Music therapy for people with substance use disorders

Claire Ghetti; Xi-Jing Chen; Annette K Brenner; Laurien G Hakvoort; Lars Lien; Jorg Fachner; Christian Gold

doi:10.1002/14651858.CD012576.pub3

Musicoterapia para personas con trastornos por consumo de sustancias

Appendices

Appendix 1. Search strategy

Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive)

#1 music AND INREGISTER

#2 sing OR singing OR song* OR choral* OR choir* OR melod* OR lyric* AND INREGISTER

#3 #1 OR #2

Cochrane Central Register of Controlled Trials (CENTRAL)

#1 (Substance‐Related Disorders):MH AND CENTRAL:TARGET

#2 (Amphetamines):MH AND CENTRAL:TARGET

#3 (Cannabis):MH AND CENTRAL:TARGET

#4 (Cocaine):MH AND CENTRAL:TARGET

#5 (Designer Drugs):MH AND CENTRAL:TARGET

#6 (Heroin):MH AND CENTRAL:TARGET

#7 (Methamphetamine):MH AND CENTRAL:TARGET

#8 (Narcotics):MH AND CENTRAL:TARGET

#9 (Street Drugs):MH AND CENTRAL:TARGET

#10 (amphetamine* or drug* or polydrug or substance or cannabis or cocaine or "hash oil*" or hashish or heroin or lsd or marihuana or marijuana or methadone or mdma or morphine or ecstasy or methamphetamine* or narcotics or opioid* or opiate* or opium):ti,ab AND CENTRAL:TARGET

#11 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10

#12 (Alcohol Drinking):MH AND CENTRAL:TARGET

#13 (alcohol* near (abstain* or abstin* or abus* or addict* or consum* or dependen* or disorder* or drink* or excess* or misus* or problem* or risk* or withdrawal*)):ti,ab,kw AND CENTRAL:TARGET

#14 #12 OR #13

#15 (Music Therapy):MH AND CENTRAL:TARGET

#16 (Music):MH AND CENTRAL:TARGET

#17 music*:ti,ab,kw AND CENTRAL:TARGET

#18 (sing or singing or song* or choral* or choir* or melod* or lyric*):ti,ab,kw AND CENTRAL:TARGET

#19 #15 OR #16 OR #17 OR #18

#20 #14 OR #11

#21 (abstin* or abstain* or abuse* or addict* or dependen* or misuse or overdose or withdrawal* or disorder*):ti,ab,kw AND CENTRAL:TARGET

#22 #21 AND #11

#23 #12 OR #13 OR #22

#24 #19 AND #23

MEDLINE (PubMed)

Substance‐Related Disorders[MeSH]
Amphetamines[MeSH] OR Cannabis[MeSH] OR Cocaine[MeSH] OR Designer Drugs[MeSH] OR Heroin[MeSH] OR Methamphetamine[MeSH] OR Narcotics[MeSH] OR Street Drugs[MeSH] OR amphetamine*[tiab] OR drug*[tiab] OR polydrug[tiab] OR substance[tiab] OR cannabis[tiab] OR cocaine[tiab] OR "hash oil*"[tiab] OR hashish[tiab] OR heroin[tiab] OR lsd[tiab] OR marihuana[tiab] OR marijuana[tiab] OR methadone[tiab] OR mdma[tiab] OR morphine[tiab] OR ecstasy[tiab] OR methamphetamine*[tiab] OR narcotics[tiab] OR opioid*[tiab] OR opiate*[tiab] OR opium[tiab]
#1 OR #2
abstin*[tiab] OR abstain*[tiab] OR abuse*[tiab] OR addict*[tiab] OR dependen*[tiab] OR misuse[tiab] OR overdose[tiab] OR withdrawal*[tiab] OR disorder*[tiab]
#3 AND #4
Alcohol Drinking[MeSH]
((alcohol*[tiab] AND (abstain*[tiab] OR abstin*[tiab] OR abus*[tiab] OR addict*[tiab] OR consum*[tiab] OR dependen*[tiab] OR disorder*[tiab] OR drink*[tiab] OR excess*[tiab] OR misus*[tiab] OR problem*[tiab] OR risk*[tiab] OR withdrawal*[tiab]))
#5 OR #6 OR #7
"Music Therapy"[Mesh]
"Music"[Mesh]
music*[tiab]
sing[tiab] OR singing[tiab] OR song*[tiab] OR choral*[tiab] OR choir*[tiab] OR melod*[tiab] OR lyric*[tiab]
#9 OR #10 OR #11 OR #12
randomized controlled trial[pt]
controlled clinical trial[pt]
randomized[tiab]
placebo[tiab]
drug therapy[sh]
randomly[tiab]
trial[tiab]
groups[tiab]
groups[tiab]
#14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22
(animals[mh] NOT humans[mh])
#23 NOT #24
#8 AND #13 AND #25

Embase (embase.com)

exp drug abuse/
exp substance abuse/
((amphetamine* or barbiturate* or benzodiazepine* or cannabis or cocaine or drug* or hallucinogen* or hashish or heroin or lsd or marihuana or marijuana or methadone or mdma or ecstasy or methamphetamine* or opioid* or opiate* or opium or tranquilizer* or tranquiliser* or inhalant* or stimulant or polydrug or substance) adj5 (abstin* or abstain* or abuse* or addict* or dependen* or misuse or overdose or withdrawal* or disorder*)).ab,kw,ti.
(alcohol* adj5 (abstain* or abstin* or abus* or addict* or consum* or dependen* or disorder* or drink* or excess* or misus* or problem* or risk* or withdrawal*)).ti,ab.
1 or 2 or 3 or 4
exp music therapy/
music.ti,ab,kw.
(sing or singing or song* or choral* or choir* or melod* or lyric*).ti,ab.
6 or 7 or 8
5 and 9
exp randomized controlled trial/
exp crossover procedure/
exp double blind procedure/
exp single blind procedure/
(random* or placebo* or allocat* or crossover* or 'cross over' or trial or (doubl* adj2 blind*)).ti,ab.
11 or 12 or 13 or 14 or 15
10 and 16

CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature)

S36 S33 AND S34 AND S35

S35 S8 OR S35

S34 S8 AND S16

S33 S30 OR S31 OR S32

S32 TI(sing or singing or song* or choral* or choir* or melod* or lyric*)or AB(sing or singing or song* or choral* or choir* or melod* or lyric*)

S31 TI music or AB music

S30 (MM "Music Therapy")

S29 S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28

S28 MH "Quantitative Studies"

S27 TI placebo* or AB placebo*

S26 MH "Placebos"

S25 TI random* allocat* or AB random* allocat*

S24 MH "Random Assignment"

S23 TI randomi?ed control* trial* or AB randomi?ed control* trial*

S22 AB ( singl* or doubl* or trebl* or tripl* ) and AB ( blind* or mask* )

S21 TI ( singl* or doubl* or trebl* or tripl* ) and TI ( blind* or mask* )

S20 TI clinic* N1 trial* or AB clinic* N1 trial*

S19 PT Clinical trial

S18 MH "Clinical Trials+"

S17 S8 AND S16

S16 S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15

S15 (MH "Ketamine")

S14 (MH "Amphetamines+")

S13 (MH "Methadone")

S12 (MH "Hallucinogens+")

S11 MH "Designer Drugs"

S10 MH "Narcotics"

S9 TX(polydrug or alcohol or opioid or opiate or opium or hallucinogen or cocaine or benzodiazepine* or amphetamine*or “anti‐anxiety‐agents” or barbiturate* or “lysergic acid” or ketamine or cannabis or marihuana or marijuana or hashish or inhalant* or solvent or steroid* or methadone or morphine)

S8 S5 or S6

S7 S1 or S2 or S3 or S4

S6 TX(use* N2 drug) or TX(use* N2 disorder) or TX(use* N2 illicit)

S5 TX(addict* OR overdos* OR intoxicat* OR abstin* OR abstain OR withdraw* OR abus* OR misus* OR disorder* OR dependen*)

S4 TX(substance N3 addict*) or TX(substance N3 dependen*) or TX(substance N3 abuse*) or TX(substance N3 misus*)

S3 TX(drug N3 addict*) or TX(drug N3 dependen*) or TX(drug N3 abuse*) or TX(drug N3 misus*)

S2 (MH "Psychoses, Substance‐Induced+")

S1 (MH "Substance Use Disorders+")

ERIC

S1. TI amphetamine* OR drug* OR polydrug OR substance OR cannabis OR cocaine OR "hash oil*" OR hashish OR heroin OR lsd OR marihuana OR marijuana OR methadone OR mdma OR morphine OR ecstasy OR methamphetamine* OR narcotics OR opioid* OR opiate* OR opium

S2. AB amphetamine* OR drug* OR polydrug OR substance OR cannabis OR cocaine OR "hash oil*" OR hashish OR heroin OR lsd OR marihuana OR marijuana OR methadone OR mdma OR morphine OR ecstasy OR methamphetamine* OR narcotics OR opioid* OR opiate* OR opium

S3. S1 AND S2

S4. TI abstin* OR abstain* OR abuse* OR addict* OR dependen* OR misuse OR overdose OR withdrawal* OR disorder*

S5. AB abstin* OR abstain* OR abuse* OR addict* OR dependen* OR misuse OR overdose OR withdrawal* OR disorder*

S6. S4 AND S5

S7. S3 AND S6

S8. TI ((alcohol* AND (abstain* OR abstin* OR abus* OR addict* OR consum* OR dependen* OR disorder* OR drink* OR excess* OR misus* OR problem* OR risk* OR withdrawal*))

S9. AB ((alcohol* AND (abstain* OR abstin* OR abus* OR addict* OR consum* OR dependen* OR disorder* OR drink* OR excess* OR misus* OR problem* OR risk* OR withdrawal*))

S10. S8 AND S9

S11. S7 OR S10

S12. “music therapy”

S13. “music”

S14. TI music*

S15. AB music*

S16. S14 AND S15

S17. TI sing OR singing OR song* OR choral* OR choir* OR melod* OR lyric*

S18. AB sing OR singing OR song* OR choral* OR choir* OR melod* OR lyric*

S19. S17 AND S18

S20. S12 OR S13 OR S16 OR S19

S21. Randomized controlled trial

S22. Controlled clinical trial

S23. TI randomized

S24. AB randomized

S25. S23 AND S24

S26. TI placebo

S27. AB placebo

S28. S26 and S27

S29. SU drug therapy

S30. TI randomly

S31. AB randomly

S32. S30 AND S31

S33. TI trial

S34. AB trial

S35. S33 AND S34

S36. TI groups

S37. AB groups

S38. S36 AND S37

S39. S21 OR S22 OR S25 OR S28 OR S29 OR S32 OR S35 OR S38

S40. S11 AND S20

S41. S39 AND S40

ISI Web of Science (Thomson Reuters)

TS=(((amphetamine* OR barbiturate* OR benzodiazepine* OR cannabis OR cocaine OR drug* OR hallucinogen* OR hashish OR heroin OR lsd OR marihuana OR marijuana OR methadone OR mdma OR ecstasy OR methamphetamine* OR opioid* OR opiate* OR opium OR tranquilizer* OR tranquiliser* OR inhalant* OR stimulant OR polydrug OR substance) NEAR/5 (abus* OR abstin* OR dependen* OR addict* OR disorder* OR misuse)))
TS= clinical trial* OR TS=research design OR TS=comparative stud* OR TS=evaluation stud* OR TS=controlled trial* OR TS=follow‐up stud* OR TS=prospective stud* OR TS=random* OR TS=placebo* OR TS=(single blind*) OR TS=(double blind*)
TS=(music or sing or singing or song* or choral* or choir* or melod* or lyric*)
#3 AND #2 AND #1

Indexes=SCI‐EXPANDED, SSCI, A&HCI, CPCI‐S, CPCI‐SSH, ESCI Timespan=All years

PsycINFO

exp "substance use disorder"/
exp drug addiction/
(amphetamine* or drug* or polydrug or substance or cannabis or cocaine or hash oil* or hashish or heroin or lsd or marihuana or marijuana or methadone or mdma or morphine or ecstasy or methamphetamine* or narcotics or opioid* or opiate* or opium).mp.
1 or 2 or 3
(abstin* or abstain* or abuse* or addict* or dependen* or misuse or overdose or withdrawal* or disorder*).tw.
4 and 5
exp Alcohol Abuse/ or exp Alcoholism/
alcohol*.tw.
(abstain* or abstin* or abus* or addict* or consum* or dependen* or disorder* or drink* or excess* or misus* or problem* or risk* or withdrawal*).tw.
8 and 9
7 or 10
6 or 11
exp Music Therapy/
music*.mp.
(sing or singing or song* or choral* or choir* or melod* or lyric*).tw.
13 or 14 or 15
12 and 16
exp Clinical Trials/
(random* or (clinical adj3 trial*) or (reserch adj3 design*) or (evaluat adj3 stud*) or (prospective* adj3 stud*)).tw.
((singl* or doubl* or trebl* or tripl*) adj3 (blind* or mask*)).tw.
18 or 19 or 20
17 and 21

International Bibliography of the Social Sciences (IBSS)

(((ab(amphetamine* OR drug* OR polydrug OR substance OR cannabis OR cocaine OR "hash oil*" OR hashish OR heroin OR lsd OR marihuana OR marijuana OR methadone OR mdma OR morphine OR ecstasy OR methamphetamine* OR narcotics OR opioid* OR opiate* OR opium) AND ti(amphetamine* OR drug* OR polydrug OR substance OR cannabis OR cocaine OR "hash oil*" OR hashish OR heroin OR lsd OR marihuana OR marijuana OR methadone OR mdma OR morphine OR ecstasy OR methamphetamine* OR narcotics OR opioid* OR opiate* OR opium)) AND (ab(abstin* OR abstain* OR abuse* OR addict* OR dependen* OR misuse OR overdose OR withdrawal* OR disorder*) AND ti(abstin* OR abstain* OR abuse* OR addict* OR dependen* OR misuse OR overdose OR withdrawal* OR disorder*))) OR ((ti(alcohol*) AND ab(alcohol*)) AND (ti((abstain* OR abstin* OR abus* OR addict* OR consum* OR dependen* OR disorder* OR drink* OR excess* OR misus* OR problem* OR risk* OR withdrawal*)) AND ab((abstain* OR abstin* OR abus* OR addict* OR consum* OR dependen* OR disorder* OR drink* OR excess* OR misus* OR problem* OR risk* OR withdrawal*))))) AND (all("music therapy") OR all("music") OR (ab(music*) AND ti(music*)) OR (ti(sing OR singing OR song* OR choral* OR choir* OR melod* OR lyric*) AND ab(sing OR singing OR song* OR choral* OR choir* OR melod* OR lyric*))) AND (su(randomized controlled trial) OR su(controlled clinical trial) OR (ti(randomized) AND ab(randomized)) OR (ti(randomly) AND ab(randomly)) OR (ti(trial) AND ab(trial)) OR (ti(groups) AND ab(groups)))

ProQuest Dissertations & Theses

(((ab(amphetamine* OR drug* OR polydrug OR substance OR cannabis OR cocaine OR "hash oil*" OR hashish OR heroin OR lsd OR marihuana OR marijuana OR methadone OR mdma OR morphine OR ecstasy OR methamphetamine* OR narcotics OR opioid* OR opiate* OR opium) AND ti(amphetamine* OR drug* OR polydrug OR substance OR cannabis OR cocaine OR "hash oil*" OR hashish OR heroin OR lsd OR marihuana OR marijuana OR methadone OR mdma OR morphine OR ecstasy OR methamphetamine* OR narcotics OR opioid* OR opiate* OR opium)) AND (ab(abstin* OR abstain* OR abuse* OR addict* OR dependen* OR misuse OR overdose OR withdrawal* OR disorder*) AND ti(abstin* OR abstain* OR abuse* OR addict* OR dependen* OR misuse OR overdose OR withdrawal* OR disorder*))) OR ((ti(alcohol*) AND ab(alcohol*)) AND (ti((abstain* OR abstin* OR abus* OR addict* OR consum* OR dependen* OR disorder* OR drink* OR excess* OR misus* OR problem* OR risk* OR withdrawal*)) AND ab((abstain* OR abstin* OR abus* OR addict* OR consum* OR dependen* OR disorder* OR drink* OR excess* OR misus* OR problem* OR risk* OR withdrawal*))))) AND (all("music therapy") OR all("music") OR (ab(music*) AND ti(music*)) OR (ti(sing OR singing OR song* OR choral* OR choir* OR melod* OR lyric*) AND ab(sing OR singing OR song* OR choral* OR choir* OR melod* OR lyric*))) AND (su(randomized controlled trial) OR su(controlled clinical trial) OR (ti(randomized) AND ab(randomized)) OR (ti(randomly) AND ab(randomly)) OR (ti(trial) AND ab(trial)) OR (ti(groups) AND ab(groups)))

Google Scholar (first 100 hits)

("music therapy" AND (substance OR alcohol* OR abus* OR dependen* OR addict*) AND ("randomized controlled trial" OR "randomised controlled trial" OR "clinical controlled trial" OR “cluster randomized”))

Clinical Trials Register (via clinicaltrials.gov/)

Substance use disorder AND "Music therapy"
Addiction AND "Music therapy"
substance use AND music
drug abuse AND music
drug abuse AND "music therapy"
Substance‐Related Disorders AND Music
Substance‐Related Disorders AND "music therapy"
detox AND music (therapy)
abstinence AND music
cannabis AND music OR sing* OR music therapy
alcohol‐related disorder AND music V sing* OR music therapy
amphetamine* AND music
cocaine & music AND sing* OR music therapy

World Health Organization Register (via apps.who.int/trialsearch/)

Substance use disorder AND "Music therapy"
Substance use disorder & AND Music
Addiction AND "Music therapy"
substance use AND music
drug abuse AND music
drug abuse AND "music therapy"
Substance‐Related Disorders AND Music
Substance‐Related Disorders AND "music therapy"
detox AND music (therapy)
abstinence AND music
cannabis AND music V music therapy
cannabis AND sing*
alcohol‐related disorder AND music OR sing* OR music therapy
amphetamine* AND music
amphetamine AND "music therapy"
cocaine AND music OR music therapy

Appendix 2. Criteria for the assessment of risk of bias

No.	Item	Judgement	Description
1	Random sequence generation (selection bias)	Low risk	The investigators described a random component in the sequence generation process such as: random‐number table; computer random‐number generator; coin tossing; shuffling cards or envelopes; throwing dice; drawing of lots; minimisation.
		High risk	The investigators described a non‐random component in the sequence generation process such as: odd or even date of birth; date (or day) of admission; hospital or clinic record number; alternation; judgement of the clinician; preference of the participant; results of a laboratory test or a series of tests; availability of the intervention.
		Unclear risk	Insufficient information about the sequence generation process to permit judgement of 'low risk' or 'high risk'.
2	Allocation concealment (selection bias)	Low risk	Investigators enrolling participants could not have foreseen assignment because 1 of the following, or an equivalent method, was used to conceal allocation: central allocation (including telephone, Internet‐based, and pharmacy‐controlled randomisation); sequentially numbered drug containers of identical appearance; sequentially numbered, opaque, sealed envelopes.
		High risk	Investigators enrolling participants could possibly have foreseen assignments and thus introduced selection bias because 1 of the following methods was used: open random allocation schedule (e.g. a list of random numbers); assignment envelopes without appropriate safeguards (e.g. if envelopes were unsealed or non‐opaque or not sequentially numbered); alternation or rotation; date of birth; case record number; any other explicitly unconcealed procedure.
		Unclear risk	Insufficient information to permit judgement of 'low risk' or 'high risk'. This is usually the case if the method of concealment was not described or not described in sufficient detail to allow a definite judgement.
3	Blinding of participants and providers (performance bias) Objective outcomes	Low risk	No blinding or incomplete blinding, but the review authors judged that the outcome was not likely to have been influenced by lack of blinding; blinding of participants and key study personnel ensured, and unlikely that the blinding could have been broken.
		High risk	No blinding or incomplete blinding, and the outcome was likely to be influenced by lack of blinding; blinding of key study participants and personnel attempted, but likely that the blinding could have been broken, and the outcome was likely to be influenced by lack of blinding.
		Unclear risk	Insufficient information to permit judgement of 'low risk' or 'high risk'; the study did not address this outcome.
4	Blinding of participants and providers (performance bias) Subjective outcomes	Low risk	Blinding of participants and providers ensured, and unlikely that the blinding could have been broken
		High risk	No blinding or incomplete blinding, and the outcome is likely to be influenced by lack of blinding; blinding of key study participants and personnel attempted, but likely that the blinding could have been broken, and the outcome is likely to be influenced by lack of blinding,
		Unclear risk	Insufficient information to permit judgement of 'low risk' or 'high risk'; the study did not address this outcome.
5	Blinding of outcome assessor (detection bias) Objective outcomes	Low risk	No blinding of outcome assessment, but the review authors judged that the outcome measurement was not likely to be influenced by lack of blinding; blinding of outcome assessment ensured, and unlikely that the blinding could have been broken.
		High risk	No blinding of outcome assessment, and the outcome measurement was likely to be influenced by lack of blinding; blinding of outcome assessment, but likely that the blinding could have been broken, and the outcome measurement was likely to be influenced by lack of blinding.
		Unclear risk	Insufficient information to permit judgement of 'low risk' or 'high risk'; the study did not address this outcome.
6	Blinding of outcome assessor (detection bias) Subjective outcomes	Low risk	Blinding of outcome assessment ensured, and unlikely that the blinding could have been broken.
		High risk	No blinding of outcome assessment, and the outcome measurement was likely to be influenced by lack of blinding; blinding of outcome assessment, but likely that the blinding could have been broken, and the outcome measurement was likely to be influenced by lack of blinding.
		Unclear risk	Insufficient information to permit judgement of 'low risk' or 'high risk'; the study did not address this outcome.
7	Incomplete outcome data (attrition bias) For all outcomes except retention in treatment	Low risk	No missing outcome data; reasons for missing outcome data unlikely to be related to true outcome (for survival data, censoring unlikely to be introducing bias); missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups; for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk not enough to have a clinically relevant impact on the intervention effect estimate; for continuous outcome data, plausible effect size (difference in means or standardised difference in means) among missing outcomes not enough to have a clinically relevant impact on observed effect size; missing data had been imputed using appropriate methods; all randomised participants were reported/analysed in the group they were allocated to by randomisation, irrespective of non‐compliance and co‐interventions (intention‐to‐treat).
		High risk	Reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across interventions groups; for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk enough to induce clinically relevant bias in intervention effect estimate; for continuous outcome data, plausible effect size (difference in means or standardised difference in means) among missing outcomes enough to induce clinically relevant bias in observed effect size; 'as‐treated' analysis done with substantial departure of the intervention received from that assigned at randomisation.
		Unclear risk	Insufficient reporting of attrition/exclusions to permit judgement of 'low risk' or 'high risk' (e.g. number randomised not stated, no reasons for missing data provided; the study did not address this outcome).
8	Selective reporting (reporting bias)	Low risk	The study protocol was available and all of the study's prespecified (primary and secondary) outcomes that were of interest in the review were reported in the prespecified way; the study protocol was not available but it was clear that the published reports included all expected outcomes, including those that were prespecified (convincing text of this nature may be uncommon)
		High risk	Not all of the study's prespecified primary outcomes were reported; ≥ 1 primary outcomes was reported using measurements, analysis methods, or subsets of the data (e.g. subscales) that were not prespecified; ≥ 1 reported primary outcomes were not prespecified (unless clear justification for their reporting was provided, such as an unexpected adverse effect); ≥ 1 outcomes of interest in the review were reported incompletely so that they could not be entered in a meta‐analysis; the study report failed to include results for a key outcome that would be expected to have been reported for such a study.
		Unclear risk	Insufficient information to permit judgement of 'low risk' or 'high risk'.
9	Other sources of bias	Low risk	The study appeared free of other sources of bias.
		High risk	There was ≥ 1 important risk of bias; e.g. the study had a potential source of bias related to the specific study design used; or had been claimed to have been fraudulent; or had some other problem.
		Unclear risk	There may be a risk of bias, but there was either: insufficient information to assess whether an important risk of bias existed; or insufficient rationale or evidence that an identified problem would introduce bias.

Figure 1

PRISMA Flow Diagram

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Figure 2

Review authors' judgements about each risk of bias item presented as percentages across all included studies. Objective outcome was only assessed in six of the included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 1: Psychological outcomes (depression self‐report; various tools, BDI, HRSD, SDS; high = poor)

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Analysis 1.2

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 2: Psychological outcomes short‐term follow‐up (depression self‐report, SDS; high = poor)

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Analysis 1.3

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 3: Psychological outcomes (anxiety self‐report; SAS; high = poor)

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Analysis 1.4

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 4: Psychological outcomes short‐term follow‐up (anxiety self‐report; SAS; high = poor)

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Analysis 1.5

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 5: Substance craving (various scales; BSCS, ACQ‐SF‐R; high = poor)

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Analysis 1.6

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 6: Motivation for treatment/change (various scales; CESI, ICR, CMR; high = good)

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Analysis 1.7

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 7: Motivation to stay sober/clean (various scales, high = good)

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Analysis 1.8

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 8: Motivation to stay sober/clean short‐term follow‐up (QMAD, high = good)

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Analysis 1.9

Comparison 1: Music therapy plus standard care versus standard care alone, Outcome 9: Retention in treatment (high = good)

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Analysis 2.1

Comparison 2: Music therapy plus standard care versus active intervention plus standard care, Outcome 1: Psychological outcomes (depression self‐report; BDI; high = poor)

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Analysis 2.2

Comparison 2: Music therapy plus standard care versus active intervention plus standard care, Outcome 2: Psychological outcomes short‐term follow‐up (depression self‐report; Likert; high = poor)

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Analysis 2.3

Comparison 2: Music therapy plus standard care versus active intervention plus standard care, Outcome 3: Substance craving (various scales, high = poor)

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Analysis 2.4

Comparison 2: Music therapy plus standard care versus active intervention plus standard care, Outcome 4: Motivation for treatment/change (various tools; RTCQ‐TV, SOCRATES, URICA; higher = good)

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Analysis 2.5

Comparison 2: Music therapy plus standard care versus active intervention plus standard care, Outcome 5: Motivation to stay sober/clean (Likert, high = good)

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Analysis 2.6

Comparison 2: Music therapy plus standard care versus active intervention plus standard care, Outcome 6: Substance use short‐term follow‐up (self‐report)

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Summary of findings 1. Music therapy plus standard care versus standard care alone for people with substance use disorders

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
Music therapy plus standard care versus standard care alone for people with substance use disorders
Patient or population: people with substance use disorders Setting: detox and inpatient/outpatient rehabilitation settings Intervention: music therapy plus standard care Comparison: standard care alone
Outcomes	Risk with standard care	Risk with music therapy	Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
Psychological symptoms (depression) Assessed with: various scales Scale: various (higher score worse) Follow‐up: end of treatment	—	Mean depression in music therapy was 0.33 standard deviations lower (0.72 lower to 0.07 higher)	—	100 (3 RCTs)	⊕⊕⊕⊝ Moderate^a	—
Psychological symptoms (anxiety) Assessed with: Self‐report Anxiety Scale Scale: 20–80 (higher score worse) Follow‐up: end of treatment	The mean anxiety score for standard care was 46.1	Music therapy was 0.17 lower (4.39 lower to 4.05 higher)	—	60 (1 RCT)	⊕⊕⊝⊝ Low^b	—
Substance craving Assessed with: Scale: various (higher score worse) Follow‐up: end of treatment	—	Mean substance craving in music therapy was 0.66 standard deviations lower (1.23 lower to 0.10 lower)	—	254 (3 RCTs)	⊕⊕⊕⊝ Moderate^a	—
Motivation for treatment/change Assessed with: various scales Scale: various (higher score better) Follow‐up: end of treatment	—	Mean motivation for treatment in music therapy was 0.41 standard deviations higher (0.21 higher to 0.61 higher)	—	408 (5 RCTs)	⊕⊕⊕⊝ Moderate^a	—
Motivation to stay sober/clean Assessed with: various scales Scale: various (higher score better) Follow‐up: end of treatment	—	Mean motivation for sobriety in music therapy was 0.22 standard deviations higher (0.02 lower to 0.47 higher)	—	269 (3 RCTs)	⊕⊕⊕⊝ Moderate^a	—
Retention in treatment Assessed with: number participants retained at end of treatment	Study population		RR 0.99 (0.93 to 1.05)	199 (6 RCTs)	⊕⊕⊕⊝ Moderate^a	Higher retention better.
	725 per 1000	718 per 1000 (674 to 761)	RR 0.99 (0.93 to 1.05)	199 (6 RCTs)	⊕⊕⊕⊝ Moderate^a	Higher retention better.
Serious adverse events	—	—	—	—	—	No studies reported serious adverse events.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded one level for imprecision: optimal information size not met. ^bDowngraded two levels for imprecision: very low sample size.

Summary of findings 1. Music therapy plus standard care versus standard care alone for people with substance use disorders

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Summary of findings 2. Music therapy plus standard care compared to active intervention plus standard care

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
Patient or population: people with substance use disorders Setting: detox and inpatient/outpatient rehabilitation settings Intervention: music therapy plus standard care Comparison: active intervention plus standard care
Outcomes	Risk with active intervention	Risk with music therapy	Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
Psychological outcomes (depression) Assessed with: Beck Depression Inventory Scale: 0–63 (higher score worse) Follow‐up: end of treatment	Mean depression for active intervention was 20.3	Music therapy was 1.49 lower (4.98 lower to 2.00 higher)	—	110 (1 RCT)^a	⊕⊕⊕⊝ Moderate^b	—
Substance craving Assessed with: various scales Scale: various (higher score worse) Follow‐up: end of treatment	—	Mean substance craving in music therapy was 0.04 standard deviations lower (0.56 lower to 0.48 higher)	—	232 (3 RCTs)^a	⊕⊕⊝⊝ Low^b,c	—
Motivation for treatment/change Assessed with: various scales Scale: various (higher score better) Follow‐up: end of treatment	—	Mean motivation for treatment in music therapy was 0.46 standard deviations higher (0 lower to 0.93 higher)	—	411 (5 RCTs)^a	⊕⊕⊕⊝ Moderate^b	—
Motivation to stay sober/clean Assessed with: Likert Scale: 1–7 (higher score better) Follow‐up: end of treatment	Mean motivation to stay sober in active intervention ranged from 6.2 to 6.4	Music therapy was 0.34 higher (0.11 lower to 0.78 higher)	—	258 (3 RCTs)^a	⊕⊕⊕⊝ Moderate^b	—
Retention in treatment	—	—	—	—	—	No studies reported retention in treatment.
Serious adverse events	—	—	—	—	—	No studies reported serious adverse events.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aNumber of participants adjusted for cluster randomisation. ^bDowngraded one level for imprecision: optimal information size not met. ^cDowngraded one level for inconsistency: substantial heterogeneity (I² = 70%) likely affecting interpretation of results and with no plausible explanation.

Summary of findings 2. Music therapy plus standard care compared to active intervention plus standard care

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Comparison 1. Music therapy plus standard care versus standard care alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Psychological outcomes (depression self‐report; various tools, BDI, HRSD, SDS; high = poor) Show forest plot	3	100	Std. Mean Difference (IV, Random, 95% CI)	‐0.33 [‐0.72, 0.07]

1.1.1 Immediately after end of intervention (longer‐term interventions, e.g. rehab: approximately 1–3 months)	3	100	Std. Mean Difference (IV, Random, 95% CI)	‐0.33 [‐0.72, 0.07]
1.2 Psychological outcomes short‐term follow‐up (depression self‐report, SDS; high = poor) Show forest plot	1	60	Mean Difference (IV, Random, 95% CI)	‐1.13 [‐6.33, 4.07]

1.2.1 Short‐term follow‐up (3 months)	1	60	Mean Difference (IV, Random, 95% CI)	‐1.13 [‐6.33, 4.07]
1.3 Psychological outcomes (anxiety self‐report; SAS; high = poor) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.3.1 Immediately after end of intervention (longer‐term interventions, e.g. rehab: approximately 1–3 months)	1	60	Mean Difference (IV, Random, 95% CI)	‐0.17 [‐4.39, 4.05]
1.4 Psychological outcomes short‐term follow‐up (anxiety self‐report; SAS; high = poor) Show forest plot	1	60	Mean Difference (IV, Random, 95% CI)	‐1.49 [‐5.74, 2.76]

1.4.1 Short‐term follow‐up (3 months)	1	60	Mean Difference (IV, Random, 95% CI)	‐1.49 [‐5.74, 2.76]
1.5 Substance craving (various scales; BSCS, ACQ‐SF‐R; high = poor) Show forest plot	3	254	Std. Mean Difference (IV, Random, 95% CI)	‐0.66 [‐1.23, ‐0.10]

1.5.1 Immediately after end of intervention (1‐day interventions, e.g. in detox)	2	218	Std. Mean Difference (IV, Random, 95% CI)	‐0.37 [‐0.64, ‐0.09]
1.5.2 Immediately after end of intervention (longer‐term interventions, e.g. rehab: approximately 1–3 months)	1	36	Std. Mean Difference (IV, Random, 95% CI)	‐1.47 [‐2.21, ‐0.72]
1.6 Motivation for treatment/change (various scales; CESI, ICR, CMR; high = good) Show forest plot	5	408	Std. Mean Difference (IV, Random, 95% CI)	0.41 [0.21, 0.61]

1.6.1 Immediately after end of intervention (1‐day interventions, e.g. detox)	4	392	Std. Mean Difference (IV, Random, 95% CI)	0.42 [0.20, 0.64]
1.6.2 Immediately after end of intervention (longer‐term interventions, e.g. rehab: approximately 1–3 months)	1	16	Std. Mean Difference (IV, Random, 95% CI)	0.29 [‐0.70, 1.29]
1.7 Motivation to stay sober/clean (various scales, high = good) Show forest plot	3	269	Std. Mean Difference (IV, Random, 95% CI)	0.22 [‐0.02, 0.47]

1.7.1 Immediately after end of intervention (1‐day interventions, e.g. detox)	2	209	Std. Mean Difference (IV, Random, 95% CI)	0.20 [‐0.15, 0.55]
1.7.2 Immediately after end of intervention (longer‐term interventions, e.g. rehab: approximately 1–3 months)	1	60	Std. Mean Difference (IV, Random, 95% CI)	0.26 [‐0.25, 0.77]
1.8 Motivation to stay sober/clean short‐term follow‐up (QMAD, high = good) Show forest plot	1	60	Mean Difference (IV, Random, 95% CI)	9.29 [‐4.60, 23.18]

1.8.1 Short‐term follow‐up (3 months)	1	60	Mean Difference (IV, Random, 95% CI)	9.29 [‐4.60, 23.18]
1.9 Retention in treatment (high = good) Show forest plot	6	199	Risk Ratio (IV, Random, 95% CI)	0.99 [0.93, 1.05]

1.9.1 Immediately after end of intervention (longer‐term interventions, e.g. rehab: approximately 1–3 months)	6	199	Risk Ratio (IV, Random, 95% CI)	0.99 [0.93, 1.05]

Comparison 1. Music therapy plus standard care versus standard care alone

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Comparison 2. Music therapy plus standard care versus active intervention plus standard care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Psychological outcomes (depression self‐report; BDI; high = poor) Show forest plot	1	110	Mean Difference (IV, Random, 95% CI)	‐1.49 [‐4.98, 2.00]

2.1.1 Immediately after end of intervention (1‐day interventions, e.g. detox)	1	110	Mean Difference (IV, Random, 95% CI)	‐1.49 [‐4.98, 2.00]
2.2 Psychological outcomes short‐term follow‐up (depression self‐report; Likert; high = poor) Show forest plot	1	54	Mean Difference (IV, Random, 95% CI)	0.03 [‐1.05, 1.11]

2.2.1 Short‐term follow‐up (1 month after treatment)	1	54	Mean Difference (IV, Random, 95% CI)	0.03 [‐1.05, 1.11]
2.3 Substance craving (various scales, high = poor) Show forest plot	3	232	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.56, 0.48]

2.3.1 Immediately after end of intervention (1‐day interventions, e.g. detox)	2	196	Std. Mean Difference (IV, Random, 95% CI)	‐0.27 [‐0.57, 0.03]
2.3.2 Immediately after end of intervention (longer‐term interventions, e.g. rehab: approximately 1–3 months)	1	36	Std. Mean Difference (IV, Random, 95% CI)	0.64 [‐0.03, 1.31]
2.4 Motivation for treatment/change (various tools; RTCQ‐TV, SOCRATES, URICA; higher = good) Show forest plot	5	411	Std. Mean Difference (IV, Random, 95% CI)	0.46 [‐0.00, 0.93]

2.4.1 Immediately after end of intervention (1‐day interventions, e.g. detox)	5	411	Std. Mean Difference (IV, Random, 95% CI)	0.46 [‐0.00, 0.93]
2.5 Motivation to stay sober/clean (Likert, high = good) Show forest plot	3	258	Mean Difference (IV, Random, 95% CI)	0.34 [‐0.11, 0.78]

2.5.1 Immediately after end of intervention (1‐day interventions, e.g. detox)	3	258	Mean Difference (IV, Random, 95% CI)	0.34 [‐0.11, 0.78]
2.6 Substance use short‐term follow‐up (self‐report) Show forest plot	1	140	Risk Ratio (IV, Random, 95% CI)	1.05 [0.85, 1.29]

2.6.1 Short‐term follow‐up (1‐month post‐discharge)	1	140	Risk Ratio (IV, Random, 95% CI)	1.05 [0.85, 1.29]

Comparison 2. Music therapy plus standard care versus active intervention plus standard care

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Musicoterapia para personas con trastornos por consumo de sustancias

Appendices

Appendix 1. Search strategy

Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive)

Cochrane Central Register of Controlled Trials (CENTRAL)

MEDLINE (PubMed)

Embase (embase.com)

CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature)

ERIC

ISI Web of Science (Thomson Reuters)

PsycINFO

International Bibliography of the Social Sciences (IBSS)

ProQuest Dissertations & Theses

Google Scholar (first 100 hits)

Clinical Trials Register (via clinicaltrials.gov/)

World Health Organization Register (via apps.who.int/trialsearch/)

Appendix 2. Criteria for the assessment of risk of bias

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Appendices

Appendix 1. Search strategy

Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive)

Cochrane Central Register of Controlled Trials (CENTRAL)

MEDLINE (PubMed)

Embase (embase.com)

CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature)

ERIC

ISI Web of Science (Thomson Reuters)

PsycINFO

International Bibliography of the Social Sciences (IBSS)

ProQuest Dissertations & Theses

Google Scholar (first 100 hits)

Clinical Trials Register (via clinicaltrials.gov/)

World Health Organization Register (via apps.who.int/trialsearch/)

Appendix 2. Criteria for the assessment of risk of bias

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Instituciones a las que se accedió previamente

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