A Rationale for Music-Based Cognitive Rehabilitation Toward Prevention of Relapse in Drug Addiction

Abstract

Drug addiction is a brain disease that is chronic and relapsing and is characterized by compulsive drug seeking and use despite harmful consequences (Volkow, 2009). It is considered a brain disease because drugs of abuse change the structure and functioning of the brain (Volkow, 2009). The term addiction is essentially synonymous to the term dependence, with the latter term represented more frequently in the Diagnostic and Statistical Manual of Mental Disorders IV-TR (O'Brien, Volkow, & Li, 2006). Outcome studies of an addiction report that 65-70% of patients with alcohol dependency have been found to relapse within 1 year of treatment, the majority within the first 3 months. Relapse rates are similar or greater for those with drug or polysubstance dependency (Bauer, 2001).Recently, neuropsychologists have emphasized the need for research and treatment to focus on cognitive rehabilitation of executive function for relapse prevention (Bates, Bowden, & Barry, 2002). Executive function is the ability to formulate, initiate, regulate, and schedule a range of cognitive abilities such as working memory, cognitive flexibility, attention control, response inhibition, abstract reasoning, complex visuospatial, and visuomotor skills (Bates et al., 2002; Miller & Cohen, 2001). Problems with executive function in individuals with drug addiction have been reported to be a contributing factor to relapse (Allen, Goldstein, & Seaton, 1997; Brand, Roth-Bauer, Driessen & Harkowtisch, 2008; Parsons, 1998; Volkow & Fowler, 2000).A comprehensive neuroanatomical and cognitive framework helps provide an explanation as to why individuals with drug addiction cannot resist using drugs, lack impulse control, and have poor decision-making skills. Individuals are vulnerable to drug addiction and relapse when the process that enables them to inhibit actions becomes disabled (Bechara, 2005). With impaired ability to plan, problem-solve, and make decisions, individuals with drug addiction may yield to powerful urges to use drugs (Hoffman & Froemke, 2007). Alternatively, clients with drug addiction who gain the ability to identify possible goal-directed solutions and anticipate consequences of their actions are better equipped to succeed in implementing treatment goals and relapse prevention skills. This paper proposes that music-based cognitive rehabilitation (MBCR) may successfully address executive function deficits in individuals with drug addiction, thus reducing the likelihood of relapse.An Overview of the RationaleThe rationale for using MBCR to prevent relapse is built on the following established and proposed concepts:Established:1. Many individuals with drug addiction have diminished frontal lobe activation which impairs decision-making and impulse control.2. Neuromusicology research has shown that music stimulates attention and working memory, two neural areas associated with executive function skill.3. An increasing number of studies report that individuals with cognitive impairments benefit from music-based interventions (e.g., improved attention, working memory and planning).Proposed:4. Sufficient practice of music attention and problemsolving exercises could improve the executive function of individuals with drug addiction.5. Improved executive function could enhance behavioral problem-solving in conjunction with music psychotherapy sessions, counseling and treatment groups, and real-life decision-making.Cognitive Deficits of Individuals with Drug AddictionDrug addiction dysregulates the neurotransmitter dopamine and disrupts circuits that control compulsive behaviors (Volkow & Fowler, 2000). Drugs of abuse produce rapid surges of dopamine release and associated feelings of pleasure. Over time, the drug use disables normal dopamine production and connections to higher brain areas are weakened (Hoffman & Foremke, 2007). …