Music as Part of Drug Rehab

Addiction is an interesting and in some ways also slightly mystical phenomenon.
What makes a person become addicted to something? And
how can one release oneself from an addiction? These questions have
intrigued me for many years. As a clinician, I see drug addiction as a
problem in a person’s emotional life. It is important how a person is able
to face, tolerate, name and handle his or her emotions. In my experience
it is important to understand that addiction is both physical and psychological.
Therefore treatment and care should have effect on both levels as
well as offer the client comprehensive experiences. Additionally in my
clinical experience, drug addicts quite often have traumatic experiences
in their history and they will get in touch with their traumatic memories
during therapy process. Therefore as a music therapist we have to know
how to work with our clients so that we will help them to achieve more
integration within their levels of experience. In this article I will make
some suggestions about how to integrate music therapy practices into the
current practices of drug rehabilitation. My suggestions are based on
results of my research (Punkanen, 2006a), where I interviewed four experienced
Finnish music therapists who have worked in drug rehabilitation
for many years.
Drugs and drug addiction
Different kinds of psychoactive substances have been a part of humanity
since the beginning of times. For example, people learned early on to
know the effect plants have on human consciousness. Plants were used
for example to alleviate pain and to tranquillize one’s mind. Plants with
these magical properties were for example the betel nut, leaves of the kati
and coca plants, cannabis, fly agarics and different kinds of cacti.
The use of psychoactive plants had a strong social and ritualistic meaning.
These substances were used in religious rituals and shamans used
them to get into contact with the gods. The other participants to the rituals
used the substances to strengthen the feeling of togetherness. Of
course, these rituals also had meaning for the individuals as well, as they
offered them as a chance to expand their consciousness. (Ahlström 1998,
21.)
What does drug addiction mean, and how is it defined? According to
Reed (1994) drug addiction is often defined using false arguments, such
as how often drugs are used, which drugs are used, how large the doses
are and how long the use has been going on. Although these are important
factors to consider, as such they do not define the concept of drug
addiction. According to Reed (1994), addiction is not as such a question
of continuous use of drugs, but is defined above all by the compulsive


In my research (Punkanen, 2006) and in my clinical practice I define
music therapy as a method of psychotherapeutic treatment. It creates
strong sensorimotor and emotional experiences: non-verbal music is
combined with the verbal work that the client and therapist do together
by reflecting on the experiences created by music. The relation between
music experiences and verbal experiences can vary both during a therapy
session and the whole duration of a treatment process (see e.g. Bruscia
1998, 1-15). The possibilities and impacts music therapy offers in the
treatment of different kinds of addiction have been studied both in Finland
and elsewhere.

TREATMENT
Drug rehabilitation can be divided into two main phases. These are the
acute phase that is also called detoxification and the follow-up phase of
treatment.
In the acute phase of drug addiction treatment the client’s withdrawal
symptoms play a central role. The starting point is in alleviating pain.
Done successfully, this will help the client adhere to treatment. The central
role of music therapy at this stage appears to be in helping to alleviate
pain and adherence to treatment, which in other words means symptom
reduction and stabilization.

In the acute phase of treatment music therapy (physioacoustic method see
e.g. Punkanen, 2006b) should be used intensively, even twice a day. This
would make it possible to cut down the use of benzodiazepines and painkillers,
and help to create a therapeutic relationship with the client. Music
therapy should be individual at this stage and the methods used would be
the physioacoustic method and listening to music in the presence of the
music therapist. In using physioacoustic method all choices should be
made according to the client’s needs. The choice of treatment program
should therefore depend on the client’s somatic symptoms. In the acute
phase of treatment, clients are very anxious and distressed, and relaxing
treatment programs should be used. The hyper aroused state of the client’s
autonomic nervous system can best be calmed down with the use of
treatment programs that have slow paced and peaceful pulsations and
fairly gentle or weak vibrations. Also the duration of the program should
be decided upon according to the client’s needs. In the acute phase of
treatment the role of listening to music differs clearly from that in the follow
phase. In the acute phase one should avoid music that might activate
images that might be associated with drug use. One should aim to support
the client’s feelings of relaxation and safety. When choosing music like
this, it is good to consult studies on the subject (see e.g. Pelletier 2004,
192-214) and discuss the matter with the client. Using the physioacoustic
method and listening to music offers many therapeutic possibilities in the
acute phase, due to the therapist’s presence and an active strategy of
treatment. It is the task of the therapist to bring into discussion thoughts,
memories, images, emotions and physical sensations that have arisen
during physioacoustic treatment and the listening of music, and to outline
and focus the process at each session.


TREATMENT
In the follow-up phase of treatment music therapy should continue intensively,
which would mean two or three times a week. This intensity
would make process-like and comprehensive work possible.
In the follow-up phase music therapy can be individual or group therapy
or both. When moving from the acute phase to the follow-up phase of
treatment, it should be noted that not all clients are able commit to intensive
individual therapy. It may take some time too for the client to adjust
and mature to this kind of work. On the other hand, all clients that commit
to individual therapy are not capable of working in groups. It is often
a good strategy to use hand in hand both individual and group sessions in
music therapy. Then for example the issues that have arisen in individual
physioacoustic sessions can be encouraged to be taken up in the group
sessions. This strategy is based on the idea that subjects and themes that
in some ways touch all rehabilitation clients are good to be shared also in
the group, as it is then possible to hear different kinds of experiences and
gain a broader perspective on them. One of the objectives of group music
therapy is that it can support social relationships among clients. One
should, however, carefully consider in case of each client whether individual
therapy, group therapy or a combination of both should be used.
There are many music therapy methods that can be used in follow-up
phase of treatment. Based on my research I would recommend using
physioacoustic method, listening to music, playing, singing, writing
one’s own songs, playing in bands, using the figurenotes, the presence of
the therapist and therapeutic discussions. With these methods one can
reach the client comprehensively and consider all levels of his experience,
from sensorimotor to cognitive.
The main objective of music therapy in the follow-up phase should be to
uncover reasons for drug use and on the basis of this knowledge to integrate the client’s world of experiences. In uncovering reasons and motives for drug use the central methods in music therapy are physioacoustic method, listening to music, the presence of the therapist and therapeutical discussions. The most important thing is to be able to create
conditions in which the client can open up and be heard about his/her
experiences. When working at integrating the client’s world of experiences
it is helpful to divide the experiences into three levels: sensorimotor,
emotional and cognitive. The sensorimotor level means working with
the body. Among the methods available in music therapy, the physioacoustic
method and listening to music are very effective. The emotional
level of experience indicates to working with emotions. Methods that can
be used are interaction between therapist and client, and activities such as
listening to music, playing an instrument, singing, making one’s own
songs and playing in music therapy bands. The cognitive level of experience
is connected to working with a client’s beliefs. First, the therapist
needs to understand the significance of the client’s world of beliefs. This
means that the therapist must be able to recognize the structures of beliefs
and models of attitudes that direct the client’s choices and actions in
everyday life, and also make them visible to the client, through clienttherapist
interaction and dialogue. In this work, a therapist can use different
kinds of belief arguments and ask the client to estimate and assess
how valid or true they are to him. After this the therapist can begin to
challenge the client about how true they are and to question their usefulness,
if they interfere with rehabilitation. The client must be made to
study and work with his/her own beliefs through interactive action, the
objective being to offer him/her experiences of achievement and capability,
thus breaking the vicious circle that has maintained and strengthened
the client’s negative beliefs and fear of failure. In this work very effective
methods of music therapy are playing, singing and writing one’s own
songs.

Conclusion
Music therapy practice offers lot of possibilities in drug rehabilitation,
both acute and follow-up phase of treatment. In the acute phase of treatment
music therapy can significantly strengthen and support the client’s
adherence to treatment. In the follow-up phase of treatment music therapy’s
central role is in sorting out the reasons for addictive behavior and
in integrating a client’s levels of experience. With music therapy it is possible
to treat the client comprehensively so that all levels of experience
(sensorimotor, emotional and cognitive) are worked on. Music therapy
offers the chance for both individual and group sessions and the range of
methods available in music therapy that can be used in drug rehabilitation
is wide and versatile. It is also important to remember that music is prominent
in the world of drug users, so it appears to be absolutely necessary
to take music into consideration in drug rehabilitation and to process also
this aspect of the addiction problem.

Vision for Meditation- What do I want to accomplish with it>

- developing more of an awareness for what is actually happening in my environment, rather than reacting to every thought running through my mind
-being more mindful of other people
- calming thoughts to be more connected with God
- observe negative thoughts and emotion, detach, do not react
- develop a sense of core, identity. Lose a fear of being with myself.
- Change the negative core values I developed when I was a child due to hard circumstances
- Be goal oriented, but not take it so hard when I do not acheive a goal or if I make a mistake
- Love myself, rather than judging myself, beating myself up, or trying to fit the mold I think people will like