Richard A. Rawson,Ph.D.

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Matrix Model of Outpatient Substance Abuse
Treatment

• Richard A. Rawson,Ph.D.
• Associate Professor
• UCLA Integrated Substance Abuse Programs
• (rrawson_at_mednet.ucla.edu)

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Research-based Behavioral Treatments

• Relapse Prevention
• Marlatt, Gordon and Carroll
• Supportive-Expressive Psychotherapy
• Luborsky, Woody, McLellan, OBrien
• Individualized Drug Counseling
• Cocaine Collaborative Study

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Research-based Behavioral Treatments

• Community Reinforcement plus Vouchers
• Higgens
• Matrix Model of Intensive Outpatient Treatment
• Rawson, Obert, McCann

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The Matrix ModelIt is many treatments in one

• Out-patient, office-based
• Easy to understand
• Structure, structure, structure
• Continuing attendance is important

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Organizing Principles of Matrix Treatment

• Program components based on scientific literature
  promoting behavior change
• Program elements and schedule selected based on
  empirical support in literature and application

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Organizing Principles of Matrix Treatment

• Program focus is on behavior change in the
  present, not on assumed underlying
  psychopathology
• Matrix treatment is a process of coaching,
  supporting, reinforcing and supporting positive
  behavior change

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Organizing Principles of Matrix Treatment

• Non-confrontational, non-judgmental relationship
  between therapist and patient creates positive
  bond which promotes program participation.
• Positive reinforcement, incentives and
  contingencies used extensively to promote
  treatment engagement and retention.

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Organizing Principles of Matrix Treatment

• Accurate, understandable scientific information
  used to educate patient and family members
• Cognitive behavioral strategies used to promote
  drug cessation and relapse prevention

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Organizing Principles of Matrix Treatment

• Family therapy interventions used to engage
  families in recovery process
• Self help resources introduced and participation
  encouraged

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Organizing Principles of Matrix Treatment

• Urine and breath/alcohol testing
• used to monitor drug/alcohol use
• and support abstinence.
• Social support activities provided
• to help maintain abstinence

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Matrix Model of Outpatient Treatment
How it looks in Practice
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Matrix ModelPutting It All Together
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Matrix Model Groups

• Early Recovery (Engaging)
• Relapse Prevention (Learning)
• Social Support (Maintaining)

MATRIX
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Matrix Treatment GroupsDifferent from General
Therapy

• Focus on behavior vs. feeling
• Visit frequency results in strong transference
• Transference is encouraged
• Transference is utilized
• Goal is stability (vs. emotional catharsis)

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Matrix Treatment GroupsDifferent from General
Therapy

• Focus is on abstinence
• Bottom line is always continued abstinence
• Therapist frequently pursues less motivated
  clients
• The behavior is more important than the reason
  behind it

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Matrix Treatment GroupsDifferent from
Residential Treatment

• Less confrontational
• Progresses more slowly
• Focus is on present
• Core Issues not immediately addressed
• Allegiance is to the therapist vs. group

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Matrix Treatment GroupsDifferent from
Residential Treatment

• Non-judgmental attitude is basis of
  client-therapist bond
• Change recommendations based on scientific data
• Changes incorporated immediately into therapeutic
  style

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Matrix Early Recovery Groups
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Early Recovery Groups

• Scheduling and Calendars
• Triggers
• Questionnaires and Chart
• 12 Step Introduction
• Alcohol Issues
• Thoughts Emotions and Behaviors
• KISS (and other 12-step slogans)

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Early Recovery Issues Engaging and Retaining
TRIGGERS
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Triggers and Cravings
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Triggers and Cravings
Pavlovs Dog UCR
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Triggers and Cravings
Pavlovs Dog CR
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Early Recovery Issues Engaging and Retaining
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Early Recovery Issues Engaging and Retaining
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MATRIX MODEL TREATMENT Triggers - Places

• Drug dealers home
• Bars and clubs
• Drug use neighborhoods
• Freeway offramps
• Worksite
• Street corners

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MATRIX MODEL TREATMENT Triggers - Things

• Paraphernalia
• Sexually explicit magazines/movies
• Money/bank machines
• Music
• Movies/TV shows about alcohol and other drugs
• Secondary alcohol or other drug use

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MATRIX MODEL TREATMENT Triggers - Times

• Periods of idle time
• Periods of extended stress
• After work
• Payday/AFDC payment day
• Holidays
• Friday/Saturday night
• Birthdays/Anniversaries

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MATRIX MODEL TREATMENT Triggers - Emotional
States
? Anxiety ? Fatigue ? Anger ? Boredom ?
Frustration ? Adrenalized states ? Sexual
arousal ? Sexual deprivation ? Gradually
building emotional states with no expected
relief
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THOUGHT STOPPING

• Prevents the thought from developing into an
  overpowering craving
• Requires practice

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Accepting Non-Judgmental Empowering Supportive Und
erstanding
Patient Elicited Collaborative Ambivalence
Normal Facilitative
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MOTIVATIONAL INTERVIEWING

• Increase Motivation
• Decrease Resistance
• Increase retention
• Better outcomes

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MATRIX MODEL TREATMENT
STRUCTURE
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MATRIX MODEL TREATMENT
INFORMATION
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MATRIX MODEL TREATMENT Information - What
- Substance abuse - Sex and recovery and
the brain - Relapse prevention issues -
Triggers and cravings - Emotional
readjustment - Stages of recovery - Medical
effects - Relationships and recovery -
Alcohol/marijuana
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MATRIX MODEL TREATMENT Information - Why

• Reduces confusion and guilt
• Explains addict behavior
• Gives a roadmap for recovery
• Clarifies alcohol/marijuana issue
• Aids acceptance of addiction
• Gives hope/realistic perspective for family

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Triggers and CravingsHuman Brain
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Cognitive Process During Addiction
Introductory Phase
Relief From Depression Anxiety Loneliness Insomnia
Euphoria Increased Status Increased
Energy Increased Sexual/Social Confidence Increase
d Work Output Increased Thinking Ability
May Be Illegal May Be Expensive Hangover/Feeling
Ill May Miss Work
AOD

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Conditioning Process During Addiction
Introductory Phase
Strength of Conditioned Connection
Mild

• Triggers
• Parties
• Special Occasions

• Responses
• Pleasant Thoughts about AOD
• No Physiological Response
• Infrequent Use

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Development of Obsessive ThinkingIntroductory
Phase
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Development of Craving Response
Introductory Phase
Entering Using Site
Use of AODs
AOD Effects ? Heart/Pulse Rate ? Respiration ?
Adrenaline ? Energy ? Taste
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Cognitive Process During Addiction
Maintenance Phase
Vocational Disruption Relationship
Concerns Financial Problems Beginnings of
Physiological Dependence
Depression Relief Confidence Boost Boredom
Relief Sexual Enhancement Social Lubricant
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Conditioning Process During Addiction
Maintenance Phase
Strength of Conditioned Connection

• Triggers
• Parties
• Friday Nights
• Friends
• Concerts
• Alcohol
• Good Times
• Sexual Situations

• Responses
• Thoughts of AOD
• Eager Anticipation of AOD Use
• Mild Physiological Arousal
• Cravings Occur as Use Approaches
• Occasional Use

Moderate
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Development of Craving Response
Maintenance Phase
Entering Using Site
Physiological Response
Use of AODs
AOD Effects
? Heart ? Blood Pressure ?
Energy
? Heart ? Breathing ? Adrenaline Effects ?
Energy Taste
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Cognitive Process During Addiction
Disenchantment Phase
Social Currency Occasional Euphoria Relief From
Lethargy Relief From Stress
Nose Bleeds Infections Relationship
Disruption Family Distress Impending Job Loss
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Conditioning Process During Addiction
Disenchantment Phase
Strength of Conditioned Connection

• Triggers
• Weekends
• All Friends
• Stress
• Boredom
• Anxiety
• After Work
• Loneliness

• Responses
• Continual Thoughts of AOD
• Strong Physiological Arousal
• Psychological Dependency
• Strong Cravings
• Frequent Use

STRONG
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AOD
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Thinking of Using
Mild Physiological Response
Entering Using Site
? Heart Rate ? Breathing Rate ? Energy ?
Adrenaline Effects
Powerful Physiological Response
Use of AODs
AOD Effects
? Heart Rate ? Breathing Rate ? Energy ?
Adrenaline Effects
? Heart ? Blood Pressure ? Energy
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Cognitive Process During Addiction
Disaster Phase
Relief From Fatigue Relief From Stress Relief
From Depression
Weight Loss Paranoia Loss of Family Seizures Sever
e Depression Unemployment Bankruptcy
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Strength of Conditioned Connection
OVERPOWERING

• Responses
• Obsessive Thoughts About AOD
• Powerful Autonomic Response
• Powerful Physiological Dependence
• Automatic Use

• Triggers
• Any Emotion
• Day
• Night
• Work
• Non-Work

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Development of Obsessive ThinkingDisaster Phase
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Development of Craving Response
Disaster Phase
Thoughts of AOD Using Place
Powerful Physiological Response
? Heart Rate ? Breathing Rate ? Energy ?
Adrenaline Effects
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Outpatient Treatment Strategies

• Scheduling

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Matrix Relapse Prevention Groups
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Matrix Relapse Prevention Group Topics (Sample)

• Alcohol -The Legal Drug
• Boredom
• Avoiding Relapse Drift/Mooring Lines
• Guilt and Shame
• Motivation for Recovery
• Truthfulness
• Work and Recovery
• Staying Busy
• Relapse Prevention
• Dealing with Feelings

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Roadmap for Recovery
Withdrawal Early Abstinence/Honeymoon Protracted
Abstinence or The Wall Adjustment/Resolution
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Roadmap for RecoveryThe Wall
THE WALL
Return to Old Behaviors Anhedonia Anger Depression
Emotional Swings Unclear Thinking Isolation Family
Problems
Cravings Return Irritability Abstinence Violation
Protracted Abstinence
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Other Components of the Matrix Model
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Components Of The Matrix Model

• Family Education Lectures
• Conjoint Sessions
• Urine Testing
• Relapse Analysis
• Self help Initiation

MATRIX