How does music contribute to well-being? Perspectives from homeless young adults with problematic psychoactive substance use

Abstract

Homeless young adults with problematic psychoactive substance (PS) use face multiple challenges that compromise their well-being. Despite these challenges, few of them access psychosocial services and rather rely on personal resources to promote their own well-being. However, literature has been largely centered on their difficulties, leaving their strengths and capacities unknown. Despite this lack of knowledge, literature suggests that music is very important in the lives of young adults, especially because it helps them meet multiple well-being needs. The objective of this study was to describe and understand the perspectives of homeless young adults who experience problematic PS use on the ways music contributes to their well-being. Fifteen participants took part in semi-directed qualitative interviews that covered their experiences regarding the role of music in well-being. We also performed an iterative thematic analysis. Results highlight the marked importance of music for participants. Our study also demonstrates participants’ capacity to adapt their use of music to address the emotional, psychological, and social challenges they face. This study contributes to a better understanding of young adults’ use of music in promoting their global well-being and to the development of adapted outreach interventions that account for their capacities and interests.

Keywords

music well-being problematic psychoactive substance use homelessness young adults qualitative research

Homeless young adults (HYAs) aged 18 to 30 years old face multiple vulnerability factors that compromise their well-being. Up to 78% of HYAs in Canada experience problematic psychoactive substance (PS) use (HSABC, 2019). Problematic PS use is defined as strong urges and cravings for alcohol or other drugs, difficulties in controlling one’s consumption, and persistent PS use despite experiencing negative consequences (Centre for Addiction and Mental Health, 2023). Combined with homelessness, problematic PS use disproportionately worsens well-being outcomes. The Centers for Disease Control and Prevention define well-being as a subjective and positive evaluation of one’s life experiences on multiple dimensions (CDC, 2017; Simons & Baldwin, 2021). HYAs who use PS face particular challenges regarding the emotional, psychological, and social dimensions of well-being (CDC, 2017; Chang et al., 2018; Harpin et al., 2013; Statistics Canada, 2012). Indeed, difficulties in regulating emotions are often at the root of PS use initiation (Nikmanesh et al., 2013; Wong et al., 2013) and remain highly prevalent among those who develop problematic PS use (Stellern et al., 2023; Zareban et al., 2017). Moreover, up to 85% of HYAs report elevated psychological distress (Gaetz et al., 2016). They are also particularly at risk of suffering from mental health issues, most commonly depression, anxiety, suicidal ideations and attempts, and post-traumatic stress disorder (Coates & McKenzie-Mohr, 2010; Desai et al., 2003; Edidin et al., 2012; Iwundu et al., 2020; Kamieniecki, 2001). At the social level, this population disproportionately reports ruptured familial and social networks, intense feelings of loneliness, social exclusion, and stigmatization (Kidd, 2007; Sample & Ferguson, 2020; Sanders & Brown, 2015).

Despite experiencing multiple difficulties, few HYAs access services to address psychosocial or PS use issues, due to important individual and structural barriers (Ali & Schwan, 2019; Edidin et al., 2012; Reilly & Williamson, 2022; Schwan et al., 2018; Winiarski et al., 2020). In addition, most services focus on reducing harms associated with PS use and helping HYAs meet survival needs (e.g., eating) while paying little attention to other needs (i.e., emotional, psychological, and social; Krawczyk et al., 2022; Wang et al., 2019). As a result, HYAs generally turn to personal resources to promote their well-being (Edidin et al., 2012; Lal et al., 2013). Nevertheless, anterior research led among this population has been largely centered on their difficulties (Hubley et al., 2014).

Despite the lack of knowledge about the resources HYAs use to promote their well-being, literature shows that music plays a very important role in the lives of young adults from the general population. Indeed, young adults from the general population listen to music for up to 40 hr weekly (Lonsdale & North, 2011; North et al., 2004; Schäfer et al., 2013). Importantly, they report employing music-related activities for specific reasons including emotional regulation, promoting mental health, overcoming difficulties, and facilitating social interactions (Boer & Fischer, 2012; Bogt et al., 2017; Dingle & Fay, 2016; Lonsdale & North, 2011; North et al., 2004; Papinczak et al., 2015; Schäfer et al., 2013). Hence, music exerts multiple benefits on dimensions that characterize well-being (CDC, 2017). These benefits can be obtained from different forms of musical activities (e.g., listening, singing, playing a music instrument, composition; Caló et al., 2019; Daykin et al., 2018; Ros-Morente et al., 2019).

Research about the role of music in the lives of young adults with problematic PS use has been largely centered on the potential risks of music for PS use (Cournoyer Lemaire et al., 2021; Engels et al., 2012; Petering et al., 2017; Slater & Henry, 2013). Although very little research has been conducted among HYAs, some studies revealed optimistic results regarding the benefits of musical activities on well-being in this population. HYA commonly engage in music listening to regulate emotions (Gebhardt et al., 2014), overcome difficulties (Lal et al., 2013; Woelfer, 2014), strengthen social relationships, and alleviate feelings of loneliness (Woelfer & Lee, 2012). Individuals who share similar musical preferences and personal values may also come to identify with a music-based community, a supportive social structure that fosters a sense of community (Petering et al., 2017).

Overall, literature brings interesting insights about the ways music may benefit the well-being of HYAs. However, there are significant gaps regarding how HYAs with problematic substance use engage in musical activities to promote their well-being. First, the current state of knowledge regarding the use of music among HYAs who use PS largely relies on secondary analyses and there are very few cases where music was the focus of an in-depth study. Hence, the use of music to promote well-being in this population remains unexplored. Second, among the few examples where music was studied among HYAs who use PS, music was often portrayed as a negative force that encouraged PS use (Cournoyer Lemaire et al., 2021). In addition to further stigmatizing HYAs, this portrayal often overlooked the benefits of music. Also, the studies that did identify the benefits of music in this population were generally led in a treatment context where music was guided by a therapist, limiting our understanding of the strategies HYAs use to promote their well-being autonomously (Cournoyer Lemaire et al. 2021). Third, studies led among HYAs who use PS are often centered on music listening, with little attention given to activities such as playing a musical instrument, music composition, or identifying with music-based communities. Hence, the role of other musical activities in HYAs’ well-being remains misunderstood. Last, results from anterior research are often descriptive and give little attention to individuals’ living contexts, despite their known influence in determining the role of music (Travis et al., 2018). Moreover, although the impact of music varies according to individuals’ interpretation (Juslin & Västfjäll, 2008), HYAs’ perspectives lacked consideration.

Objective

This study aims to describe and understand how music contributes to global well-being from the perspective of HYAs who experience problematic PS use.

Theoretical perspective

This study is based on the Individual and Community empowerment framework (Travis & Deepak, 2011). This framework encompasses two dimensions. First, it considers music as an empowering resource that enables vulnerable young adults to promote their well-being. This empowerment dimension seeks to understand young adults’ capacities to adapt their use of music in their everyday lives to address well-being-related needs, at the individual and community levels. On the individual level, the model examines how music promotes self-esteem, resilience, and personal growth. On the community level, it explores how music fosters a sense of community and encourages social change. However, as demonstrated earlier, literature highlights some benefits of music on other dimensions of well-being. To enrich Travis’ framework, we employed an enlarged vision of the impacts of music to understand how it relates to the emotional (i.e., capacity to experience positive emotions and alleviate negative emotions), psychological (i.e., experience of mental health, self-acceptance, autonomy, personal growth), and social (i.e., having positive relationships, social support, connection with a significant social network) dimensions of well-being (CDC, 2017; Linley, 2013). The second dimension of the model explores the potential risks of music on PS use and is covered in a distinct research article (Cournoyer Lemaire et al., 2023).

Methodology

Research context

This research was led by E.C.L. She identifies as a woman, a young adult, and a musician, and has training in psychology and qualitative research. More information regarding her positionality can be found in another publication (Cournoyer Lemaire, 2023).

Research design

To deepen our understanding of the role of music in the well-being of HYAs who use PS from their own perspective, we used a descriptive interpretive design (Thorne, 2016). The study also included a participatory dimension. Given their rich experiential knowledge, a peer researcher (C.G., pronouns they/their/them) with lived experience regarding homelessness, PS use and music was involved throughout the study. They participated in the development of the interview guide by suggesting themes to be discussed, the recruitment of participants, the data analysis, and the writing of this article.

Sampling

The population of interest was HYAs with problematic PS use from Montreal (Canada). To take part in the study, young adults had to be aged between 18 and 30 years old and be able to understand and speak French or English. They also had to have experienced homelessness and problematic substance use within the 12 months preceding the interview. Young adults were considered homeless when they reported having no home or adequate place to sleep at least once per month, combined with difficulties meeting basic needs (e.g., securing food; Roy et al., 2011). Problematic PS use was established using the CAGE-AID (Brown & Rounds, 1995), a validated questionnaire including four yes or no questions. Answering “yes” to at least one of them signals probable PS use issues.

To ensure that participants had some lived experiences with music, they had to engage in any form of music-related activities at least once weekly. To measure this, we developed a questionnaire about the weekly frequency of their participation in music listening, practice, composition, singing, annual attendance at music events, and identification with a music-based community (Chin & Rickard, 2012). Individuals with musical anhedonia (a condition where one experiences no pleasure in music) were excluded (Barcelona Music Reward Questionnaire, Mas-Herrero et al., 2013).

Recruitment

Participants were recruited using a theoretical sampling strategy (Patton, 2002; Pires, 1997). Theoretical sampling, iterative to the data collection and analysis, allowed us to identify profiles that were needed to enrich data collection and to attain empirical saturation (Pires, 1997). The sample was diversified by age, gender, and involvement in music-related activities.

Participants were recruited through the weekly presence of E.C.L. and C.G. at two harm reduction organizations in Montreal. The authors introduced the research to HYAs and those who were interested were invited to complete a contact sheet and an eligibility form. Prior to their participation, each participant gave their written and informed consent. Following their participation, participants received a compensation of $20 CAD. The ethics committee CIUSSS Estrie-CHUS approved the project (grant no. 2020-329).

Data collection

E.C.L. conducted semi-structured interviews lasting 90 to 120 min (Rubin & Rubin, 2012). Interviews were conducted in a private space within community organizations, with the exception of six interviews that were conducted virtually due to the COVID-19 pandemic.

We developed an interview guide based on the literature, the theoretical framework, and the perspective of the peer researcher. It included 10 open-ended questions and follow-up questions. The peer researcher helped us ensure that the language and the themes were adapted to the research and population. The interviews explored the role music plays in participants’ global well-being, the contexts where participants used music and for what reasons. We explored different types of musical activities including music listening, practice of an instrument, attending music events, and identifying with music-based communities. For example, the interview guide asked “How would you describe the role of music in your life?” and “How does music relate to your mental health?” The guide was iterative to the data collection and was adjusted throughout the study to enrich data quality.

A timeline was used to facilitate the recall of significant life events (e.g., relationships, mental health changes, discriminatory experiences). Participants also identified their musical involvement and the importance attributed to music at different time points in their lives to understand the links between involvement in music and significant life events. Interviews were recorded, transcribed, and anonymized. Each participant was attributed a pseudonym.

Participants completed a sociodemographic questionnaire. We also documented the severity of use of different PS in the 3 months preceding the interview using the Alcohol, Smoking, and Substance Involvement Screening Test (Henry-Edwards et al., 2003).

Analyses

We performed a thematic analysis (Miles et al., 2014). The transcribed interviews were coded using NVivo12 and a mixed analytical grid (Laperrière, 1997; Miles et al., 2020). Deductive themes were developed from the conceptual framework and the literature (e.g., impacts of music on emotional, psychological, and social well-being). To account for emerging data, inductive themes were developed iteratively during the analytical process. To do so, we attributed specific codes to novel information, which were then grouped into larger themes and added to the coding grid.

A second member of the research team co-codified two interviews. Meetings were set to discuss convergent and divergent coding and to improve the analytical grid until the inter-rater concordance rate exceeded 80%. The peer researcher was then involved in the identification and interpretation of emerging themes. To do so, they read the coded interview excerpts, identified significant information to put forward, and held meetings with the first author to share and discuss their observations. These meetings led to the classification of data according to the themes of emotional, psychological, and social well-being. Finally, the peer researcher helped to select and translate (from French to English) interview excerpts to illustrate the results.

A trajectory analysis was performed on the life events and music timelines to understand their concurrent evolution over time as well as how the use of music changes across life events and living contexts (Brunelle & Bertrand, 2010). Descriptive analyses were conducted on the sociodemographic questionnaire using SPSS (Statistical Package for the Social Sciences).

Results

Participants

Fifteen participants took part in the study. They were aged between 23 and 30 years old (M = 25.53, SD = 2.48) and identified as women (n = 6), men (n = 8), and non-binary (n = 1). Participants identified as heterosexual (20%), bisexual (26.7%), pansexual (26.7%), and homosexual (13%). Most reported being Caucasian (n = 13), one identified as African, and one as “half African and half Canadian.” The sample displayed different profiles of PS use where the most commonly problematic substances were cannabis (87%), stimulants (80%), cocaine (67%), alcohol (60%), hallucinogens (47%), and opioids (40%). Eight participants experienced problematic consumption of multiple substances. All participants listened to music daily, 47% practiced an instrument, singing, or music composition; 60% attended a music event in the year preceding the interview; and 33% identified with a music-based community, specifically punk, hip-hop, and electronic sub-cultures (see Tables 1 and 2).

Table 1.

Sample characteristics.

Characteristics	n	Percentage
Gender
Woman	6	40
Man	8	53.3
Non-binary	1	6.7
Sexual orientation
Heterosexual	3	20
Homosexual	2	13.3
Bisexual	4	26.7
Bicurious	1	6.7
Pansexual	4	26.7
Demi-sexual	1	6.7
Ethnicity
Caucasian	13	86. 7
African American	1	6.7
Métis	1	6.7
Highest level of education
Few years high school studies	2	13.3
Completed high school degree	4	26.7
Equivalence of high school studies	2	13.3
Completed professional studies (Diploma in vocational studies)	1	6.7
Few years of college studies	1	6.7
Completed college studies	1	6.7
Some university classes/years of study	3	20
Completed university studies	1	6.7
Annual income ($CAD)
Less than $12,000	6	40
$12,000 to $19,999	4	26.7
$20,000 to $29,999	2	13.3
$30,000 to $39,999	2	13.3
$40,000 to $49,999	1	6.7

Table 2.

PS use profile and music involvement.

Characteristics	n	Percentage
CAGE-AID (total scores)
1	0	0
2	3	20
3	3	20
4	9	60
ASSIST (level of severity)
Low risk	0	0
Moderate risk	7	46.67
High risk	8	53.33
Involvement in musical activities
Music listening (weekly)	15	100
Practice an instrument, sing, or compose music (weekly)	7	46.66
Attend music events (once in last year)	9	60
Identify with a music-based community (currently)	5	33.33

Note. The CAGE-AID total scores represent the number of participants who answered positively to one, two, three, and four questions.

Perspectives on music and well-being

Participants reported using different music-related activities, including music listening, music practice, attending music events and identifying with music-based communities, to promote multiple dimensions of well-being. According to participants, music empowers them to address emotional, psychological, and social needs. Trajectory analyses also revealed that the intensity of music use varied over time, where HYAs tended to get more involved in music-related activities when they faced difficult events, including traumatic experiences; physical, emotional, and sexual violences; psychological distress and suicidal ideations; and social exclusion.

Music and emotional well-being

All participants reported using music listening for emotional regulation purposes. Music is an accessible, simple, and effective tool used to regulate, express, and connect with inner emotions. Most participants reported adapting their music listening to improve their mood and to maintain positive emotional states despite difficult life conditions.

All along my life, each time I was really down and that I listened to music I liked, well not only it changed my mood but you know, it cheered me up. [. . .]. Because I am no longer in a negative mood and really, not sad but you know, I am no longer blaming all and everything, I am more able to concentrate on “Well today at least I breathe”, you know, I am very . . . how to say, grateful you know. I am very happy to be alive. (Yan)

Importantly, most young adults reported that the intensity of music use varies according to their life circumstances. Participants use music more intensively when they experience negative emotions and greater emotional needs, and use music less when they feel better.

When I feel good, when I am in a good period where I am not too emotional, I am able not to have earphones. But when I don’t feel good, forget it! I automatically have my earphones on my ears. [. . .] Just because I want to calm myself down. (Martin)

However, in the context where music is considered an important tool, which some participants referred to as a therapy, the inability to access music during negative circumstances may hinder young adults’ capacity to regulate their emotions and to feel better.

For me, music is a therapy so if you take music away from me when I don’t feel good, well what do you expect me to do? You know, I can’t . . . really . . . like I can’t live without music. Music is vital in my life. [. . .] I feel [emotions] better, I go through them more easily. You know, when I have music, for example I am angry I will listen to music, music is a means to calm me down or soothe my emotions, to better digest them. It is easier to . . . it’s more difficult to regulate my emotions if I don’t have music. (Charles)

Music listening and composition also allow some participants to express their emotions in a socially acceptable manner and without negative consequences, in contrast with the use of violence enacted toward self or others.

This is how I let loose, how I express my emotions. It’s. . . Yeah, I’m someone who speaks very well, [. . .] But the thing is, when things get to me personally, emotionally, like. . . I freeze, and I’m like. . . I just want to break everything. That’s where music, that’s what saves my life. [. . .] If I don’t take time for myself, to like live my emotions, a temperament that we would consider normal for the majority of people, me, I will explode. It’s. . . it’s like a volcano that erupts, you don’t want to see that. So that’s why, often, I listen to music alone to live my emotions, like moderately. (Martin)

Many participants experienced traumatic events and violence during childhood, conditions that led them to repress their emotions. They reported that the inability to feel emotions, regardless of their nature, constitutes a negative experience and is dehumanizing. In this context, most participants referred to music as “the language of emotions” and use it to feel emotions.

Sometimes, I guess that I want to be, for example sad, so I put on sad music to make myself sad. Sometimes, it feels like you want to, you need to live something so you, like, use music to provoke it. [. . .] I should be sad, but I am unable to connect with it, so I will put on sad music to help me connect with my sadness. (Emma)

In addition, some participants use music to elicit emotions at specifically chosen moments that they consider appropriate, mainly when they are alone.

Sometimes I think that it’s important to live your sadness. When it’s appropriate, which is to say not before hanging out with friends. When I know that I have time for myself and I say to myself “okay now I feel like living my sadness and letting these emotions loose”, well then I would say it’s okay to be sad at this moment. But if for example I have to meet up with friends, if I have to go to work, if there’s something that tells me that this negative emotion is not welcome, well then I will listen to upbeat music to try to change my mood, so that afterwards I can go to work, hang out with friends, smiling and in a good mood. (Maëlle)

Music and psychological well-being

The majority of participants reported using music to promote their psychological well-being. Most HYAs reported living with mental health issues, mainly mood and anxiety disorders, and trauma. They reported that music was an important tool to overcome the difficulties related to mental health and to promote resiliency during adverse life events. Beyond the promotion of mental health, involvement in music is considered deeply gratifying, which in turn increases self-esteem.

Mental health

For participants who reported having experienced or experiencing suicidal ideations and mood disorders, music brings significant emotional and psychological support to the point where music contributed to the survival of some participants. As a result of an increased ability to regulate their emotions, participants diminished the frequency of their suicidal ideations and attempts, and many reported that music had saved their lives. This was especially the case for those who engaged in the practice of a music instrument or music composition.

Yeah, it’s really like the fact that . . . I was listening to my music again. I was letting loose, . . . I expressed my emotions and I . . . I composed some music, I recorded my music, I . . . with my ipod, I can record my music. So, I make vocal memos, I record, I play it back, . . . anyways, it’s a technique, but it’s really like . . . it’s my way to stop doing crimes, to stop . . . wanting to slit my wrists or to hang myself. (Martin)

HYAs who use PS often experience limited access to healthcare resources. The severity of psychological symptoms may also vary over time. In this context, participants reported that music became much more important when mental health symptoms were at their peak.

When I was a teen, I didn’t have my diagnosis yet, I didn’t know why I was always suicidal, so it was . . . and I let my emotions overwhelm me and everything. So it was more important to have it [music] then as a support, whereas now, I take medication. (Maëlle)

Participants who reported living with anxiety disorders (e.g., social anxiety) or with associated symptoms reported using music to create a calm, isolated, and safe space despite that they often find themselves outside, in public spaces surrounded with strangers.

I had a friend who gave me a cellphone that I lost about 6 months ago, so maybe it doesn’t help with my social anxiety because I think it helped me a lot having music in my ears all the time while I was walking you know . . . [it helped me to] create myself a bubble I guess. It’s fun to walk while listening to music. [. . .] It gives a reason not to listen to everything around me, it creates a sort of barrier. (Mia)

For most participants who experienced traumatic events, traumas were linked with violence and sexual abuse, and resulted in social ruptures and general distrust toward adults. Music appeared particularly important to them, as identifying with artists and music that express similar experiences as theirs helped them feel understood and reduced loneliness. Music also contributed to reduce the commonly co-occurring suicidal ideations and encouraged resilience.

Oh well when I was 22, I was kidnapped and sexually abused and all that, and after that I was no longer able to talk or to sleep, so all I was doing was listening to music all the time you know. And like it helped me get over it, you know. It wasn’t very sad music either, that would not have helped, but yeah, on the long term, it helped me. It literally stopped me from killing myself. (Emma)

Beyond the use of music to address mental health issues, the practice of a music instrument reinforced self-esteem, self-worth, and feelings of competency in achieving something positive, especially in the context where participants experienced stigmatization and social exclusion.

You know, sometimes, when I’m not doing well, when I’m lacking self-confidence, well, I tell myself “Geez, I am a damn good musician!” When I listen to songs, I am able to reproduce every sound in my head. I tell myself that if I still have that talent, all is not lost, you know . . . I always remind myself that I am a god of a drummer, and I will always be a god of a drummer. It gives me value, you know, I see myself as something in life . . . I have that as a talent. If something happens, I always have that, no matter what happens. Whether I’m hurt, not well, I will always be able to play music, regardless. I am a musician. (Sam)

Music and social well-being

The previous sections demonstrated that engaging in music listening and practice empowered participants to address individual needs. In the case of social well-being, the benefits of music emerge as it is shared with others. Participants’ involvement in music events and identification with music-based communities empowered them individually but also collectively. According to participants, such communities promote the development of social and supportive relationships while fostering a sense of belongingness.

Participants reported that music listening and taking part in festive events facilitated the development of positive bonds with others, reinforced the significance of social relationships, and gathered people around pleasurable social moments, especially when they shared similar musical interests.

Often you just match with people, you go out to meet friends in shows, or when you’re a teen you know and you listen to metal, you will hang out with people who listen to metal. Especially when you’re young, I noticed that, you could say that people classify themselves by their musical tastes. [. . .] Like me, I hung out a lot with punks because punk was my preferred musical style. (Emma)

Homelessness and problematic PS use may also lead to losing sight of significant others. Some participants reported using music to connect with and recall positive memories about persons who are no longer accessible.

There have been moments when I felt pretty alone where I listened to music that reminded me of certain people in my social circle, who, with my drug use, ended up being farther away from me. I could listen to music that reminded me of my father because I wanted to be with my father but due to the present situation, I was more solitary than family-oriented [. . .] it helped me. (Alex)

Some participants also composed music to communicate their concerns with the larger population, with the hope that it would educate society about issues like homelessness, and bring positive changes.

One or two months ago, I started writing compositions. It is really touching and it makes me feel good. It helps me vent, and it sensitizes people about multiple concerning issues. (Fanny)

The two participants who reported identifying with an ethnic minority reported using music to connect with their culture, to gain knowledge about it, and to feel proud about their identity despite experiencing exclusion or discrimination based on this identity.

I would say there is an identity component in music. I am a racialized person, I am of Cameroonian origin. [. . .] I never went in Cameroon, I don’t necessarily know the culture there. So for me, discovering African music makes me feel less white washed. And in fact it makes me feel good when I see that there is good music made in Africa, from Cameroon. So . . . In fact it makes me proud when I see that . . . because sometimes people have racist ideas related to African cultures. (Maëlle)

Beyond taking part in music-related activities such as music practice or listening, some participants, and specifically those who identify as women, gender minorities and sexual minorities, identify with music-based communities such as punk, hip-hop, and electronic sub-cultures. Those groups represent safe spaces where young adults feel accepted and develop a sense of belongingness. These groups also represent an occasion to rebuild a family despite young adults’ ruptured relations with biological family members. Belonging to music-based communities empowers young adults and their communities to contribute to the survival of each other, and to denounce social justice issues.

[punk and electronic subcultures] It really promotes open-mindedness, it talks a lot of outrage, of breaking social conventions that are considered outdated, changing your path, being more alternative, in the sense of being independent. I found my place, as being a young gay man who was living a lot of internalised homophobia. So for me, to find a group of like-minded friends, and its because of music that I was able to find this, people that were open-minded enough to accept me and welcome me, because for them, the difference, not that they didn’t see it, but they accepted it. Instead of closing their eyes on it or preaching ignorance and pretending that it was not there, well to see it and to accept it and to honor it, I found a nice refuge in there. (David)

Other participants gathered into these communities to promote social changes and collective well-being.

It [music-based community] gives a sense to my life because I listen to the lyrics and like, it gives me a drive, you know, it talks about . . . Radiohead can be very political, like about how the world is fucked up and everything. And you know, it’s like, I am not the only one who believes this. You know, there are people who acknowledge that the world is fucked up and you know, it’s not me who is fucked up, it is the world you know. Yes I have my own issues and all, but it is our society and our culture, like, crappy, that really brings me down. (Kim)

Discussion

This study aimed to describe and understand how music contributes to well-being, from the perspective of HYAs with problematic PS use. Music empowered young adults on the individual level by helping them address emotional and mental health issues, promote self-esteem, and achieve personal growth. This is especially true in periods of high psychological distress, during which many participants reported that music saved their lives. Music also empowered young adults on the community level, by facilitating the development of social relationships, their sense of belonging, and their connection with cultural origins. Music-based communities also helped them recreate a safe social environment.

Our results are coherent with literature about the importance of music for young adults from the general population (Boer & Fischer, 2012; Lonsdale & North, 2011; Schäfer et al., 2013). However, although literature among HYAs was largely centered on their difficulties even with regards to music, our empowerment perspective highlighted its major importance in promoting their well-being. Not only do HYAs use music to address a range of emotional, psychological, and social needs, the importance of music also intensifies within the context of homelessness and problematic PS use, where it goes as far as contributing to survival by promoting the management of emotions and psychological symptoms that threaten HYAs’ lives. Music-based communities also play an important role in breaking isolation, providing social support and a sense of security in the context of adverse living conditions. These represent protective factors against premature death, knowing that using drugs alone, experiencing violence, or suicidal behaviors are among the primary causes of death in HYAs (Bardwell et al., 2019; Dowell et al., 2017; Zordan et al., 2023).

In the literature and within community organizations, the concept of survival is often based on physical needs (e.g., eating adequately, being housed, Canadian Alliance to End Homelessness, 2024; Jego et al., 2018; Martinez et al., 2021). However, some HYAs who use PS experience severe psychological distress that also threatens their survival. Coherently, young adults’ psychological needs should be given greater consideration (Barile et al., 2019; Gaetz et al., 2016; Winiarski et al., 2020). In this perspective, music is a promising tool that should be more available in the organizations designed for populations at risk of psychological distress. This could take the form of a creative room where music listening devices and instruments are available, and where individuals can engage in music alone or with friends. This could be complemented with a guide instructing how music can facilitate the management of mental health difficulties.

Our study also highlights HYAs’ well-being needs and informs us about the ways music can contribute to meet them. Most HYAs experience emotional issues, which are often at the root of PS use (Nikmanesh et al., 2013; Wong et al., 2013). Yet, services designed for this population are often centered on strategies specifically designed to address PS use, without necessarily providing resources to facilitate emotional regulation (CMHA, 2023). For HYAs who use PS, the opportunity to access emotional regulation strategies is even more limited, which hinders their capacity to manage emotions properly. Facilitating autonomous access to resources like music would be particularly relevant in the context of homelessness (e.g., having a space with available listening devices or musical instruments). Namely, studies demonstrate that facilitating access to well-being-promoting strategies for HYAs reduces their exposure to violence, PS use, mental health issues, and suicidal ideations (Bonell et al., 2016; Menefee et al., 2022; Petering et al., 2021; Pisani et al., 2012; Sloan et al., 2018).

Moreover, literature about music and well-being among people with problematic PS use is mainly focused on music listening (Ghetti et al., 2022). Our exploration of the benefits of other music-related activities deepens our comprehension about how music improves different well-being dimensions. Music listening and playing are generally performed alone to address personal emotional and mental health needs, playing music contributes to developing one’s sense of worthiness, growth, and competency, and belonging to a music-based community nurtures social needs. Our results are coherent with previous research regarding the benefits of music practice and songwriting on well-being among vulnerable young people (Chakrabarti, 2021; Hansen, 2016; Marese, 2020), though the latter mostly emerged from interventions administered by professionals (Marese, 2020; Myers-Coffman et al., 2019; Myers-Coffman et al., 2020). Our study supports the importance of promoting access to music to support the development of young adults’ competencies and autonomy in acting positively on their well-being even in the absence of professional support.

Although young adults who identify with music-based communities (e.g., punks) are often stigmatized to the point that it may hinder their access to treatment services (Cournoyer Lemaire et al., 2023), taking their perspective into account allowed us to better understand the role of music-based communities for HYA who use PS. Our results show that those communities contribute to address important needs that are otherwise hardly met for HYAs with problematic PS use (e.g., re-creating a family), and have been linked with increased health equity (Bartleet & Heard, 2024). Our results suggest that identifying with a music-based community is particularly prevalent among HYAs who are at the intersection of structurally marginalized identities, including gender and sexual minorities. Although music has not been studied under this intersectional lens, literature shows that HYAs who identify with gender and sexual minorities are at increased risk of suffering from mental health issues, problematic substance use, stigmatization, and violence compared with those who do not identify with those minorities (Alessi et al., 2020; Hao et al., 2021; LoSchiavo et al., 2020; Schick et al., 2019). Identifying with a music-based community may provide gender- and sexually diverse HYAs with a supportive group who welcomes their identities and a greater sense of security. This social support may then reduce the severity of mental health and substance use issues (Postuvan et al., 2019; van der Star & Bränström, 2015).

Although music-based communities may expose young adults to other risks (e.g., PS use; Petering et al., 2017), their importance in HYAs’ lives needs to be acknowledged and welcomed without judgment, including within services designed for HYAs. This could contribute to reduce prejudices and facilitate the outreach of HYAs who use PS and who identify with different profiles.

Limitations

The study includes some limitations. A part of it was conducted during the COVID-19 pandemic. Some meetings were conducted virtually, which may have affected the interviewer’s capacity to establish a trusting relationship with participants and might have influenced their level of disclosure regarding sensitive themes. Also, though not all participants were interested in each type of music-related activity, some reported not being involved in the practice of instruments or in music events due to difficulties accessing those activities, which may limit our understanding of some musical experiences. Another limitation is that our sample was mainly composed of Caucasians, which limits our understanding of music’s benefits in other ethnic groups.

Strengths

This study allowed us to gain an in-depth understanding of the capacities of HYAs in using music to promote well-being. This brings new light on the strengths of this population who have been largely stigmatized through a lasting focus on their difficulties. This study is among the first to explore the role of different types of music-related activities on several dimensions of well-being while considering the perspectives of HYAs who use PS. Importantly, each part of the study was enriched by the contribution of a peer researcher to ensure that the protocol was adapted and relevant to the targeted population, to facilitate the development of trusting relationships within the community of HYAs, and to ensure the relevance of the results.

Implications and future perspectives

This study highlights the capacities of HYAs who use PS to act positively on their well-being, which may reduce the stigmatization they experience. In the interventions designed for HYAs, the stigmatization associated with music and substance use often leads to a restricted access to music. Namely, it is common for services like addiction rehabilitation centers to prohibit music listening devices for their clients. This could limit individuals’ capacity to regulate their emotions and mental health symptoms, and could be detrimental.

Our results may inform people who work in services designed for vulnerable young adults about the potential benefits of music for their global well-being and increase their sensitivity to the importance of music in their lives. Our results could contribute to promote young adults’ access to music in such services and encourage service providers to integrate musical activities in their programs so that individuals can use music as a well-being-promoting strategy. Acknowledging the resources valued by young adults and their capacity to use them autonomously to promote their well-being could also facilitate outreach efforts and their maintenance in psychosocial and treatment services.

Finally, the participatory dimension of our study allowed us to tailor the research to the realities of HYAs’ living context and gain a deeper comprehension about the benefits of music, in an empowering and non-stigmatizing manner. Future research would also benefit from involving HYAs, community workers, and clinical professionals in the development of research as well as intervention programs meant to promote the well-being of HYAs who use PS to ensure they are adapted to their needs and capacities.

Footnotes

Acknowledgements

We wish to thank the research team and collaborators of the Gender-ARP project (Research Chair on Gender and Intervention in Addiction).

Authors’ note

The article has not been published elsewhere. However, the study is part of the first author’s doctoral dissertation, which is published in the institutional theses repertory of the Université de Sherbrooke ().

Authors’ contributions

The study was mainly developed and realized by E.C.L., under the supervision of K.B. and C.L. The study was part of a larger international project in which M.J.-R. and A.L. took part in developing the research protocol and design. For the specific research presented in this article, data collection and analysis were mainly performed by E.C.L and validated with C. G. The first draft of the article was also written by E.C.L. and all authors commented on previous versions of the article. All authors read and approved the final article.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Program Gender-Net (Canadian Institutes of Health Research) and the Fonds de recherche du Québec – Société et culture (FRQSC).

Ethics statement and approval

Informed consent was obtained from all patients for being included in the study. The study was approved by the CIUSSS de l’Estrie-CHUS (Sherbrooke, Canada, grant no. 2020-329).

ORCID iD

Elise Cournoyer Lemaire

Research data

Although we acknowledge the relevance of data sharing, it is not possible to share our data as this would significantly increase the risk of breaking participants’ confidentiality.

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