Presentation on theme: "Matrix Model of Outpatient Treatment for Substance Dependence Originally Developed Specifically For Stimulant Abuse and Dependence METH SUMMIT May 19-21,"— Presentation transcript:
Matrix Model of Outpatient Treatment for Substance Dependence Originally Developed Specifically For Stimulant Abuse and Dependence METH SUMMIT May 19-21, 2003 Fargo, North Dakota Ahndrea Weiner M.S., LMFT Clinical Director Matrix Institute on Addictions
Methamphetamine Treatment Admissions In 1993, amphetamine treatment admission rates were high in a few Western States - - California, Oregon, Hawaii and Nevada. By 1999, high amphetamine treatment admission rates were seen in most States west of the Mississippi. Between 1993 and 1999, amphetamine treatment admission rates increased by 250 percent or more in 14 States and by 100 to 249 percent in another 10 States. Methamphetamine is the primary form of amphetamine seen in the United States and made up 94 percent of all amphetamine treatment admissions reported to SAMHSA's Treatment Episode Data Set (TEDS) in 1999.
Definition of Effectiveness The degree to which a therapeutic technique decreases the amount of frequency of drug or alcohol use, promotes prosocial behavior change compatible with a drug-free lifestyle and/or increases the engagement or retention of patients in process of treatment or self- help.
Treatment Medical & Behavioral Drugs Sedatives Stimulants Opioids Alcohol Medical Treatment Yes No Yes Behavioral Treatment Yes
Manuals in Psychosocial Treatment Reduce therapist differences Ensure uniform set of services Can more easily be evaluated Enhance training capabilities Facilitate research to practice
Matrix Model An Integrated, Empirically-based, Manualized Treatment Program
Motivation for Treatment Why is it harder for a stimulant abuser to enter the treatment system? What does it mean to say someone is motivated to do treatment? How can we compete with the pull of drugs like methamphetamine?
How Stimulants Effect the Willingness to Enter Treatment Methamphetamine does NOT make you sick; therefore, the drug use is not the problem. Methamphetamine allows long periods of no drug use; certainly the drug is not the problem.
What Research Tells Us about Addiction People with drug and alcohol dependencies do not have unique personalities
What Research Tells Us about Denial People with dependencies show no higher level of denial than the normal population Measures of denial are not clearly related to treatment or outcome
What Research Tells Us about Treatment Patient drug use, compliance, and outcome are powerfully influenced by therapist characteristics and environment Direct confrontation yields poorer compliance and outcomes
Assumptions in Working with Mandated Clients
The stick is enough. There is no need for a carrot.
Assumptions in Working with Mandated Clients Clients are either motivated or not. If they are not, there is little we can do.
Assumptions in Working with Mandated Clients People change only when they have to. The first and most important step in recovery is to admit and accept the fact that you have the disease of addiction.
Assumptions in Working with Mandated Clients Someone who continues to use is “in denial.” The best way to “break through” the denial is direct confrontation.
Four Principles of Motivational Interviewing 1.Express empathy 2.Develop discrepancy 3.Avoid argumentation 4.Support self-efficacy
1. Express Empathy Acceptance facilitates change Skillful reflective listening is fundamental Ambivalence is normal
2. Develop Discrepancy Awareness of consequences is important Discrepancy between behaviors and goals motivates change Have the client present reasons for change
3. Avoid Argumentation Resistance is signal to change strategies Labeling is unnecessary Shift perceptions Clients attitudes shaped by their words, not yours
4. Support Self-Efficacy Belief that change is possible isimportant motivator Client is responsible for choosing and carrying out actions to change There is hope in the range of alternative approaches available
MATRIX MODEL TREATMENT INFORMATION/EDUCATION
Triggers & Cravings
Trigger Definition A trigger is a stimulus which has been repeatedly associated with the preparation for, anticipation of or the use of drugs and/or alcohol. These stimuli include people, things, places, times of day, and emotional states.
Triggers and Cravings Pavlov’s Dog
Cognitive Process During Addiction Relief From Depression Anxiety Loneliness Insomnia Euphoria Increased Status Increased Energy Increased Sexual/Social Confidence Increased Work Output Increased Thinking Ability AOD Introductory Phase May Be Illegal May Be Expensive Hangover/Feeling Ill May Miss Work
Conditioning Process During Addiction Introductory Phase Triggers Parties Special Occasions Responses Pleasant Thoughts about AOD No Physiological Response Infrequent Use Strength of Conditioned Connection Mild
Development of Obsessive Thinking Introductory Phase Sports Food School TV Girlfriend Hobbies Job AOD Family Exercise Parties
Development of Craving Response Introductory Phase Entering Using Site Use of AODs AOD Effects Heart/Pulse Rate Respiration Adrenaline Energy Taste
Cognitive Process During Addiction Abuse Phase Depression Relief Confidence Boost Boredom Relief Sexual Enhancement Social Lubricant Vocational Disruption Relationship Concerns Financial Problems Beginnings of Physiological Dependence
Conditioning Process During Addiction Abuse 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
Development of Obsessive Thinking Abuse Phase AOD Food School TV Girlfriend Hobbies Job AOD Family Exercise Parties
Development of Craving Response Abuse Phase Entering Using Site Physiological Response Use of AODs AOD Effects Heart Rate Breathing Effects Adrenaline Effects Energy Taste Heart Blood Pressure Energy
Cognitive Process During Addiction Addiction Phase Social Currency Occasional Euphoria Relief From Lethargy Relief From Stress Nose Bleeds Infections Relationship Disruption Family Distress Impending Job Loss
Conditioning Process During Addiction Addiction 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
Development of Obsessive Thinking Addiction Phase AOD Food AOD TV Girlfriend AOD Job AOD Family AOD Parties
Development of Craving Response Addiction Phase Thinking of Using Mild Physiological Response Entering Using Site Heart Rate Breathing Rate Energy Adrenaline Effects Powerful Physiological Response Use of AODsAOD Effects Heart Rate Breathing Rate Energy Adrenaline Effects Heart Blood Pressure Energy
Cognitive Process During Addiction Severe Dependency Phase Relief From Fatigue Relief From Stress Relief From Depression Weight Loss Paranoia Loss of Family Seizures Severe Depression Unemployment Bankruptcy
Conditioning Process During Addiction Severe Dependency Phase Strength of Conditioned Connection Triggers Any Emotion Day Night Work Non-Work Responses Obsessive Thoughts About AOD Powerful Autonomic Response Powerful Physiological Dependence Automatic Use OVERPOWERING
Development of Obsessive Thinking Severe Dependency Phase AOD
Development of Craving Response Severe Dependency Phase Thoughts of AOD Using Place Powerful Physiological Response Heart Rate Breathing Rate Energy Adrenaline Effects
IMPLEMENTING MATRIX MODEL OUTPATIENT TREATMENT
MATRIX TREATMENT MODEL Different from Residential Treatment 1.Less confrontational 2.Progresses more slowly 3.Focus is on present 4.“Core Issues” not immediately addressed 5.Allegiance is to therapist (vs. group)
MATRIX TREATMENT MODEL Different from Residential Treatment 6.Nonjudgmental attitude is basis of client- therapist bond 7.Change recommendations based on scientific data 8.Changes incorporated immediately into lifestyle
MATRIX TREATMENT MODEL Different from General Therapy 1.Focus on behavior vs. feelings 2.Visit frequency results in strong transference 3.Transference is encouraged 4.Transference is utilized 5.Goal is stability (vs. emotional catharsis)
MATRIX TREATMENT MODEL Different from General Therapy 6.Focus is on abstinence 7.Bottom line is always continued abstinence 8.Therapist frequently pursues less motivated clients 9.The behavior is more important than the reason behind it
Treatment Components of the Matrix Model Individual Sessions Early Recovery Groups Relapse Prevention Groups Family Education Group 12-Step Meetings Social Support Groups Relapse Analysis Urine Testing MATRIX
MATRIX MODEL OF OUTPATIENT TREATMENT Organizing Principles of Matrix Treatment Create explicit structure and expectations Establish positive, collaborative relationship with patient Teach information and cognitive-behavioral concepts Positively reinforce positive behavior change
MATRIX MODEL OF OUTPATIENT TREATMENT Organizing Principles of Matrix Treatment (cont.) Provide corrective feedback when necessary Educate family regarding stimulant abuse recovery Introduce and encourage self-help participation Use urinalysis to monitor drug use
COMPONENTS OF THE MATRIX MODEL Groups 1. Early Recovery 2. Relapse Prevention 3. Family Education Lectures
COMPONENTS OF THE MATRIX MODEL Other o Social Support o Conjoint Sessions o Urine Testing o Relapse Analysis
EARLY RECOVERY GROUP Goals 1.To provide structured place for new patients to learn about recovery skills and self-help programs. 2.Introduce patients to basic tools of recovery. 3.To introduce outside involvement and create an expectation of participation as part of Matrix treatment.
EARLY RECOVERY GROUP Goals 4.Help patients adjust to participating in groups at Matrix and outside. 5.Allow the patient co-leader to provide a model for gaining initial abstinence. 6.Provide the patient co-leader with increased self-esteem and reinforce his or her progress.
EARLY RECOVERY GROUP Topics Scheduling and Calendars Triggers Questionnaires and Chart 12 Step Introduction Alcohol Issues Thoughts Emotions and Behaviors KISS (and other 12-step slogans)
RELAPSE PREVENTION GROUP Goals 1.To allow clients to interact with other people in recovery. 2.To present specific relapse prevention material. 3.To allow co-leader to share long term sobriety experience.
RELAPSE PREVENTION GROUP Goals (continued) 4.To produce some groups cohesion among clients 5.To allow group leader to witness interpersonal interaction of clients. 6.To allow clients to benefit from participating in a long-term group experience.
RELAPSE PREVENTION GROUP Sample Topics 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 Total Abstinence Sex and Recovery Trust Be Smart; Not Strong Defining Spirituality Relapse Justification Reducing Stress Managing Anger Compulsive Behaviors Repairing Relationships
MATRIX MODEL FAMILY INVOLVEMENT Family Education Family Support Groups Conjoint Sessions Encouraging Family to Get Assistance Encouraging Family to Support Sobriety
MATRIX MODEL SELF-HELP GROUPS Source of Support and Camaraderie Source of Spiritual Strength Source of New Activities and Friends Lifelong Support System Multiple Forms of 12-Step Groups Alternative to 12-Step Groups
MATRIX MODEL URINALYSIS AND BREATH TESTING Method for Monitoring Treatment Progress Treatment Accountability Assistance for Patient Reduce Arguments and Capriciousness Provides Data for Family or Employer