I B.L. Wheeler (Red.). Music therapy handbook (s.354-366). New York: The Guilford Press.
• Pickett, E. (1991). Guided imagery and music (GIM) with a dually diagnsed woman having multiple addictions. I K.E. Bruscia (Red.) Case studies in music therapy (s.497-512). Gilsum, NH:  Barcelona Publishers.
• Punkanen, M. & Ala-Ruona, E. (2011). Making my body a safe place to stay: A psychotherapeutically oriented approach to vibroacustic therapy in drug rehabilitation. I A. Meadows (Red.) Developments in music therapy practice: Case study perspectives. (s.350-367). Gilsum NH: Barcelona Publishers.
• Soshensky, R. (2001). Music therapy and addiction. Music Therapy Perspectives, 19, 45-52. Tuastad, L. (2016). ”Til alle som har falt… en gang”. Erfaringar frå rusførebyggjande konsertføredrag for konfirmantungdomar. I Stensæth, K., Krüger, V. & Fuglestad, S. (Red). I transitt – mellom til og fra: om musikk og deltagelse i barnevern. (s.191-210). Oslo: NHM-publikasjoner.

Theoretical perspectives

• Aldridge, D. & Fachner, J. (Red.) (2010). Music therapy and addictions. London: Jessica Kingsley Publishers.
• Gardstrom, S.C. & Hiller J. (2013). Resistances in group music therapy with women and men with substance use disorders. Voices, 16 (3).
• Ghetti, C.M. (2004). Incorporating music therapy into the harm reduction approach to managing substance use problems. Music Therapy Perspectives, 22 (2), 84-90.
• Kielland, T., Stige, B., & Trondalen, G. (2013). Musikkterapi i rusfeltet. Rusfag, 1, 43-51.
• Lesiuk, T.L. (2010). A rationale for music-based cognitive rehabilitation toward prevention of relapse in drug addiction. Music Therapy Perspectives, 28, 124-130.

Music therapy in women-focused substance use treatment

Gender-specific treatment programmes are available in some substance use treatment settings in Norway, particularly within interdisciplinary specialist substance use treatment services (TSB). The potential contribution of music therapy to women’s experiences during treatment is described in a review and thematic analysis of the relevant literature (Johnsen, 2016).

The analysis of eight identified publications found that music therapy provides women with opportunities to experience a safe space, address complex issues and life stories, engage with their emotions (including both experiencing positive emotions and processing difficult feelings), develop self-awareness, body awareness, and positive self-esteem, and improve interpersonal relationships.

These findings suggest that music therapy both supports and actively contributes to gender-specific treatment. Further research is needed on women in substance use treatment, particularly regarding service users’ perspectives on how music therapy is experienced and how it supports their recovery processes (Johnsen, 2016).

Music therapy in women-focused substance use treatment

• Johnsen, K. M. M. (2016). Music Therapy, Women and Substance Use Problems: A Systematic Literature Review and Thematic Synthesis [Master's thesis]. University of Bergen, Bergen, Norway.

Implementation in services

Implementation guide

The music therapy research and education community at the Norwegian Academy of Music, in collaboration with the Norwegian Association for Substance Use Services, has developed an implementation guide for music therapy in substance use and mental health services:

• Kielland, T., Solli, H. P., & Trondalen, G. (2020). Implementation Guide for Music Therapy in Substance Use and Mental Health Services. Centre for Research in Music and Health (CREMAH), Norwegian Academy of Music.

Selected publications

• Andersen, G. (2023). “Now We Need to Prioritise”: Referral Pathways and Access to Music Therapy in Mental Health and Substance Use Services. A Mixed-Methods Study [Master's thesis]. Norwegian Academy of Music, Oslo.
• Tombre, Ø. O. (2023). “When It Happens, It Happens”: A Qualitative Interview Study of the Working Lives of Three Music Therapists in Low-Threshold Substance Use and Mental Health Services [Master's thesis]. Norwegian Academy of Music, Oslo.

Films about music therapy and mental health

• Arts and Health Stories: Arve (World Health Organization)
• HOME AGAIN: Concert lecture with Morten Sommerbakk and Lasse Tuastad
• Six films about music therapy from the National Network for Music Therapy in Substance Use and Mental Health Services:
  • Belonging through Music Therapy
  • Recovery through Music Therapy
  • User Participation through Music Therapy
  • Identity through Music Therapy
  • Music Therapy in Specialist Health Services and Everyday Life
  • Mastery and Self-esteem through Music Therapy
• Film from Kongsberg School of Music and Performing Arts
• Music Therapy at FACT Gjøvik

Music therapy programmes in Norway

• Master’s Degree in Music Therapy at the Norwegian Academy of Music
• Integrated Master’s Degree in Music Therapy at the University of Bergen

Additional educational opportunities are also available at bachelor's and PhD level. See:

• Polyfon’s overview of educational programmes in music therapy and music and health

Media coverage

• ROP 2017: Information video about music therapy in substance use services
• NRK 2017: Music therapy
• TV2 2015: Music Became the Lifeline

Working groups and national network

• Polyfon’s Working Group for Mental Health and Substance Use Services
• National Network for Music Therapy in Substance Use and Mental Health Services

Ongoing research projects

• At CREMAH, Norwegian Academy of Music
• At GAMUT, University of Bergen
• At GAMUT, NORCE

Researchers in Norway working on music therapy and substance use

The research centres GAMUT at the University of Bergen/NORCE and CREMAH at the Norwegian Academy of Music contribute to the international research frontier in this field.

Researchers welcome enquiries regarding lectures, information, or potential collaboration on research related to music therapy and substance use services.

• Monika Geretsegger, NORCE/GAMUT
• Christian Gold, NORCE/UiB/GAMUT
• Bettina Flater, NMH/CREMAH
• Claire Ghetti, UiB/GAMUT
• Merete Holme, NMH/CREMAH
• Viggo Krüger, UiB/GAMUT
• Randi Rolvsjord, UiB/GAMUT
• Marie Skånland, Ansgar University College
• Hans Petter Paulen Solli, NMH/CREMAH
• Brynjulf Stige, UiB/GAMUT
• Gro Trondalen, NMH/CREMAH
• Lars Tuastad, UiB/GAMUT

Additional information

The Norwegian Association for Substance Use and Addiction Services has developed a knowledge base on music therapy in treatment.

The National Network for Music Therapy in Substance Use and Mental Health Services also maintains a dedicated Facebook group, where information and updates related to music therapy in substance use services are shared.