FALCO: Fighting Addictions, improving Lives: COmprehensive drug rehabilitation with music

1. Deliverable:

Music therapy: Clinical and socioeconomic outcome parameters and long-term measuring instruments in individuals with substance use disorders. A systematic review

Background
Substance use disorder (SUD) is associated with a high global burden of disease, with 1.3% of all disability-adjusted life years lost due to illicit drugs and 4.2% due to alcohol [1]. There are 1 million high-risk opioid users in the European Union [2]. Multimorbidity is highly prevalent and includes polysubstance use, co-occurring mental health conditions, and various sequelae which could be prevented by more effective SUD treatment, including infectious and non-communicable diseases [1]. SUD is also related to crime and poverty through multiple bidirectional links, which increases the societal importance of improving rehabilitation in SUD [1]. Many patients drop out or do not benefit from existing non-pharmacological and pharmacological interventions [3].

Music can engage the brain’s reward system similarly to addictive substances [4-6]. It is also rated as one of the most intrinsically rewarding activities [7]. Therefore, music can provide an effective and affordable addition to reduce SUD [8]. Due to the high level of relapses in the first year after the treatment, an evaluation of substance use patterns in the second year following treatment is needed [8]. Longer lengths of substance use treatment are associated with lower levels of substance use at long-term follow-ups and better engagement in aftercare programmes [9, 10]. More extended periods of music interventions would likely be required to impact substance use behaviours at long-term follow-ups. Thus, it is crucial to investigate the impact of MT on retention in treatment over more extended periods and evaluate the long-term impacts of MT for people with SUDs [8]. For that purpose, a systematic review will be carried out to identify appropriate long-term (>1 year) outcome measures and tools. In order to better understand which outcomes might be most relevant for patients, we will conduct interviews with SUD patients. This shared understanding of perspectives will ultimately aid in understanding patient-relevant measuring instruments.

Aims of the report
The report aims to give an overview of clinical (e.g. addiction severity, recovery, substance use, craving) and socioeconomic (i.e. payer-relevant criteria such as integration to work life, unemployment days, health service use, retention in treatment) outcome parameters and types of (serious) adverse events identified in the existing evidence (of music therapy) in people with SUD (RQ1), how these outcomes are measured, and which characteristics do those instruments have (RQ2).

As research on the long-term outcomes of (long-term) MT treatment is lacking, next to our results of the systematic review (i.e. RQ1+2), fact sheets will give an overview of which measuring instruments are appropriate, feasible and user-relevant, especially for long-term measures (RQ3). Additional interviews with SUD service users in two partnering countries, Norway and Poland, will give insights into SUD service user’s perspectives. The main question of the interviews is whether these service user inputs correspond to the outcomes/instruments from the review's prior research questions. In Austria, we aim to collect the perspectives of three service users. These perspectives will help us understand service-user-relevant measuring instruments for further work packages for the FALCO project.

Research questions (RQs)

RQ1: Which clinical and socioeconomic outcome parameters and types of (serious) adverse events can be identified in the existing evidence (of music therapy) in people with SUD? (à review of relevant clinical and socioeconomic outcome parameters and types of (serious) adverse events)

RQ2: How are these clinical and socioeconomic outcome parameters and types of (serious) adverse events measured, and what are the characteristics of those instruments? (à review of measuring instruments and their characteristics)

RQ3: Which measuring instruments are appropriate, feasible and user-relevant, especially for long-term measures in patients with SUDs? (à fact sheets of long-term measuring instruments)

Methods RQ1 & RQ2

• Systematic literature search of clinical music therapy studies (only reviews)
• Databases: The Cochrane Library, Centre for Reviews and Dissemination (CRD) database, Embase, MEDLINE, PsycINFO, Web of Science
• Manual search and brief survey in selected countries (AUT, NOR, POL) regarding additional instruments measuring socioeconomic criteria; possible sources: websites of SUD rehabilitation centres, institutions evaluating SUD rehabilitation centres, healthcare system payers (insurances), general search in Google and Google Scholar (e.g. evaluation reports, project reports, validation reports)
• If applicable: manual search in non-MT areas (patients with SUDs) à which additional socioeconomic instruments can be found?
• Creating a table of relevant clinical and socioeconomic outcome parameters and types of (serious) adverse events
• Creating a table of measuring instruments and their characteristics (deliverable 1)
• No risk of bias assessment (e.g. AMSTAR - Assessing the Methodological Quality of Systematic Reviews) since the focus is on the outcome parameters and measuring instruments and not on the effectiveness/efficacy of music therapy

Methods RQ3

• Presentation of a long and short list of measuring instruments (from prior RQs) to the FALCO partners
• Prioritisation of a short list of measuring instruments among FALCO partners à Are the selected instruments appropriate for long-term (>1 year) measurements?
• Manual search for specific measuring instruments from the shortlist: appropriate for long-term measures, languages, validation (validity/accuracy/reliability literature), minimum important difference, pros & cons etc.
• If applicable: search for measuring instruments for non-SUD à transferability to SUD?
• Creating fact sheets of the most appropriate, feasible and user-relevant long-term measuring instruments

Service user involvement

In the frame of the systematic review, interviews with people with lived experience are planned in three countries (Austria, Norway, Poland). Professional knowledge cannot replace the lived experiences of people with SUDs, as the service users are the key actors contributing to the project. In this report, service user involvement should achieve knowledge that would otherwise not be produced and should help uncover, e.g., restrictions or suffering due to SUD or aspects that should improve due to MT. We aim to explore with people with lived experience their understanding of patient-relevant outcomes and consequently measuring instruments.

The service users might have additional physical illnesses, disabilities or mental illnesses and are a vulnerable group. Therefore, the interviews take place at the Anton Proksch Institute, where psychotherapists, clinical/health psychologists, or social workers can protect and inform the participants.

Methods

• Creating a semi-structured interview guide for the service user involvement among input from FALCO partners
• Creating participant information sheet and consent form
• Ethical approval
• Service user acquisition in Austria, Norway, and Poland
• Interviews will be conducted in a clinical setting (outpatient clinic, daycare centre or other hospital setting)
• The interviewees should be in therapy with at least one year of sobriety but not in music therapy
• Recruitment in Austria within the outpatient clinic by their practitioners (doctors, psychotherapists, clinical and health psychologists, social workers) at the Anton Proksch Institute, Vienna
• Doing face-to-face interviews with three service users at each site, which are audio-recorded using a smartphone voice recorder
• Transcribing using e.g. Good Tape, Trint or Word 365 and translating interviews
• Analysing and interpreting interviews with the qualitative content analysis using e.g. MAXQDA
• Summarising nine service user interviews

Interview guideline

• Do these service user inputs correspond to the outcomes/instruments from RQ1 & RQ2? (service user relevant instruments)

Workflows are organised according to the principle of dual control; the results are subject to internal and external reviewers.