Rapport médical #1 (en anglais)
Title: Complementary Therapy for
Addiction: 'Drumming Out Drugs'
Author(s): Winkelman, Michael
Source: American Journal of Public Health; Apr2003, Vol. 93 Issue 4, p647, 5p
Document Type: Article
Subject(s): DRUG abuse
SUBSTANCE abuse -- Treatment
Objectives. This article
examines drumming activities as complementary addiction treatments
and discusses their reported effects.
Methods. I observed drumming circles for substance
abuse (as a participant), interviewed counselors and Internet mailing
list participants, initiated a pilot program, and reviewed literature
on the effects of drumming.
Results. Research reviews indicate that drumming
enhances recovery through inducing relaxation and enhancing theta-wave
production and brain-wave synchronization. Drumming produces pleasurable
experiences, enhanced awareness of preconscious dynamics, release
of emotional trauma, and reintegration of self. Drumming alleviates
self-centeredness, isolation, and alienation, creating a sense
of connectedness with self and others. Drumming provides a secular
approach to accessing a higher power and applying spiritual perspectives.
Conclusions. Drumming circles have applications
as complementary addiction therapy, particularly for repeated relapse
and when other counseling modalities have failed. (Am J Public
Health. 2003;93:647-651)
Recent publications(n1-n8) reveal that substance abuse rehabilitation programs
have incorporated drumming and related community and shamanic activities into
substance abuse treatment. Often promoted as "Drumming out Drugs," these
programs are incorporated in major rehabilitation programs, community centers,
conference workshops and training programs, and prison systems. Although systematic
evaluations of the effectiveness of drumming activities are lacking, experiences
of counselors and clients indicate that drumming can play a substantial role
in addressing addiction. Evidence suggesting that drumming enhances substance
abuse recovery is found in studies on psychophysiological effects of drumming(n9-n13)
and the therapeutic applications to addictions recovery of altered states of
consciousness,(n14) meditation,(n15-n19) shamanism,(n20-n21) and other shamanic
practices.(n22-n24)
METHODS
This report is based on information acquired from observations of drumming
activities in substance abuse programs; interviews with program directors and
counselors about the effects and experiences induced; a pilot program introducing
drumming for recovering addicts; and on-line discussions and published material
on drumming effects. Because of confidentiality issues, the programs observed
did not permit interviews with clients. Clients' perspectives were provided
by the directors and counselors involved in the program.
RESULTS
The following summarizes research done during 2001 on programs in Pennsylvania,
Virginia, Wisconsin, and Missouri. Participant observation was carded out
in the first 2 locations; interviews and published material were used for
descriptions of activities and assessment of their effects at all sites.
Mark Seaman and Earth Rhythms of West Reading, Pa
Seaman is recovering from addiction; he began drumming as a way to express
himself and become part of a community. He was searching for natural altered
states of consciousness. His engagement with drums led to a personal transformation
and an involvement with the recovery industry through counselors he knew at
the Caron Foundation in Wernersville, Pa.(n3) They wanted to expose adolescents
in substance abuse treatment to drumming. The counselors said that these shut-down,
angry, disenfranchised youth came alive as drumming gave them an avenue of
expression. Initially, his programs were closely tied to the therapeutic process.
Now, however, they are offered as recreational activity, and use drumming to
create healing energy.
Activities. Seaman's programs begin with his drumming
as people enter the room. They pick up drums and are free to play
them as they choose. He then introduces warm-up exercises to make
people feel comfortable with the drums, teaching people how to
hit the drums without emphasizing anything technical. A vocal element
is introduced to engage the group in coordinated chanting/singing
activities to get their energy going. He allows people to play
spontaneously to lay the groundwork for nonverbal communication
and asks participants to show how they feel through playing a rhythm
on the drums. Call-and-response activities are used to connect
the group. A subsequent activity gives each participant the opportunity
to briefly use the dram to express feelings. The group engages
in the creation of improvisational music that produces a feeling
of great accomplishment and engages a "letting go" process
through visualization. Seaman ends his program with an application
of the Alcoholics Anonymous' 11th step (meditation), using meditation
music and a variety of percussion instruments to reinforce a visualization
process to connect with a higher power. "I get people relaxed,
give them permission to leave their body and go on a journey. I
talk about forgiveness, acceptance and surrender. I work [on] release
of guilt from the wreckage that they have produced through their
addictions. The visual imagery connects with the inner child, to
release baggage, to awaken true potential, to image contact with
higher power that covers and embraces them in a space of joy and
healing."
Effects. The participants enthusiastically receive
the drumming. Staff emphasized that the youths particularly need
drumming when group dynamics are stressed because of conflict within
the group, and when the group's sense of unity and purpose is disrupted
by a client's relapse to drugs. Seaman finds that drumming pulls
a group together, giving a sense of community and connectedness.
The terminal meditation activity induces deep relaxation, eases
personal and group tensions, and often leads to strong emotional
release. Seaman suggests that drumming produces an altered state
of consciousness and an experience of a rush of energy from the
vibrations, with physical stimulation producing emotional release.
Because addicted people are very self-centered, are disconnected,
and feel isolated even around other people, the drumming produces
the sense of connectedness that they are desperate for, he says. "All
of us need this reconnection to ourselves, to our soul, to a higher
power. Drums bring this out. Drums penetrate people at a deeper
level. Drumming produces a sense of connectedness and community,
integrating body, mind and spirit." Seaman's program is designed
to induce a spiritual experience that is upbeat and fun. Meditation, "letting-go," and "rebirthing
experiences" allow people to leave behind the things they
don't want (e.g. their addictions) and engage the themes of recovery
within the dynamics of group drumming.
Ed Mikenas and the Lynchburg
Day Program
Ed Mikenas(n6,n25) has a background as a musician, music therapist, and substance
abuse counselor; he has also taken training from the Foundation for Shamanic
Studies. He first discovered the positive effects of drumming for recovery
when he worked as a substance abuse counselor at a group home for girls. Mikenas'
interest in drumming preceded this program, beginning with a concert for the
Partnership for Prevention of Substance Abuse. Currently, his programs are
provided in colleges, after-school programs, city programs, and psychology
and addiction conferences. The drumming reinforces other programs for both
prevention of and recovery from addiction in a community context. Drumming
emphasizes self-expression, teaches how to rebuild emotional health, and addresses
issues of violence and conflict through expression and integration of emotions,
says Mikenas.
Activities. Mikenas uses group drumming in substance
abuse counseling to activate and reinforce the recovery process.
Participation as a group leader or follower induces experiences
that can mirror the recovery process-confidence, uncertainty, insecurity
in leading, security in following, desire for change, or novelty.
Drumming activities allow spontaneous expressions of leadership
skills. Mikenas exposes participants to a variety of percussion
instruments and helps them learn basic sounds, rhythms, and complex
polyrhythmic dances. Sessions begin with warm-ups on bass tones
to give safe and easy exercises and to coordinate the group. These
are followed by edge tones at greater acceleration and the use
of stop and start signals. More complex movements (heel-to-toe,
switching hands, slap tones) are then introduced, emphasizing the
use of the non-dominant hand. Mikenas uses Afrocentric traditions,
particularly Afro-Cuban and Brazilian rhythms and the Afro-Caribbean
Yoruba-based religions.(n25) The gods are used as representations
of archetypes to help people access their unconscious dynamics
and connect their experiences with spirituality and community.
Mikenas says that these spiritual experiences connect clients with
a "higher power" and reestablish connections with their "natural
selves."
Effects. Mikenas finds that the activities of
drumming produce entertainment, an altered state of consciousness,
and an energy that draws people in. Drumming also provides opportunities
for coordinating sound and movement to assist in mental, physical,
and emotional development processes. The pulse of drumming in a
context that combines self-expression helps coordinate activities
and solve problems, says Mikenas. Drumming gives an opportunity
to learn leadership and discover one's own potentials. The drum's
sounds, rhythms, and energy elicit emotional issues and may work
as an "eraser" to remove effects of trauma. Mikenas suggests
that "with drumming, a group of people go from chaos and noise
to an orderly sense of feeling all the same. Drumming helps express
and address unhealthy emotional reactions that allow drugs to appear
to meet emotional needs." He says drumming entrains the brain
and stimulates pleasurable feelings without drugs. "Drumming
makes you feel good. When they connect, it makes them glow. It
helps people fit in. Drumming teaches nurturing, respect, participation,
and personal relationships. Drumming changes speaking, feeling,
and acting, and helps you learn to act from the heart." Because
group drumming gives participants different roles, individuals
have to coordinate their parts. Therefore, they must focus on others.
This gives them an experience with working together in a structured
way. Mikenas says that a structured positive learning experience
in lives that are often chaotic helps participants establish contact
with themselves and connect with the collective consciousness.
Mikenas considers benefits of drumming to include enhanced sensorimotor
coordination and integration, increased bodily awareness and attention
span, anxiety reduction, enhanced nonverbal and verbal communication
skills, greater group participation and leadership skills and relationship
building, and self-skills for self-conscious development and social
and emotional learning.(n25)
Myron Eshowsky's Shamanic Counseling
Approach
Myron Eshowsky was trained as a shamanic counselor by the Foundation for Shamanic
Studies. His experiences, beginning in the mid-1980s, range from inpatient
psychiatric acute care settings to private practice, community mental health
centers, and prisons. Eshowsky worked with adults in a community mental health
center in Madison, Wis, employing shamanic counseling approaches to apply spiritual
perspectives to address psychological, emotional, and spiritual problems.(n1)
His success led the drug/alcohol unit of his agency to refer clients with a
history of severe addiction and significant mental health issues. He subsequently
worked with at-risk youth and gangs at an alternative high school and provided
programs for mental health centers, community-based antiviolence groups, hospitals,
health maintenance organizations, public schools, and prisons,(n1,n2,n26,n27)
Activities. The shamanic drumming programs provided
by Eshowsky include a mix of activities--story telling, journeying,
healing work, dancing, spiritual divination, and group ceremonies.
He engages adolescents in drumming activities and teaches them
to journey on their own; he also often journeys himself to do healing
work. Eshowsky uses shamanic journeying(n28) to find out information
about clients, their power animals, spiritual intrusions, and soul
loss.(n29) These shamanic activities may provide healing (e.g., "soul
retrieval") or information subsequently used in ritual therapeutic
interactions that involve other family members to provide community
support. He uses ceremony and ritual to provide a context for clients
to connect with their issues while simultaneously placing them
in a global context. He says that this provides healing and a sense
of belonging that helps clients define who they are.
Effects. Participants report that drumming and
shamanic journeying calm them down and help them deal with their
high-stress lives. "Drumming helps them to experience a kind
of peacefulness and provides a spiritual learning context that
allows them to talk about their deeper concerns. It provides an
opportunity for being heard that they don't often feel [they have]." Eshowsky
reports that participants have a major reduction in crack cocaine
and marijuana use as well as a reduction in drug-related violence
and contact with the criminal justice system. This also enhances
their school participation and performance. Eshowsky's work with
shamanic healing is often effective for people in desperate situations,
when other counseling modalities have failed; he reports a number
of remarkable recoveries.(n1,n2,n26,n27) A particularly successful
application has been with youth in street gangs, for whom application
of the principles of core shamanism has been useful in providing
healing and spiritual justice by addressing issues of despair and
powerlessness.
Daniel Smith's Shamanic Approach
Daniel Smith(n7) is the former director of the Center for Addictive Behaviors
and program director of the Herman Area District Hospital Alcohol and Drug
Unit in St. Louis, Mo. After years of use of shamanic drumming techniques
and training by the Foundation for Shamanic Studies, Smith introduced drumming
into his work as a licensed clinical social worker in a substance abuse
rehabilitation program. He has taught drumming and shamanic techniques
as an alternative and complementary therapy for addiction at wellness events,
professional trainings, large conferences, and weekend retreats.
Activities. Incorporation of core shamanic principles
within managed care has created tensions, but Smith says that he
has found an uneasy acceptance among the staff of the psychiatric
settings through bridging activities such as yoga, breath work,
music therapy, mask making, and addressing issues of the inner
child and family-of-origin dynamics.(n13), (n15-n19,n30,n31) Smith
uses the shamanic approach for clients who repeatedly relapse.
For clients who know what they need to do for recovery but cannot
achieve sobriety, the concepts of soul retrieval, depossession
(e.g. exorcism), extraction, power animal, and spirit retrieval
may be applicable.(n20) Smith focuses on "rebirthing," a
kind of "spiritual surgery" akin to what Alcoholics Anonymous
calls a spiritual awakening. This experience causes the addicted
person to undergo a profound change in his or her response to life,
says Smith. Music and dance activities are used for both cognitive
restructuring and physical exercise. Smith finds that yoga activities
produce mental--physical bridging and the integration clients need
to detoxify their bodies. He says breath work produces mental--physical
integration and takes clients into altered states of consciousness.
Mask making and rituals help solidify powers accessed in the nonordinary
reality experiences; mask wearing incorporates helping spirits
and the changes in personality necessary to create a new sense
of self as a recovering person, says Smith. Shamanic techniques
are introduced and reinforced through rituals with symbols of flight
(birds, feathers) that help prompt visionary experiences reflecting
common themes in recovery--symbolically flying from the hells of
addiction and soaring through the sky. The technique to which Smith
attributes the greatest success in working with chronic recidivists
is "shapeshifting," which borrows from techniques of
Perkins.(n32) Rituals orient clients and help provide a sense of
calm, a sense of inner balance, and connection with a greater power.
Stone (rock) divination procedures are used: clients look for answers
to their questions through what they see in a rock. This process
allows them to connect with the power of the universe, to externalize
their own knowledge, and to internalize their answers; it also
enhances their sense of empowerment and responsibility, says Smith.
Effects. Smith says that drumming and shamanic
activities address addiction through reintegrating aspects of the
self in rituals for soul retrieval and power animal retrieval.
Through these activities, people gain access to traumatic assaults
that have driven their abusive relations with drugs. Spirit world
journeys provide direct access to these early experiences in a
context that reduces barriers to awareness. Ancestor spirits or
other helpful spirit guides and allies encountered in rituals and
journeys facilitate the resolution of trauma. These experiences
are healing, bringing the restorative powers of nature to clinical
settings. Shamanic activities bring people efficiently and directly
into immediate encounters with spiritual forces, focusing the client
on the whole body and integrating healing at physical and spiritual
levels.
Pilot Program at the Phoenix
Shanti Group
Before conducting the research reported in the previous sections, I presented
a shamanic drumming circle based on the principles of core shamanism(n28,n33,n34)
to clients of the Phoenix Shanti Group as part of MPH internship activities.
These clients were HIV-positive, and most were addicted to crack cocaine, methamphetamine,
or opiates. These drumming activities were not part of regular program activities
but were offered as a voluntary supplemental activity. The shamanic drumming
activities were explained to the group in terms of their potential for inducing
relaxation and natural altered states of consciousness that substitute for
drug-induced highs. Suggestions for successful participation from the clinical
director that were conveyed to the group included explaining the need for consistent
attendance to achieve positive results. Additional recommendations included
journaling of the session experiences to integrate them and chart the client's
development. A few clients attended drumming groups held immediately after
mandatory group sessions, but most declined. None of the clients currently
in the intensive treatment program at Shanti attended the regular weekend evening
sessions offered across more than a year, although some of Shant's prior clients
(graduates of the program) did attend. This lack of voluntary participation
in supplemental activities suggests that successful introduction of drumming
activities in rehabilitation requires that they be incorporated into the mainstream
of the program. Clients' interest will likely be strongly affected by the attitudes
expressed by regular counselors.
Inquiries posted to an on-line drumming Internet mailing list provided additional
important information about the use of drumming in rehabilitation and on the
relationships between community drumming activities and drug use. One respondent
said, "I have found that music, especially drumming, creates that same
kind of bonding and interdependent unity without putting chemicals and smoke
in my body. I really like being high on community drumming and want to share
that." Another noted, "There is no doubt in my mind that the dram
circle and other musical initiatives are having a positive effect on the whole
community. Drumming prevents children from getting into the drug culture, creating
something positive and creative that children can identify with at an early
age to build up their confidence and self-esteem. A sense of belonging to a
community is the best protection there is. Drum circles give them tools to
create a sense of community purpose and groundedness in their lives."
In contrast, others commented on widespread drug use in drumming circles. Many
drum circles accept (or fail to challenge and exclude) the use of drugs before,
during, and after drumming sessions. This tolerance makes existing community
drumming circles an uncertain source of support for maintaining sobriety. Successful
use of drumming to guide and maintain sobriety probably requires the creation
of programs specifically designed for the recovering community.
Physiological Effects of Drumming
Drumming produces a variety of physical and psychological effects. A recent
popular book on drumming reviews research suggesting the positive effects
of drumming in the treatment of a wide range of physical conditions, mental
illness, and personality disorders.(n5) Drumming enhances hypnotic susceptibility,
increases relaxation, and induces shamanic experiences.(n35) Drumming and
other rhythmic auditory stimulation impose a driving pattern on the brain,
particularly in the theta and alpha ranges.(n9-n12,n33,n35) The enhanced
?- and a-wave entrainment produced by drumming typifies general physiological
effects of altered states of consciousness(n33,n35,n36) and mediation.(n19)
ASCs involve a mode of consciousness,(n33) a normal brain response reflected
in synchronized brain-wave patterns in the theta (3-6cycles per second
[cps]) and alpha (6-8cps) ranges. This response is produced by activation
of the limbic brain's serotonergic circuits to the lower brain. These slow-wave
discharges produce strongly coherent brain-wave patterns that synchronize
the frontal areas of the brain with ascending discharges, integrating nonverbal
information from lower brain structures into the frontal cortex and producing
insight.(n33)
Physiological changes associated with ASC facilitate healing and psychological
and physiological well-being through physiological relaxation; facilitating
self-regulation of physiological processes; reducing tension, anxiety, and
phobic reactions; manipulating psychosomatic effects; accessing unconscious
information in visual symbolism and analogical representations; inducing interhemispheric
fusion and synchronization; and facilitating cognitive--emotional integration
and social bonding and affiliation.(n33)
CONCLUSIONS
Drumming produces physiological, psychological, and social stimulation that
enhances recovery processes. Drumming induces relaxation and produces natural
pleasurable experiences, enhanced awareness of preconscious dynamics, a
release of emotional trauma, and reintegration of self. Drumming addresses
self-centeredness, isolation, and alienation, creating a sense of connectedness
with self and others. Drumming provides a secular approach to accessing
a higher power and applying spiritual perspectives to the psychological
and emotional dynamics of addiction. Drumming circles have important roles
as complementary addiction therapy, particularly for repeated relapse and
when other counseling modalities have failed.
Drumming circles and other shamanic altered state of consciousness activities
can address multiple needs of addicted populations.
These includes(n8)
•Physiological dynamics, inducing the relaxation response and restoring
balance in the opioid and serotonergic neurotransmitter systems
•Psychodynamic needs for self-awareness and insight, emotional healing,
and psychological integration
•Spiritual needs for contact with a higher power and spiritual experiences
•Social needs for connectedness with others and interpersonal support
Drumming may reduce addiction by providing natural alterations of consciousness.(n8),
(n18-n19) Shamanic drumming directly supports the introduction of spiritual
factors found significant in recovery from substance abuse.(n21,n37-n39) Because
recidivism is widespread, treatment success may mirror the natural recovery
rate,(n40) and current methods have little success,(n41) the use of drumming
and other altered states of consciousness as complementary therapies with considerable
promise is justified.
Drumming groups may also aid recovery by enhancing health through their effects
on social support and social networks. The health implications of social support
have been increasingly recognized.(n42-n43) These forms of support are of considerable
significance for well-being in an increasingly atomized society in which traditional
family- and community-based systems of support have become seriously eroded.
Thus, deliberate enhancement of social support is a potentially significant
contributor to physical, emotional, and mental health. The social support available
from community drumming circles is one such source. These social effects are
not merely palliative but constitute mechanisms for producing psychobiological
effects. Central to these effects is an amelioration of the stress response,
a significant factor in drug use and recidivism.(n19)
The use of drumming as part of substance abuse rehabilitation is far more widespread
than the few cases reviewed here might suggest. Incorporation of drumming within
Native American treatment programs has been repeatedly mentioned to me. A recent
book reviewing the scope of research on the effects of drumming reports on
programs in New York and California in which drumming is incorporated into
addictions treatment.(n5) The Foundation for Shamanic Studies has several decades
of experience in applying shamanic altered state of consciousness in both training
and therapy.(n20) They have identified a variety of contexts in which shamanic
approaches may be useful in reducing substance abuse.
The physiological effects of drumming and the positive effects of group drumming
experiences on recovery that are attested to by counselors who have incorporated
these activities into substance abuse rehabilitation programs provide a compelling
rationale for the utilization and evaluation of this resource. Winkelman(n8)
suggests a variety of ways in which the shamanic paradigm and altered states
of consciousness can be applied to substance abuse rehabilitation.
Human Participant Protection
Research was approved by the institutional review board of the Arizona State
University and by the Shanti internal review board.
Acknowledgments
The research was supported by a National Institute of Drug Abuse postdoctoral
fellowship awarded to the investigator through the Arizona Center for Ethnographic
Research and Training.
I thank the individuals who made this research possible, particularly Scott
Reuter and the Phoenix Shanti Group; Mark Seaman of Earth Rhythms, West Reading,
Pa; and Ed Mikenas of Urban Wilde, Lynchburg, Va.
Requests for reprints should be sent to Michael Winkelman, PhD, MPH, Department
of Anthropology, Box 872402, Arizona State University, Tempe, AZ 85287-2402.
This article was accepted May 20, 2002.
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~~~~~~~~
By Michael Winkelman, PhD, MPH
Michael Winkelman is with the Department of Anthropology, Arizona State University,
Tempe. e-mail: michael.winkelman@asu.edu
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Source: American Journal of Public Health, Apr2003, Vol. 93 Issue 4, p647,
5p
Item: 9380247