Singing Plus Therapy System for Suicide Prevention and Opioid Addiction Management

B. A. Rohrbach, Captain Karaoke®, Musicologist 
June 12th, 2017

Table of Contents

  • Abstract 
  • Current State of Suicide Cases in the United States 
  • Depression 
    • Common Treatment and Management Techniques 
      • Opioid Medication 
      • Other Management Techniques 
  • Singing Plus Therapy System 
    • Singing Plus Therapy System and Depression 
      • Use of visual support. 
      • Engagement of familiar karaoke music 
      • Creation of rhythm 
      • Generalization of skills 
  • Conclusion 
  • References


Depression has been noted to be a major cause of suicide cases in the United States, with a mortality of approximately 600,000 persons between 1999 and 2015. Some of the research done on the problem indicates social isolation as well as drug addiction to be the common cause of depression ultimately leading to suicide in 80% chances. One of the recommended treatment regimens for depression is the use of pain pills, opioid, which has greatly failed as it results in addiction and worsening of the situations; it’s also connected to exploitation by the drug industries who recommend overdose with a mind-set of minting more income. This research article examines the current state of suicide cases in the country, common causes of depression and its everyday management. We explore the use of the Singing Plus therapy system as a better alternative in solving the depression problem hence reduction of suicide cases.

Current State of Suicide Cases in the United States

Suicide has been a major and continuing public health concern in the United States in the recent years with approximately 600,000 people dying between 1999 and 2015 peaking at the later. This is according to the mortality and morbidity weekly report published by the Centre for Disease Control and Prevention. (Keggler et. al., 2017). These cases of suicide have been connected to a number of risk factors including depression and life crisis as a result of social rejection, drug addiction as well as limited access to mental health care when necessary. (Keggler , 2017)


Depression is one of the most common mental disorders in the United States. (NIMH, 2016). The current research has found that it can result from a combination of genetic , environmental as well as varied psychological factors. Some of the risk factors include, but not limited to; personal or family history of depression; major life changes, trauma or stress; certain physical illness such as diabetes, cancer heart disease, Parkinson’s disease; and some medications and related addictions such as pain pills. (Swierzewski, 2001) 

This mental problem can happen at any age (NIMH, 2016), but notably, its often witnessed in adulthood. Presently, it is recognized as occuring in children and adolescents, although sometimes manifesting with more prominent irritability than low mood, which is a common sign. (NIMH, 2016). Worth noting is that many chronic mood and axiety disorders in adults do begin as high levels of anxiety in children.

Common Treatment and Managemnt Techniques

Treatment and management of depression has continued to evolve overtime. Presently, the major regimen for treatment include psychotherapy which involves talking to the patient by a therapist, and medications such as antidepressants including opoids. (Swierzewski, 2001)

Opioid Medication

A maintenance program with opioid agonists (methadone, buprenorphine, LAAM) is an effective treatment for people who are dependent on opioids in terms of retention in treatment and reduced use of opioids. Depression is however still prevalent and negatively impacts on treatment outcomes. Treatment with antidepressant drugs has therefore been proposed. These adjunct drug treatments include tricyclic antidepressants (doxepin, desipramine, and imipramine) and selective serotonin reuptake inhibitors (SSRIsfluoxetine, sertraline). (Swierzewski, 2001) 

A current study’s lead author quoted a startling statistics that “the use of prescription opioid analgesics has quintupled recently and that more than 200 million prescriptions were issued to patients in 2009 in the US.” 

Given the magnitude of their use, their link to depression could constitute a “public health problem,” he said. (NIMH, 2016) 

It wouldn’t be the first time the drugs have been linked to health problems of epidemic proportions. (Swierzewski, 2001). Prescription drug abuse has been called the fastest-growing drug problem in the US by the Centers for Disease Control and Prevention (CDC), as the number of deaths from opioid painkillers like hydrocodone and oxycodone rose nearly four-fold between 1999 and 2009. (Swierzewski, 2001) 

Men are still more likely to die from prescription painkiller overdoses (NIMH, 2016), but women are quickly catching up. Nearly 50,000 such deaths occurred among women between 1999 and 2010, and the statistics revealed by the CDC give a sombre view of this growing problem 
  • More than 6,600 women, or 18 women every day, died from a prescription painkiller overdose in 2010 
  • There were four times more deaths among women from prescription painkiller overdose than for cocaine and heroin deaths combined in 2010. 
  • In 2010, there were more than 200,000 emergency department visits for opioid misuse or abuse among women — about one every three minutes. 
The problem, once primarily seen in inner cities, is now even spanning to rural areas, hitting people of all ethnic backgrounds and income levels. 

Opioids like morphine, codeine, oxycodone, hydrocodone and fentanyl are one of the most commonly abused drug classes. These drugs are not only addictive, they can lead to slowed breathing and death if too much is taken, and the risks are compounded if you add alcohol to the equation. (Swierzewski, 2001). Hydrocodone, a prescription opiate, is synthetic heroin. It’s indistinguishable from any other heroin as far as your brain and body is concerned. So, if you’re hooked on hydrocodone, you are in fact a good-old-fashioned heroin addict. (Pani P., Vacca R., Trogu E., Amato L. and Daroli M., 2010)

Worse, pain-killing drugs like fentanyl are actually 100 times more potent than natural opioids like morphine, making the addictive potential and side effects associated with prescription drug use much higher. At the root of the problem, of course, is the fact that so many Americans are struggling with pain. (Keggler S., Stone M., Holland M., 2017). Chronic pain affects 100 million Americans – that’s more than the number impacted by diabetes, heart disease and cancer combined.Yet, many physicians simply do not know how to help their patients manage, or eliminate, chronic pain without the use of these risky drugs. (NIMH, 2016)

Other Management Techniques

Cognitive Behavior Therapy 

This is one of the preferd treatment modules for depression. It aims at helping the victim change their state of mind and teaching them on how to view life in a more positive perspective, and also how to appreciate themselves for experiencing pleasure and accomplishment. It is noted to help the patient gain new insight, feel better and improve their mood generally. (NIMH, 2016) The cognitive behavior therapists believe that the major causes for depression include low self esteem; inability to set rational or achievable goals, and pessimism. These, they help the patient to realize hence giving them more control of their life. (Swartz, 2013) 

Psychotherapy treatment 

The goal of this treatment tehnique is to help te patient change their self perception and behavior. Its geared to treatment of depression as a manifestation of cognitive-behavioral dysfunction. The therapists generally depend on suggestions, hypnosis, and reeducation to reform self esteem as well as help the person to design coping strategies which will help in dealing with sadness, grief, pleasure and achievements. (Maratos A., Gold C., Wang X., Crawford M., 2008). Anttidepressants are normally tagged along in this treatment plan.

Singing Plus Therapy System

This kind of therapy (Maratos A., Gold C., Wang X., Crawford M., 2008) is classified under music therapeutic techniques which are an established health profession whereby music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. 

After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients’ abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words. (Bodner E., Jancu J., Gilboa A., Sarel A., Mazor A., Amir D., 2007) 

The work of the AMTA New York City Music Therapy Relief Project, combined with over fifty years of practice and research in music therapy, has demonstrated the impact of music therapy as ‘second-wave’ relief in helping to cope with events surrounding a crisis and its aftermath. The directed use of music and music therapy is highly effective in developing coping strategies, including understanding and expressing feelings of anxiety and helplessness, supporting feelings of self confidence and security, and providing a safe or neutral environment for relaxation. (Swartz, 2013)

Singing Plus Therapy System and Depression

The use of Karaoke music with Word Skillz® memory card system therapy has been found to have numerous significant outcomes for patients with major depressive disorder. (Lazar, 2014). A systematic review of five randomized trials found that people with depression generally accepted this kind of therapy and was found to produce improvements in mood when compared to standard therapy. (Swartz, 2013) Another study showed that MDD patients were better able to express their emotional states while listening and singing along to sad music than no music or involvment with happy, angry, or scary music. The authors found that this therapy helped patients overcome verbal barriers to expressing emotion, which can assist therapists in successfully guiding treatment. (Maratos A., Gold C., Wang X., Crawford M., 2008) 

Other studies have provided insight into the physiological interactions between the Singing Plus ‘Karaoke’ therapy system and depression. It has been shown to decrease significantly the levels of the stress hormone cortisol, leading to improved affect, mood and cognitive functioning. A study also found that the participation in the therapy sessions led to a shift in frontal lobe activity (as measured by EEG) in depressed adolescents especially when they were involved with word skill tests during the session. It was also shown to shift activity from the right frontal lobe to the left, a phenomenon associated with positive affect and mood. 

This therapy method is normally applied in four music-therapist recomended strategies which enable realization of significant results; these strategies are:

Use of visual support.

While music is an effective memory cue and learning modality, many patients still perform best when visual cues are paired with auditory stimuli. Using Word Skillz memory cards, song story books, digital pictures, and even physical gestures has proved to increase the patients’ understanding of the lyrics they are hearing or singing. (Lazar, 2014)

Engagement of familiar karaoke music

For patients with limited interests or are difficult to engage, a lesson plan is created around one of their favorite songs. For example, they can be printed, given in the form of digital lyric sheets or in the Word Skillz memory cards format, which the patient can read the song lyrics out loud, identify unfamiliar vocabulary, test key words, and discuss the song’s meaning. Afterward, patients can complete a related writing activity based on the central themes in the song. (Lazar, 2014)

Creation of rhythm

There is a focus in the Singing Plus therapy system (especially with those with acute depression symptoms) on structuring the patient’s visual environment. What about auditory information? Verbal instructions and dialog can also be overwhelming for patients who have difficulty filtering for the important information they should attend to. Rhythm helps emphasize key words, add a predictable cadence, and naturally gets the body in sync with and tuned into the activity. 

The patient can tap the syllables to their name on a drum to help with their articulation and pacing. Tapping a rhythm on the table, a knee, or a drum is also a great tool for patients who speak too fast or are difficult to understand. (Lazar, 2014)

Generalization of skills

After a song, ask the patient is asked the “Wh” questions (who, what, when, where, why) about the song content in spoken language. (Lazar, 2014). Visual supports from the song during related non-music activities are normally used. For example the therapist might use pictures from a smiley song as cues when asking the patient to smile. Actually, smiling even when you don’t mean it, has been found to also improve mood. (Lazar, 2014) 

Use of lyrics from the songs as cues are employed throughout the session. If a behavioral song cues the patients to keep their hands down, it may be introduced by singing the “hands down” phrase at other times during the day when the therapist sees the patient becoming restless. Later it can be faded into a spoken voice. (Lazar, 2014)


From the study, it can be concluded that for reduction of the rate of suicide in the United States, the underlying causes should be carefully examined and properly dealt with. A major concern in the varied number of causes is depression. Even though there are complex and advanced means of managing this mental disorder, such as the brain stimulation techniques and the complicated central nervous system targeting medications e.g. the opioids, it is of utmost importance to consider a more effective (in terms of cost and results) and with limited side effects means of treatment and management. 

With reference to this, the Singing Plus therapy system, which includes the use of familiar karaoke music for mood elevation for the patient plus the use of Word Skillz® memory cards for cognitive involvement of the patient undergoing the therapy should be considered, as it is a more fun means of treatment which the patient enjoys compared to antidepressants such as opioids. Offering a natural alternative with Singing Plus may lower the negative effects of opioids, which normally induce acute depression and thoughts of suicide to the patient during the first weeks of treatment, which may result in a more positive person, wishing for a better quality of life.


Bodner E., Jancu J., Gilboa A., Sarel A., Mazor A., Amir D. (2007). Finding the Words for Emotions: The Reactions of Patients with Major Depressive Disorder Towards Various Music Excerpts. Arts in Psychotherapy , 142-150. 
 Keggler S., Stone M., Holland M. (2017). Trends In Suicide By Level of Urbanization In The United States. Center for Dissese Control and Prevention, U.S- Health and Human Services. Atlanta: Center for Dissese Control and Prevention. 
Lazar, M. (2014, September 18th). Four Ways To use Music With Special Needs Students. Retrieved June 6th, 2017, from George Lucas Educational Foundation: 
Maratos A., Gold C., Wang X., Crawford M. (2008). Music Therapy for Depression. The Cochrane Database of Systematic Reviews
NIMH. (2016, October). Depression. Retrieved June 7, 2017, from National Institute of Mental Health: 
Pani P., Vacca R., Trogu E., Amato L. and Daroli M. (2010, July 19). Pharmacological Treatment for Depression During Opioid Dependence. Retrieved June 6, 2017, from Cochrane Database of Systematic Reviews: 
Swartz, K. L. (2013, June 19). Depression: Music Therapy. Retrieved June 6th, 2017, from remedy’ 
Swierzewski, S. J. (2001, february 2nd). Treatment for Depression. Retrieved June 5th, 2017, from remedy’