Measuring Music's Therapeutic Impact
Featured Guest: Dr. Constance Scharff
As health insurers limit access to some aspects of addiction treatment, how can providers still incorporate experiential therapies that can engage and heal the entire brain?
We’ll answer this with author and addiction researcher Constance Scharff of Rock to Recovery on this episode of Recovery Unscripted.
Interviewer: Could we start by having you tell us a bit about that, and how you got into this world, started in the treatment world?
Dr. Scharff: I started getting sober about 23 years ago. I’ve been sober for 20 years now. The first few years were rough because I had a co-occurring disorder. I have trauma, depression, anxiety. Back then, we didn’t really know how to treat that. I did finally get sober, but I was not happy in my sobriety. I was very often very depressed, suicidal.
At the same time, I was sober in the west side of Los Angeles. That’s where I get sober. There were a lot of guys coming over, men and women, coming back from Irag and Afghanistan, from the Va Hospital that’s in Brentwood, and at the 12-Step meetings that I went to. They were killing themselves. Nobody was staying sober. They were killing themselves. I was in graduate school at that time. I’m miserable and depressed and suicidal and sober, right? These other guys and men and women are not making it. There was one man in particular, very young marine, who had done several tours, had been very badly wounded in battle and had a wife and a baby and killed himself. I thought, “We have to do better.”
Interviewer: It’s because of the trauma, kind of the same thing you were experiencing.
Dr. Scharff: Because of the trauma. I really related to the veterans. Even though that the details of the story were different, the emotions– I was like, “I get you guys. I get you guys.” I was really moved especially when that young marine killed himself. I thought, “We just have to do better.” I was in graduate school at that time. I changed everything. I changed my dissertation topic. I changed my dissertation chair. I changed everything. I thought, “What are the best ways that we can approach addiction treatment because what we’re doing isn’t working?”
If you have a co-occurring disorder, what we did 20 years ago, it didn’t address that. We didn’t address them at the same time. The thought was, “We’ll deal with the addiction and then deal with.” Well, I couldn’t do that, right? I drink two liters or more of hard liquor a day. Even by alcoholic standards, I go for it. As soon as I put that down, the trauma came up. I didn’t know what to do with those feelings.
Interviewer: Is that was how you’re coping?
Dr. Scharff: That’s how I was dealing with it, yes. The literature in 12-Step program says, “Seek outside help.” I thought, “You know what? I’m going to be part of the solution. I’m going to be part of that outside help.” I look at complimentary therapies. “What are the things that we can do in conjunction with traditional psychotherapy and the things that we do traditionally in treatment programs to aid in recovery and make it an easy and more comprehensive process?” That’s what my specialty is.
I was very fortunate out of graduate school, a friend of mine at a high-end treatment center in California created a position for me in research. That’s what I did for many, many years.
Interviewer: You’re studying the efficacy, outcomes, research end of it?
Dr. Scharff: Yes. What I looked at, he gave me the opportunity to travel all over the world speaking about addiction treatment and best practices, also in consulting with mostly non-profit organizations, also looking at the research that’s being done across fields. Not the efficacy of that treatment center, but across fields, at what’s working and and how does it work.
For example, lots of treatment centers do yoga, well, what is it about yoga that’s so attractive, right? What is it about yoga that works? What I started looking at was, “What are the different types of yoga?” There’s a bunch of research happening, for example, in India. What are the different types of yoga? Why does it work? What we found out is not the poses at all, it’s the breath. The yogas that focus on breath works, on breathing, kundalini yogas and those types of things tend to be more effective in changing the brain.
One of the things that I was very fortunate is I came into the field at that time when the brain research really started to take off. We’re looking a lot at the neurology of addiction and addiction treatment and mental health, mental illness because we now know how different therapies affect the brain and we now know how addiction affects the brain.
When I was in school, we thought that if you had some brain damage, that was it. It was over. The brain was very static. Now, we understand concepts like neuroplasticity, right? That the brain is constantly changing, rewiring itself, reworking itself. We understand how it develops through the age of 25, how it prunes itself in the teenage years and early 20s, different things about the brain. Now, we can look at these complimentary therapies. I like the complimentary therapies because they have few side effects, right?
What happens if you go into a yoga session, right? You could if you were overactive, strain yourself or injure yourself in some way but most of that doesn’t happen in addiction treatment most of the time, right?
Dr. Scharff: Most of the time, there’s a bunch of guys farting and laughing in the back, right? There’s some chick falling asleep, right? That’s just the reality of it. There’s no side effect but the benefits can be very outstanding. That’s what we see with Rock to Recovery. What we see with music therapy is that music fires the entire brain. When you have an addict who’s trapped in what we call a feedback loop, a drug-seeking behavior, because the problem is not really the drug itself. Once we detox, yes, the problem was the drug, then that problem-
Interviewer: Will be over.
Dr. Scharff: – should go away, right? We both know that when someone enters recovery after they detox, they very often get worse. A lot of the problems, emotionalism, that all gets–
Interviewer: It’s been numbed for a long time.
Dr. Scharff: Right, it amplifies. We need to get the person off of that obsessive thought process of drug-seeking behavior. One of the ways to do that is to fire the brain in different ways. Music therapies, in particular, they release endorphins. You have, basically, get a natural high which drug addicts love. You got a bunch of people who are like, “I don’t really want to be here.” You’re like, “Well, we’re going to make you high naturally.” They’re like, “Let me show up for that.” [laughs] “Give me a shake here, dude.” I came in contact with Rock to Recovery at the treatment center that I worked at. One of our guys, Sonny Mayo, who was with Sevendust and Snot, the number of bands, plays often with Ugly Kid Joe now, I was so impressed because we had a group of people who– Nobody had more than two weeks clean. They’re all very fragile, very sick. They were so engaged in the session. To be honest, I thought I was going to see a third grade recital and be like, “Yey, that’s so exciting. Oh, yeah. I’m going–”
Interviewer: You have to feign your enthusiasm.
Dr. Scharff: Exactly. I was like, “Oh my gosh. This is–” They weren’t going to win a Grammy, but it was a solid song. They were into it. What really sold me was the next day, I was giving a presentation to all the clients in the residential treatment center. As they were bringing people from the different houses, they all had their phones out. They’re like, “Hey, did you hear what we did yesterday?” Like, “I want to share my song with you.” I’m like, “Oh, no, but we sure did this.”
I’ve never seen people that sick and fragile so excited about the music.
Interviewer: They’re excited about treatment?
Dr. Scharff: Yes. These are patients who literally are like, “Give me my suitcase back. I’m leaving.” We’ve had people, “What do I have to do to get out of here? Assault somebody? I’ll assault somebody. Let’s go.” They want to stay. They’re excited. They get to go back to that touch-tone of the song because it’s uploaded to the web. They keep getting to go back during the hard times. From that moment, I was like, “I need to be involved with this.” That’s how it started.
Interviewer: I know you’ve written a couple of books also yourself?
Dr. Scharff: I have, yes. I wrote Ending Addiction For Good with Richard Taite, who was the founder of that treatment center that I worked for. I wrote an award-winning poetry book, Meeting God at Midnight under my Hebrew name, Ahuva Batya.
I’m now currently working on a book with Wes Geer, the founder of Rock to Recovery, called Rock to Recovery, about music therapy, both the science of what happens in treatment with music therapy, also, the stories of some of our musicians who have had careers and are doing this now, and also, with clients, veterans, individuals in mental health settings and addicts in recovery who have used this program to benefit them.
Interviewer: You said you got introduced to Rock to Recovery as a program in this treatment center. Now, you’re writing a book with the founder. Tell us what was the journey between those two points and why did you decide to write this book.
Dr. Scharff: Well, when I met Sydney at the treatment center, he’s like, “We’re looking for a doctor to do research.” I said, “Well, I’m not your person because I was working at a treatment center that had hired Rock To Recovery.” Rock To Recovery is an ancillary service, going to over a hundred treatment centers. I said, “It’s a conflict of interest. I can’t get paid out of the same pocket.”
When I left that treatment center, I was like, “Guys, what do you need?” I had a meeting with Wes and a couple of other people on the board. He said, “We’d love to have research.” All the doctors were like, “No, that’s not going to help you because, unfortunately, although there’s a lot of lip service about evidence-based practice, we could provide the evidence base about Rock To Recovery, but the reality is it wouldn’t change whether or not insurance was going to pay for it.”
Insurance is increasingly not paying for addiction treatment, for the number of days that people really need to recover. You see that shortened stays all over the place. Insurance want you to “fail out of lower levels of care”, but what does that mean? It means relapse. Relapse very often with the opioid crisis means death.
We were like, “Let’s take this right to the people.” Wes and I talked about writing a book and he said, “Well, I’m just a rockstar. I don’t really know about writing a book.” I was like, “Hello. I’ve written several. I would love to write it with you.” That’s how the partnership began.
Interviewer: You’re using the research but the target is less the clinicians, health insurance and more just the people to convince the culture of the value.
Dr. Scharff: Correct, because the reality is, is that with the lack of support for the Affordable Care Act, the way it’s being undermined with the lack of enforcement of the Parity Act, the Mental Health and Addiction Parity Act, we’re seeing these programs increasingly not being paid for. We’re seeing addicts having a harder and harder time getting the treatment that they need. We’re looking at changing the funding base.
Well, I don’t need to convince insurance to pay for it if they’re not going to pay for it anyway. We’re looking at foundations and different funding opportunities and donors, to build an endowment so that eventually we could just give our product away. That would be the end goal. Is that any treatment center, if you can pay for it that’s great, but we want to be in any treatment center that wants us. We want our bottleneck point to be having great musicians, who can provide the service, not lack of funding.
Interviewer: Right, because the demand is there, I’m sure.
Dr. Scharff: The demand is there. At a certain point, there’s only so many real well-qualified professional musicians who are in recovery and have the right heart for it. There’s lots of musicians who want that gig, but you have to really have the heart to go, and to be with really struggling people at a very difficult time in their lives. That should be our bottleneck not “I can’t give it, I’ve got people ready to go, but we need more funding for it.” That’s why we went with the popular book as opposed to clinical research or going towards insurance companies and clinicians.
Interviewer: Yes, and so you’re here as part of an event today, and your actually kicking off launching this Rock To Recovery program here in Tennessee, because it’s been in California for a while, right?
Dr. Scharff: Super excited. Yes, 12/12/12 is when we started. Okay, we’re now in over 100 treatment centers in Southern California. We recently expanded to Northern California as well. We do over 450 sessions a month. We also have a contract with the Department of Defense and work with the Air Force Wounded Warrior Project. They are right now at Invictus games, which is super exciting to watch them. Seeing people that we’ve worked with winning medals at the Invictus games.
That’s super exciting. When we got the opportunity to come to Nashville, it was an automatic yes because music city. It’s just the right fit for us. We have a wonderful program administrator here, Phil Bogard who’s played with Jelly Roll and Walker McGuire and was a founding member of Ingram Hill, and just loves bringing this program to people in need. Hopefully this is just the start here in Nashville, and then expanding throughout Tennessee.
Interviewer: Yes, and so we just got to partake, be part of a live session-
Dr. Scharff: We just did a session, yes.
Interviewer: – see what it’s all about. How do you describe it to people when you’re introducing them to the concept of music therapy, and then what Rock To Recovery does?
Dr. Scharff: I think the most important part is for people to understand that this program is for non-musicians, because there’s so much focus especially here in Tennessee, in Nashville in particular. On musicians helping other musicians and that’s not what we do. We bring musicians in to help people who have either never played music. Occasionally we get someone who’s had some piano lessons or something, but most of the people have never had any musical training. To get them engaged with something that is innately part of us. You hear a song that you love, and you automatically start clapping your hands.
You automatically start dancing when you’re a little kid, until someone tells you that you’re no good. Which is what, that’s the reality of it for people. The beautiful thing for me about music is that we can all do it. There is nobody who can’t shake a shaker, and so we can get those people involved. Addicts, they feel so bad about themselves and everybody’s down on them, but when we form a band, there’s a magic there because we’re doing this together.
Nobody’s backstabbing and stealing your dope, and going out with your girlfriend or whatever. There’s that sense of camaraderie that gets to be built, and you get to accomplish something. At the end, they’re so proud, A, I finished and, B, it was a really good product. It’s really magical. You write a song in an hour and it’s good. They’re generally quite good, and so you really get to feel that sense of accomplishment and see that.
Interviewer: Yes, and it seems like that’s a rare combination of building the community and having something to be proud of.
Dr. Scharff: Right, and the community building is super important for the treatment center, because not only do–
Interviewer: That helps in the next session.
Dr. Scharff: That’s right, because one of the things that used to be treatment, you’d go to a bunch of process groups. Well, how many times can I listen to you complain about your life? I didn’t even like you to begin with. Now all day, it’s like, “My Aunt Jo did blah, blah.” Other thing too is some of the people really have some serious problems. In addition to co-occurring disorders, we work with people who two weeks earlier killed somebody, and going up on vehicular manslaughter charges, and maybe they’re going to go to prison.
To be like, “Okay right, let’s bring that into the room.” The feelings about that but also, “Right now what we’re doing is writing a song.” Because I don’t know how you face that, worrying about that.
Interviewer: Taking it one step at a time.
Dr. Scharff: Exactly, and so to try to process that. That’s a wonderful thing, because when someone brings that into a session, then we can take that to their therapist and other support services within the treatment center and say, “Okay, here’s some stuff that got brought up in the session, and now you guys can deal with that.” It’s a lot easier to put things that you’re feeling into a song, because it’s a little bit disengaged, than to look at, a PhD-level professional in society whatever, and be like, “Okay, so this is what I’m feeling.”
It’s a lot easier to put that into a song. That’s what we can then offer to the treatment center.
Interviewer: Yes, and so that’s what we just saw at this event, is everybody’s talking about, going around the room, they’re saying like, “Okay, this is
something I’m dealing with. This is one way that I have had success, or one way then maybe I envisioned that I can try to tackle this.” That’s where it starts?
Dr. Scharff: Right. Well, that’s a really important part of the program that Wes put in, because especially when we started an addiction treatments because they are downers, right? Addicts are not coming into treatment because they’re having their best day. They’re coming in because they’re having their worst. We see this too with the work with veterans, and the trauma that’s there. There’s always that desire to turn the song in a way that’s positive. In the song that we just did, the suggestion for the title was drowning. Wes was like, “Can we take that into a positive note?”
Interviewer: Yes, because that’s part of the song. That’s part of the journey, but that’s maybe not that the note we want to end on.
Dr. Scharff: Right, and so we chose a different title for it instead. We had one veteran that we worked with. She wrote, it was like a two or three-minutes spoken word bridge, in the middle of a song about how she wanted to kill herself. How she’d been suicidal the night before, and Wes let that be in the song because that was something that needed to be expressed. He was very careful and he made then the chorus. Which is the hook.
That’s where the money is. We’re in Nashville. Let’s talk about the truth. The money’s in the chorus, and the part that you leave singing is not her depressing soliloquy. Which was important for her to express but, “Hey, we’re all in it together, or whatever.” The lyrics were that, “I can turn this around, we can have a better day.” We had a lot of phoenix rising from the ashes imagery, but that’s what how we turn that around.
We have room for the darkness because that’s true and that needs to be expressed, but we also really try to bring that to the light.
Interviewer: Just show that there is hope.
Dr. Scharff: Make it positive. Yes, absolutely. Well, we’re all about hope because if there is no hope, then why am I doing this? When we’re using, I’d rather shoot dope till I die if there’s no hope that my life can be radically different. Addicts can’t imagine that. They can’t imagine that at first, and so that’s where we’re trying to lead them. People look at me, they’re like, “You’re sober 20 years?” I’m like, “Yes.” “You travel all over the world?” “Yes.” “You work with the rockstars?” “Yes.” That’s what sobriety looks like for me.
“Will your journey be the same?” I don’t know. Probably not, but could it be if that’s what you really wanted? Yes.
Interviewer: Could you have imagined that 20 years ago that this is what you’d be doing?
Dr. Scharff: No, I absolutely believed that I would be dead by 25. I started trying to get sober at 22, and I really thought there’s no way that this can work. There’s absolutely no way. Now I’m in my mid-40s. I’m like, “How did that happen? Look at this. I’ve written books and do everything I ever wanted.
Interviewer: I guess you said you’re in the research side of this.
Dr. Scharff: I’m in research, yes.
Interviewer: What can you tell us about what you’ve seen firsthand, people responding to music therapy, people coming out of the program. Is there some research elements that you can share?
Dr. Scharff: Yes, sure. A lot of what we’re looking at right now, treatment centers are calling a treatment-based evidence as opposed to research-based evidence, because there’s an extreme lack of funding for real research into complimentary therapies, because where’s the profitability? If I’m going to give you money to do research on something, it’s usually coming out right now, and addiction is coming out of pharma and they want to see the good results.
We know what happens to the bad results, but we want to see the good results of what happens to MAT therapies. I don’t have a problem with MAT therapies, it’s a different thing.
Interviewer: Again looking to appeal to these solutions as opposed to other stuff, yes.
Dr. Scharff: Right. Listen, some of those things especially in early treatment are fantastic. I’m not bashing that, but if there’s no profit– If I teach you how to meditate, then I’m out of the picture.
Interviewer: There’s no big meditation money out there.
Dr. Scharff: No, and this is same thing with Rock to Recovery. If I teach you how to write a song, you can get with your buddies and write and form a band, a garage band. We see that in the veterans centers, where in the VA Hospitals, these guys, men and women, form a band that is like a real band. There are people who move in and out of it, but they’ll play together for years.
What we’re seeing is, what are the treatment outcomes? You’ll see this in a lot of the treatment centers that have been around for a long time, and the people who’ve been around in treatment for a long time, is we’ve seen so many thousands and thousands of case studies. We get a good idea for what works and what doesn’t.
The founders of the original 12-Step program understood this too. One of the things that they would say is, “Your disease is doing push-ups in the corner.” You’re thinking that it’s getting stronger, because they’ve observed people who relapsed after a long time, they go back to drinking and using how they did before, and very often die.
What we’ve learned is they had the observation right. They didn’t understand the reason, what’s actually happened is that the brain is wired. My brain thinks that I drank two liters or more of hard liquor a day, and if I was to relapse at this point, I would start drinking pretty quickly two liters and more of hard liquor a day, but I’m not 22-year-old kid with a high tolerance anymore, I’m a woman in her mid-40s who has no tolerance, so I would die.
That’s what we see, right now with opioids. When’s the most likely time a person is going to die? It’s directly after leaving treatment in that relapse period, and because their tolerance has gone down, but they think their brains still believes that they use at that higher level and they–
Interviewer: That’s what they need to get high.
Dr. Scharff: That’s what they need to get high and they overshoot the mark and die, setting aside whatever. That’s what we’re really looking at, is trying things in treatment settings and seeing how they work. Then my job in part is to say, “Okay, so Rock to Recovery, wherever it’s offered is, if not, it’s among the most popular programs, and because it’s fun.” Who wants to go to process group, when you can go write a song with somebody who’s cool? Okay, it’s popular.
We see what happens afterwards. People want to get into the thing, they’re trading their songs around. We see that they don’t leave treatment as frequently. Then my job is to partner with researchers at universities who may be don’t need as much funding to get involved, and to get them to look at what happens neurologically, is really the focus right now.
Interviewer: Is still looking at the brain itself?
Dr. Scharff: Looking at the brain itself and what happens in FMRI scans, and similar things. Then also people who are doing biochemical brain research, what are those feel good chemicals that are being released? Which ones and how much and does it–?
Interviewer: That can be measured.
Dr. Scharff: That can be measured.
Interviewer: That’s not saying, “Hey, I had a great time writing the song.” It’s a real real measurement.
Dr. Scharff: It’s a real measurement, and so when we can partner with those researchers– If you’re out there, we would love to partner with you. If we can partner with those researchers and find out, is it the singing? Is it the playing the music? Is it just being in the same room? Some of the things we can tell, observationally, in the session we were in, the people who had shakers and were clapping and were participating, were smiling.
If you looked at the people who were standing around the room and not clapping and just observing, they were not smiling. All right, so I know that participation means something, but exactly what that means, we need the research help to–
Interviewer: Sure, to still discovering that quantifiable element of it.
Dr. Scharff: Exactly. Then at some point when insurance changes because it always does, then we can take that information when it matters and present that.
Interviewer: Yes. I guess something I often ask people is how do they respond to skepticism. I imagine with music therapy, with music, there are still people, all the way up from insurance, all the way down to patients who are not sure about that’s the thing. Is this going to be effective? Is this going to be worth my time? What do you say to that?
Dr. Scharff: Well we get two kinds of pushback. One is from insurance and whatever, who just don’t want to pay for it. It’s just a profitability issue. We very often, when we are paid for it, it’s part of a bundle. We get bundled in, or it’s a recreational therapy. I’m not too concerned about that because–
Interviewer: Just like you said it could change in a year.
Dr. Scharff: It can change, and we’re looking at how we can just move that funding base, so that it isn’t insurance-dependent, because it hurts my heart when we can’t give something away to someone who needs it.
Interviewer: Because you know it’s probably going to help them and you can’t give it.
Dr. Scharff: Right, because we’re all in recovery. We don’t do this because of the, I’m on the board, I’m not getting paid. I do this because I care. When we get an individual in a session, they’re demoralized in some way. That’s usually the pushback. They’re either so sick and hopeless and they know they’re dying. They’re like, “I don’t see how writing this song is going to help me.”
The guys, because they’re all in recovery, get that, and can talk addict to addict and say, “I get that, I understand where you’re coming from. Just give it a try. Just pick up the shaker. Just try the shaker and if you don’t like it, it’s okay.” They can’t help but respond positively, because that’s how the brain works. The other kind of pushback that we get is people who have been told that they can’t sing or they can’t play music. You know that whole, “You suck.”
Interviewer: That person who is a dancing 3-year-old, and then eventually they just got beaten down.
Dr. Scharff: Right, like, “You should never sing again.” There are occasionally people who are abjectly tone deaf. That happens, but you don’t need that in Rock to Recovery. We’re not putting you on at the [unintelligible 00:29:17]. It’s like 6, or 10, or 12 of us in a room together encouraging each other. One of the things in the session is you’re rad, you’re rad, you’re rad. It’s all this encouragement, and being part of the group.
The program administrators work with that too and say, “You know what? That person who told you that you were no good at singing or dancing, or just not a good person because you’re an addict or whatever, that person’s not in the room. That person’s not here. I’m here with you and we’re going to walk through this together.” The beautiful thing about that, is that applies outside of the room. We can do things together that you could not do alone, and that’s part of the message.
One of the beautiful things about Rock To Recovery is we give instructions. Play this note three times. Sing this line twice. They don’t necessarily get other places, and these are the directions for life. You do the next indicated step, and here’s what the next indicated step is. The next indicated step is pick up the shaker and shake it on the, shake, shake, shake on that beat.
Interviewer: Yes. Instead of looking at this massive daunting, barrier or whatever, you have to overcome your life. Looking at it, just one tiny step [crosstalk]. Cool. I just wrap up with this last question.
Dr. Scharff: Sure.
Interviewer: Everyone who does this, give themselves to this work, like you said, you’re just on the board. This is obviously a thing you’re passionate about. Everyone who does this has their own reasons for getting up, wanting to do this every day, get into it. Could we end, by having you wrap up or by having you sum up, kind of why this mission of helping people find recovery is so important to you?
Dr. Scharff: I come from a background with a lot of trauma. People who come from history like mine, generally end up as suicides or overdoses, we don’t make it. I was so blessed to have people who just believed in me, and encouraged me, and did not let me just constantly backslide into that place of worthlessness and self-doubt, and whatnot.
This is really my opportunity to pay it forward, because having been in graduate school and gotten to research all this stuff at the treatment center before to do this research and know what works. That’s what excites me, is like we know and I will tell anybody– These programs have a synergistic effect.
We don’t have any pretense of writing a song cures addiction, that’s not what we’re doing. We are giving a positive experience, a brain chemical boost, a burst of different activity in the brain, and then passing you off to the next thing that’s going to give you that next burst, and then together, we can change your life. We can change your life and that’s what’s so encouraging to me about Rock To Recovering about addiction treatment in general, is that there are good treatment centers out there.
I mean, we hear about the bad ones on the news, but there are good treatment centers out there that do good work. If you want a new life, it can be yours.
Interviewer: Yes. All right. Well, Dr. Scharff, thank you so much for your time being with us.
Dr. Scharff: Thank you.