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Recovery Sings: Successful Music Therapy for Patients in Substance Use Programs

By Bon Walsh, MEd, LPC, CET II

Methadone clinics usually open very early to accommodate patients who need to come for dosing prior to going to work. Therapeutic activities also tend to start just as early,
to accommodate the schedules of many patients. But it's rare that as staff begin to assemble in the clinical area of SOAR, an outpatient substance abuse treatment program specializing in methadone treatment for opiate addiction in Philadelphia, they're treated to live musical performances or singing several days a week. 

This artistry is the contribution of Music Therapist Kathleen Killeen, MSW, MPA, LCSW, ACSW, CMT. Killeen was hired more than a year ago with the mission of starting and operating a music program, which has rapidly grown into a thriving component unmatched in scope by other substance abuse programs in the city.

On a typical group day, patients often fight for a spot in her sessions, since the groups are "open" instead of assigned. They may be disappointed if there isn't room for them to attend when they wish, but there are several sessions offered throughout the week. Killeen spends much of her own time with extensive preparation for each group, and usually features the most popular songs of one or more musicians. During group, there are usually a variety of activities, such as music appreciation listening; brainstorming about music video ideas; video viewing; solo or group singing; reading informational articles, or musician interviews or biographies; and lively discussion.

Killeen has worked with mentally challenged patients in prisons and nursing homes, among other settings. Her roots are in the child welfare system where she spent 20 years. Her own career timeline coincided with the development of music therapy within substance abuse treatment as a movement dating back to the 1970s (Baker, Gleadhill,  & Dingle, 2007). Killeen plays a variety of instruments and enjoys both writing and teaching music. She holds degrees in music therapy, social work, and public administration. "My pursuit of the business background was designed to be able to approach corporations as sponsors for my work," Killeen says. "Unfortunately, we see nationwide that the creative arts are funded less frequently [than other programs] and are often not covered by insurance at all." 

She now blends her specialties at SOAR, where she says she wanted to learn from opiate-dependent individuals who are achieving stability on medication. Although their goal is total abstinence, some patients still struggle with dependency on prescription medications or even illicit substances. Since patients could relapse on other substances during the methadone program, soothing tools such as Native American drumming have shown merit (Winkelman, 2003). Harm reduction is often a necessary and vital part of the ongoing process in tandem with the methadone regimen (Ghetti, 2004).

Killeen notes that the average methadone clinic population has many chronic users who can be cynical and are often judgmental of both themselves and others. They might ignore the fact that since most narcotics are depressant drugs, they may have depleted necessary brain chemicals that help balance depression (Khorramabadi, 2014). Methadone treatment is unique in that most patients remain in such a program for a year or more. Initially, people who are opiate dependent need to stabilize their blocking dose. Then they are counseled extensively to sort through layers of addictive history and behaviors to uncover the complicated web of catalysts that lead to their substance use. Eventually, they may begin a gradual medically supervised taper-off process, ending in the necessary component of aftercare planning. Throughout these stages, Killeen says she depends on the many facets of music therapy to help her patients obtain emotional safety.  

As a social worker, Killeen is keenly sensitive to the clinical issues often inherent in the substance abuse or dual-diagnosis populations. Through music, Killeen says she finds that patients more frequently acknowledge and are more open to discussing trauma. Previously, their feelings and expressions in general may have been perceived as numb. Habitual, nonproductive, and painful emotional patterns often are ingrained (Soshensky, 2001). In some cases, multiple dual-diagnosis hospitalizations have left patients confused about contradictory psychiatric impressions and labels. As a result, they may resent or fear psychotropic medication compliance.

Another complicating factor is that some patients were born into opiate-dependent families, or had observed negative norms of possible drug-economy activity in the household. Many have been traumatized by their own self-destructive outcomes, such as near-fatal overdoses. Opiate-dependent patients may also have a greater than average number of medical issues, such as hepatitis, severely compromised immune systems, and chronic pain from accidents that may have occurred due to previous drug impairment.

Often, patients with any of these precursors and life experiences first attend Killeen's groups out of a sense of novelty, and return with a strong desire to create an alternative to their "chemical high." They also explore how their memories of drug abuse may be unconsciously associated with certain song lyrics or performers. Such cues are carefully noted and addressed in therapy (Aldridge & Fachner, 2010).

Killeen says she observes a fraternal camaraderie in the majority of her group patients that they might never have encountered in their own families or communities—something that they may have formerly enjoyed as peer validation during their period of active addiction. They now can trade their sense of "belonging" to the drug culture, with its desperation and false allegiances, for more positive peer pressure.

Killeen says she's thrilled with the occasional improvisation in the groups. "Musical structure naturally fosters creativity," she adds. It also develops sensory experiences that encode brain function and form self-expression. (Aldridge & Fachner, 2010). One patient explains: "We learn that music industry stars who've been our idols are a lot like us if they've experienced addiction."

Another of Killeen's "regulars," who plays piano, sums it up: "Kathleen has shown me that the ingredients of rhythm are building blocks in music and in life."

Killeen wants her program to become more recognized. At this time, several local businesses provide the program with materials and one music store in particular has been of great assistance, she reports. Her aspirations include procuring grants or benefactors, having more multicultural patients provide their favorite music, and perhaps even guiding an entire music department at SOAR. She'd like to see researchers turn their attention toward studying people who are methadone dependent and their behaviors both before and after the exposure to music therapy. At present, she notes, there's almost nothing published along these lines. "Work isn't work to me; it's fun! I love to watch my patients come alive through music."

— Bon Walsh, MEd, LPC, CET II, has been a substance abuse therapist for more than 35 years and specializes in experiential techniques.

References
Aldridge, D., & Fachner, J. (2010). Music therapy and addictions (Google eBook). (pp. 19-20, 30, 72-73). Jessica Kingsley Publishers.

Baker, F. A., Gleadhill, L. M., & Dingle, G. A. (2007). Music therapy and emotional exploration: Exposing substance abuse clients to the experiences of non-drug-induced emotions. The Arts in Psychotherapy, 34(4), 321-330.

Ghetti, C. M. (2004). Incorporating music therapy into the harm reduction approach to managing substance abuse problems. Music Therapy Perspectives, 22(2), 84-90.

Khorramabadi, Y. (2014). Impact of music-therapy on reducing anxiety, depression and stress in narcotic addicts. International Journal of Applied and Basic Sciences, 8(2), 201-205.

Soshensky, R. (2001). Music therapy and addiction. Music Therapy Perspectives, 19(1), 45-52.

Winkelman, M. (2003). Complementary therapy for addiction: Drumming out drugs. American Journal of Public Health, 93(4), 647-651.