Author(s): Walter S Mathis
Substance Use Disorders remain a costly and dangerous illness despite decades of focused research and a sophisticated understanding of the mechanisms of acute and chronic use in the brain. It is clear that available therapies have only partial efficacy and effort should be made to translate a growing neuroscience understanding to improved therapeutic interventions. Compelling evidence suggests that the acute reinforcing effects of drugs of abuse are due to increased dopamine release in the nucleus accumbens, a brain mechanism associated with the processing of reward and saliency. But, with chronic drug use, select elements of striatal dopaminergic neurotransmission (receptors, transports, enzymes) are down-regulated, rendering a hypodopaminergic state when not augmented by drug use. This state contributes to drug craving, seeking, and ultimately relapse. Hence it is a target for relapse prevention. Recently it has been confirmed that listening to highly pleasurable music can induce not only a strong psychophysiologic response, but also dopamine release in the same neurocircuits as drugs of abuse. Hypothetically this effect of music could have therapeutic potential as an inducer of dopamine release that might ameliorate the hypodopaminergic state of the abstinent addict as a form of agonist substitution. However, a thorough review of the literature found no clinical trials assessing this potential therapeutic effect. Obstacles for consideration in such a trial are also discussed.
