Music therapy in a community outpatient service: a pilot study exploring craving and psychological dimensions of Substance Use Disorder by assessing neural biomarkers, psychometric tests, and semi-structured interviews

Background: Music therapy (MT) has been shown to be effective for multiple clinical endpoints in clients with Substance Use Disorder (SUD) such as craving, depressive and anxiety symptoms. Despite the advancements in the state-of-the-art of MT research for SUD, there remains a gap regarding the impact of MT interventions in community services. Additionally, there is a lack of studies that explore neurophysiological measures and more conventional subjective assessments such as psychometric tests and interviews.

Methodology: Sixteen participants with SUD were recruited from a community service based in London to be part of a mixed-methods randomized-controlled feasibility clinical trial. This thesis represents a pilot study covering part of the scope of the parent clinical trial. Ten participants received six weekly MT sessions in addition to the standard treatment (ST) offered by the community outpatient service – four of them participated in a group MT intervention while six of them in an individual MT intervention – and six participants received ST only. Pre-/post-intervention as well as in-session measures have been collected utilizing electroencephalography in addition to psychometric tests and semi-structured interviews addressing craving, depressive, and anxiety symptoms, inhibitory cognitive control, and the music-therapeutic process. An intention-to-treat approach was employed.

Results: Fourteen participants completed the study: two participants from individual MT dropped out due to a relapse episode. Preliminary results showed (1) lower neurophysiological craving arousal post-MT intervention as compared to ST; (2) lower subjective evaluation of craving intensity after MT sessions; (3) different impact of MT and ST on neurophysiological asymmetry related to affective processing potentially underlying depressive symptoms; (4) enhanced neural mechanisms related to sensorimotor response inhibition following MT; (5) qualitative themes reflecting absence of craving, reluctance towards craving discussions, narratives on experiences, emotions, and the therapeutic process.

Discussion: MT might facilitate lower post-intervention arousal related to craving as compared to ST, but the conscious perception of this decrease is noticeable only after MT sessions. The differential brain asymmetry may represent higher emotional regulation and introspection associated with MT compared to ST. MT may facilitate neuromodulation that boosts inhibitory cognitive control functions. Themes emerging from semi-structured interviews highlight the transformative potential of MT in alleviating craving and stimulating reflection. Interpretations from this pilot study must be taken with caution and a larger clinical trial would help to substantiate these findings.