1. Matrix Institute on Addictions,
STAGES OF RECOVERY
Drug Court Conference
Normal, OK. September, 2014
Matrix Institute on Addictions,
Sam Minsky, MA, LMFT

2. THE STAGES OF RECOVERY
A ROADMAP
© 2006 Matrix Institute

3. Early Abstinence/Honeymoon Adjustment/Resolution
Roadmap for Recovery
Withdrawal
Early Abstinence/Honeymoon
Protracted Abstinence/The Wall
Adjustment/Resolution
Slide 2
Stages to be discussed:
Withdrawal
Early Abstinence/Honeymoon
Protracted Abstinence/The Wall
Adjustment/Resolution

4. STAGES OF RECOVERY OVERVIEW Honeymoon The Wall Adjustment Withdrawal
DAY
180
DAY
DAY 15
DAY 45
DAY
120
These stages are most pertinent for stimulant users but when discussed in group all clients can subjectively relate to the stages of recovery.
Honeymoon
The Wall
Adjustment
Withdrawal
Resolution
© 2006 Matrix Institute

5. Stages of Recovery - Stimulants
WITHDRAWAL STAGE
DAY
DAY 15
Some of the issues that may lead to client termination or dropout during the Withdrawal stage.
Medical Problems
Alcohol Withdrawal
Depression
Difficulty Concentrating
Severe Cravings
PROBLEMS
ENCOUNTERED
Contact with Stimuli
Excessive Sleep
© 2006 Matrix Institute

6. MATRIX MODEL TREATMENT
Primary Manifestation of
Withdrawal Stage
Behavioral
Cognitive
Confusion
Inability to
Concentrate
Behavioral
Inconsistency
Emotional
Relationship
Depression/Anxiety-
Self-Doubt
Mutual Hostility-
Fear

7. MATRIX MODEL TREATMENT Relapse Factors - Withdrawal Stage
Unstructured time
Proximity of triggers
Alcohol/marijuana use
Powerful cravings
Paranoia
Depression
Disordered sleep patterns
Relapse factors during the withdrawal stage - During withdrawal, patients are disoriented, depressed, fatigued, and feel very much out of control. They do not understand what is happening to them, and require very explicit direction during this period. During this stage, drug and alcohol triggers, thoughts, and cravings may be prevalent. A depleted neurochemistry translates into irritability, depression and disordered sleep.
© 2006 Matrix Institute

8. Stages of Recovery - Stimulants
HONEYMOON STAGE
DAY 15
DAY 45
Also known as the “Pink Cloud”. Feels relatively good to the clients especially when compared to how they felt during the Wall but still rife with clinical challenges. Many feel cured.
Over-involvement With Work
Overconfidence
Inability to Initiate Change
Inability to Prioritize
Alcohol Use
Episodic Cravings
Treatment Termination
PROBLEMS
ENCOUNTERED
© 2006 Matrix Institute

9. Primary Manifestation of Inability to Prioritize
MATRIX MODEL
Primary Manifestation of
Honeymoon Stage
Behavioral
Cognitive
High Energy-
Unfocused Behavior
Inability to Prioritize
Emotional
Relationship
Overconfidence/
Feeling Cured
Denial of
Addiction Disorder

10. MATRIX MODEL Primary Manifestation of the Wall Stage Behavioral
Cognitive
Sluggish
Low Energy/Inertia
Relapse Justification
Emotional
Relationship
Depression/Anhedonia
Irritability/
Mutual Blaming/Impatience

11. MATRIX MODEL TREATMENT Relapse Factors - Honeymoon Stage
Overconfidence
Secondary alcohol or other drug use
Discontinuation of structure
Resistance to behavior change
Return to a chemical influenced lifestyle
Inability to prioritize
Periodic paranoia
Slide 21
Relapse factors during the Honeymoon Stage - During this stage, the patient’s mood typically improves, energy increases, cravings diminish, confidence and optimism increase; and, it may feel as if the problem with chemical substances is over. This stage is also popularly known as the pink cloud stage. Many patients become over-involved with work to the point of workaholism. An inability to prioritize may be a problem during this period. One of the most important treatment activities during this stage involves channeling, in some order of importance, the honeymoon energy toward specific recovery tasks. It is critical that patients recognize that this period is temporary. They need to use the energy available during this period to put together a solid structure of activities and build momentum that will carry through subsequent recovery stages.
© 2006 Matrix Institute

12. Stages of Recovery - Stimulants
THE WALL
DAY 45
DAY
120
Inertia
Depression
Return to Cocaine Stimuli
Relapse Justification
Cognitive Rehearsal
Treatment Termination
Alcohol Use
Relapse
The main event of the recovery process particularly when the DOC is a stimulant.
PROBLEMS
ENCOUNTERED
© 2006 Matrix Institute

13. “The Wall” One Patient’s Account Physical Symptoms:
“Lack of energy was almost constant even if I slept for hours. Lack of memory, inability to concentrate and a grey film over my vision clouded my world. My sleep became mixed-up. I would be dead tired during the day and experience insomnia at night.”
© 2006 Matrix Institute

14. “The Wall” One Patient’s Account Apathy:
“Throughout The Wall I didn’t care about anything or anybody. Including myself. Nothing seemed important, nothing felt good. Boredom and hopelessness were constant companions. I felt the whole thing would never end.”
© 2006 Matrix Institute

15. “The Wall” One Patient’s Account Loneliness and Isolation:
“More than anything I felt alone. I felt like I was the only person in the world who knew how I felt. Even my therapist and my C.A group didn’t understand. I went to meetings and often still felt alone.”
© 2006 Matrix Institute

16. Some handout samples.
© 2006 Matrix Institute

17. THE BENEFITS OF EXERCISE
Aerobic/Cardio seems to be the best for reducing or in some cases eliminating Post Acute Withdrawal Syndrome (Wall)
20 or more minutes a day
Increase respiration
Increase pulse rate
Light sweat
Increases endorphin production which may help stabilize neurotransmitter regulation

18. Adjustment/Resolution Stage
Stages of Recovery - Stimulants
Adjustment/Resolution Stage
DAY
120
DAY
180
In an outpatient Tx model it is better to address more “psychodynamic” issues after a base of at least some abstinence has been established. Sometimes well intentioned clinicians can hasten client dropout or relapse by charging prematurely into deeper issues. The clients do not have adequate coping mechanisms in place and may resort back to using after leaving the clinic if the groups have unleashed too much emotionality. The MM philosophy posits that if these issues can be placed on the back burner or dealt with more in the individual sessions the clients will benefit more from treatment. The groups in the MM are primarily skill building groups.
Anger
Guilt
Isolation
Boredom
PROBLEMS
ENCOUNTERED
Vocational Dissatisfaction
Relationship Problems
Overconfidence
Lack of Goals
Underlying Psychopathology
resurfaces
© 2006 Matrix Institute

19. Primary Manifestation of Commitment to Recovery
MATRIX MODEL
Primary Manifestation of
Adjustment Stage
Behavioral
Cognitive
Sloppiness
Regarding Limits
Drifting From
Commitment to Recovery
Emotional
Relationship
Experiencing
Normal Emotions
Surfacing of
Long-Term Issues

20. Stages of Recovery Relapse Factors - Adjustment Stage
Secondary alcohol or other drug use
Relaxation of structure
Struggle over acceptance of addiction
Maintenance of recovery momentum/commitment
I feel cured syndrome
Re-emergence of underlying pathology
Relapse factors during the Adjustment/Resolution stage - Some of the problems associated with stage are as follows. Recovering patients often have an implicit feeling of being “cured”, which translates into resuming drug and alcohol use, relaxation of structure, and discontinuation of recovery activities or behaviors (post treatment syndrome), therefore relapsing. Other relapse factors are drifting back to using friends, secondary drug and/or alcohol use, compulsive behaviors, neglecting recovery activities or exercise, not dealing with emotional issues, and losing the momentum of recovery. Other problems are related to the acceptance of the addiction and the possible re-emergence of underlying pathology. Material from individual psychotherapy or relationship issues may emerge requiring additional attention.
A. Preventing relapse requires the use of some self-monitoring skills, which will provide warning signals if a person begins to move towards relapse.
B. Underlying issues need to be addressed in a counseling or psychotherapeutic setting.
C. Ongoing participation in self-help programs and treatment support groups are vitally important in maintaining long-term sobriety.
© 2006 Matrix Institute

21. Traditional View of Psychotherapy for Substance Abuse
Until 1960 psychodynamic oriented psychotherapy was the primary professional approach to substance abuse treatment.
Assumed that substance abuse behavior was a manifestation of underlying psychopathology.
If resolution of underlying psychopathology could be achieved, substance abuse would be lessened.

22. MATRIX MODEL DIFFERENCES
General Psychotherapy
Matrix Model
Focus on feelings
Emotional catharsis as a means to gain sobriety
Addiction or abstinence may or may not be discussed
Unmotivated clients are not pursued
Behavioral focus a priority
CBT as a means to laying foundation for recovery
Abstinence is highlighted and tools are discussed
Ambivalent or unmotivated clients are accepted and the norm
© 2006 Matrix Institute

23. MATRIX TREATMENT MODEL Different from General Therapy
Focus on behavior vs. feelings
Visit frequency results in strong bonding with the counselor and the group
This bonding encouraged and utilized
Goal is stability (vs. emotional catharsis)
© 2006 Matrix Institute

24. MATRIX TREATMENT MODEL Different 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
© 2006 Matrix Institute

25. MANUALIZED TREATMENT The Matrix Model
Reduces therapist differences
Ensures uniform set of services
Enhances training capabilities
Facilitates research to practice
Can be more easily evaluated
MATRIX
The benefits of using manualized formats in the psychosocial treatment of drugs and alcohol.
© 2006 Matrix Institute

26. EVIDENCE BASED THERAPIES (EBT’S) THAT ARE INCORPORATED IN THE MATRIX MODEL
Cognitive Behavioral Therapy
Motivational Interviewing
Contingency Management
12- Step Facilitation
Community Participation
Family Therapies
© 2006 Matrix Institute

27. INTENSIVE OUTPATIENT PROGRAM SCHEDULE
A sample schedule for the Matrix IOP program is illustrated in
the following table:
INTENSIVE OUTPATIENT PROGRAM SCHEDULE
Week
Monday
Tues.
Wed.
Thurs.
Friday
Saturday
& Sunday
Weeks 1
Through 4
6-7 PM
Early
Recovery
Skills
7-8:30 PM
Relapse
Prevention
12-step
Meeting
Or other community participation
Family
Education
Group
12-Step/
Spiritual
Meetings
and Other
Activities 5 16 or
Social
Support 17 52
Urine testing and breath-alcohol testing conducted weekly
Ten individual sessions during the first 16 weeks
© 2006 Matrix Institute

28. MATRIX MODEL Organizing Principals
STRUCTURE
Create explicit structure and expectations
Establish positive, collaborative relationship w/ clients
Teach information and cognitive-behavioral concepts
Positively reinforce positive behavior change
Provide corrective feedback when necessary
Educate family regarding substance abuse recovery
Introduce and encourage self-help participation
Use urinalysis to monitor drug use
© 2006 Matrix Institute

29. MATRIX MODEL Organizing Principals
STYLE
Nonjudgmental, supportive attitude
Engagement & Retention
Strong bond with individual counselor or group
Minimal use of confrontation
Use of recovering role models in group
Ability to work with relapse

30. COGNITIVE BEHAVIORAL THERAPY
Key Concepts
Encouraging and reinforcing behavior change
Recognizing and avoiding high risk settings
Behavioral planning (scheduling)
Coping skills
Conditioned “triggers”
Understanding and dealing with craving
Understanding basic psychopharmacology principles
Self-efficacy (MI Concept)
© 2006 Matrix Institute

31. TRIGGERS AND CRAVINGS & ROADMAP TO RECOVERY
Foundation of the Matrix Model & are 2 of the FAM ED topics
Material needs to be learned by the counselor so they can teach it to the clients.
Information is woven through all the topics
Clients will begin speaking the language of the model and integrating it into their recovery
Brain Chemistry and Functioning
Classical Conditioning & Cognitive Behavior Therapy
Stages of Recovery