GAMUT - The Grieg Academy Music Therapy Research Centre, Grieg Academy, University of Bergen, Bergen, Norway.
CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Science, Beijing, China.
Cochrane Database Syst Rev. 2022 May 9;5(5):CD012576. doi: 10.1002/14651858.CD012576.pub3.
Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving.
To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober.
We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews.
We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD.
We used standard Cochrane methodology.
We included 21 trials involving 1984 people. We found moderate-certainty evidence of a medium effect favouring MT plus standard care over standard care alone for substance craving (standardised mean difference (SMD) -0.66, 95% confidence interval (CI) -1.23 to -0.10; 3 studies, 254 participants), with significant subgroup differences indicating greater reduction in craving for MT intervention lasting one to three months; and small-to-medium effect favouring MT for motivation for treatment/change (SMD 0.41, 95% CI 0.21 to 0.61; 5 studies, 408 participants). We found no clear evidence of a beneficial effect on depression (SMD -0.33, 95% CI -0.72 to 0.07; 3 studies, 100 participants), or motivation to stay sober/clean (SMD 0.22, 95% CI -0.02 to 0.47; 3 studies, 269 participants), though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result. There was no evidence of beneficial effect on anxiety (mean difference (MD) -0.17, 95% CI -4.39 to 4.05; 1 study, 60 participants), though we are uncertain about the result. There was no meaningful effect for retention in treatment for participants receiving MT plus standard care as compared to standard care alone (risk ratio (RR) 0.99, 95% 0.93 to 1.05; 6 studies, 199 participants). There was a moderate effect on motivation for treatment/change when comparing MT plus standard care to another active intervention plus standard care (SMD 0.46, 95% CI -0.00 to 0.93; 5 studies, 411 participants), and certainty in the result was moderate. We found no clear evidence of an effect of MT on motivation to stay sober/clean when compared to active intervention, though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result (MD 0.34, 95% CI -0.11 to 0.78; 3 studies, 258 participants). There was no clear evidence of effect on substance craving (SMD -0.04, 95% CI -0.56 to 0.48; 3 studies, 232 participants), depression (MD -1.49, 95% CI -4.98 to 2.00; 1 study, 110 participants), or substance use (RR 1.05, 95% CI 0.85 to 1.29; 1 study, 140 participants) at one-month follow-up when comparing MT plus standard care to active intervention plus standard care. There were no data on adverse effects. Unclear risk of selection bias applied to most studies due to incomplete description of processes of randomisation and allocation concealment. All studies were at unclear risk of detection bias due to lack of blinding of outcome assessors for subjective outcomes (mostly self-report). We judged that bias arising from such lack of blinding would not differ between groups. Similarly, it is not possible to blind participants and providers to MT. We consider knowledge of receiving this type of therapy as part of the therapeutic effect itself, and thus all studies were at low risk of performance bias for subjective outcomes. We downgraded all outcomes one level for imprecision due to optimal information size not being met, and two levels for outcomes with very low sample size. AUTHORS' CONCLUSIONS: Results from this review suggest that MT as 'add on' treatment to standard care can lead to moderate reductions in substance craving and can increase motivation for treatment/change for people with SUDs receiving treatment in detoxification and short-term rehabilitation settings. Greater reduction in craving is associated with MT lasting longer than a single session. We have moderate-to-low confidence in our findings as the included studies were downgraded in certainty due to imprecision, and most included studies were conducted by the same researcher in the same detoxification unit, which considerably impacts the transferability of findings.
物质使用障碍（SUD）是指继续使用一种或多种精神活性物质，包括酒精，尽管这对健康、功能和社会关系有负面影响。自 2013 年以来，全球范围内药物滥用增加了 10%，而有害使用酒精与所有死亡人数的 5.3%有关。音乐治疗（MT）对药物滥用问题的直接影响尚不清楚，但它可能有助于缓解相关的心理症状和减少物质渴望。
比较音乐治疗（MT）加标准护理与标准护理单独或与标准护理加积极对照干预对心理症状、物质渴望、治疗动机和保持清醒/清醒的动机的影响。
我们检索了以下数据库（从成立到 2021 年 2 月 1 日）：Cochrane 药物和酒精专门登记册；CENTRAL；MEDLINE（PubMed）；其他八个数据库和两个试验登记处。我们还手动检索了所有检索到的研究和相关系统评价的参考文献列表。
我们纳入了比较 MT 加标准护理与标准护理单独或 MT 加标准护理与积极干预加标准护理对 SUD 患者的研究。
我们使用了标准的 Cochrane 方法。
我们纳入了 21 项试验，涉及 1984 人。我们发现，在物质渴望方面，MT 加标准护理与标准护理单独相比，具有中等确定性的中等效应（SMD-0.66，95%置信区间（CI）-1.23 至-0.10；3 项研究，254 名参与者），有显著的亚组差异，表明 MT 干预持续一至三个月的时间，对渴望的减少更大；对于治疗/改变的动机，我们发现 MT 具有小到中等的效果（SMD0.41，95%CI0.21 至 0.61；5 项研究，408 名参与者）。我们没有发现 MT 对抑郁（SMD-0.33，95%CI-0.72 至 0.07；3 项研究，100 名参与者）或保持清醒/清醒的动机（SMD0.22，95%CI-0.02 至 0.47；3 项研究，269 名参与者）有有益影响的明确证据，尽管效应大小从大有利效应到无效应不等，我们对结果不确定。对于接受 MT 加标准护理的参与者与接受标准护理单独的参与者相比，MT 对保留治疗没有有益的影响（风险比（RR）0.99，95%CI0.93 至 1.05；6 项研究，199 名参与者）。与另一种积极干预加标准护理相比，MT 加标准护理对治疗/改变的动机有中等程度的影响（SMD0.46，95%CI-0.00 至 0.93；5 项研究，411 名参与者），结果的确定性为中等。我们没有发现 MT 对保持清醒/清醒的动机有明显的影响，与积极干预相比，尽管效应大小从大有利效应到无效应不等，我们对结果不确定（MD0.34，95%CI-0.11 至 0.78；3 项研究，258 名参与者）。我们没有发现 MT 对物质渴望（SMD-0.04，95%CI-0.56 至 0.48；3 项研究，232 名参与者）、抑郁（MD-1.49，95%CI-4.98 至 2.00；1 项研究，110 名参与者）或物质使用（RR1.05，95%CI0.85 至 1.29；1 项研究，140 名参与者）在一个月的随访时有明显的影响，与积极干预加标准护理相比，MT 加标准护理。没有关于不良反应的资料。由于随机和分配隐藏过程的描述不完整，大多数研究存在选择偏倚的高风险。由于对主观结果（主要是自我报告）的结果评估者缺乏盲法，所有研究都存在检测偏倚的高风险。我们认为，这种缺乏盲法所引起的偏倚不会在不同的组之间有所不同。同样，参与者和提供者都无法对 MT 进行盲法。我们认为接受这种类型的治疗是治疗效果本身的一部分，因此，所有的主观结果都处于低风险的绩效偏倚。由于最佳信息大小未达到，我们将所有结果降低了一个级别，对于样本量非常小的结果降低了两个级别。
本综述结果表明，作为标准护理的“附加”治疗，MT 可以导致物质渴望的适度降低，并可以增加接受脱毒和短期康复治疗的 SUD 患者的治疗/改变动机。持续时间超过单次治疗的 MT 可显著降低渴望。由于不精确，纳入的研究被降级了一个级别，而且大多数纳入的研究是由同一位研究人员在同一个脱毒单位进行的，这极大地影响了研究结果的可转移性，因此我们对研究结果的置信度较低。
