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MATRIX MODEL: THE FORMAT

MATRIX MODEL: THE FORMAT. MM PART 2. MATRIX MODEL OF OUTPATIENT TREATMENT. Organizing Principles of Matrix Treatment. Create explicit structure and expectations Establish positive, collaborative relationship with patient

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MATRIX MODEL: THE FORMAT

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  1. MATRIX MODEL: THE FORMAT MM PART 2 © 2006 Matrix Institute

  2. MATRIX MODEL OFOUTPATIENT 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 © 2006 Matrix Institute

  3. MATRIX MODEL OFOUTPATIENT 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 © 2006 Matrix Institute

  4. MATRIX TREATMENT MODELDifferent from General Therapy • Focus on behavior vs. feelings • Visit frequency results in strong transference • Transference is encouraged • Transference is utilized • Goal is stability (vs. emotional catharsis) © 2006 Matrix Institute

  5. MATRIX TREATMENT MODELDifferent 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

  6. MATRIX TREATMENT MODELDifferent from Residential Treatment • Less confrontational • Progresses more slowly • Focus is on present • “Core Issues” not immediately addressed • Allegiance is to therapist (vs. group) © 2006 Matrix Institute

  7. MATRIX TREATMENT MODELDifferent from Residential Treatment • Nonjudgmental attitude is basis of client-therapist bond • Change recommendations based on scientific data • Changes incorporated immediately into lifestyle © 2006 Matrix Institute

  8. Program Schedule A sample schedule for the Matrix IOP program is illustrated in the following table: © 2006 Matrix Institute

  9. MATRIX MODEL:THE PRACTICE © 2006 Matrix Institute

  10. MATRIX MODEL TREATMENTScheduling - Pitfalls • Scheduling unrealistically • Neglecting recreation • Being perfectionistic • Therapist imposing schedule • Spouse/parent imposing schedule © 2006 Matrix Institute

  11. 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 © 2006 Matrix Institute

  12. Admission Beginning Helping Checklist (Conjoint) Drugs, Alcohol and Sex Recovery Checklist Drug and Alcohol Dreams During Recovery Patient Status Review The Wall Checklist Middle Helping Checklist (Conjoint) Emotions and Recovery Post Treatment Evaluation and Phase II Plan COMPONENTS OF THE MATRIX MODELIndividual & Family Sessions (10) Optional Topic: Relapse Analysis Chart © 2006 Matrix Institute

  13. BEGINNING HELPING CHECKLIST • Helping Checklist for Family Members • Beginning Stage of Recovery • Indicate which of the following you are willing and/or able to do to help. Then check with the recovering person to see which of those items would be helpful to him or her: • ____ 1. I will allow you to talk to me about cravings and feelings of wanting to use or drink. • ____ 2. I will allow you to wake me during the night to talk when you cannot sleep. • ____ 3. I am willing to remind you of the reasons for stopping drug/alcohol use when you forget. • ____ 4. I will walk away from you if you abuse me. • ____ 5. I am willing to try to tolerate and accept withdrawal symptoms as a medical condition. • ____ 6. I will help you avoid triggers to use or drink. • ____ 7. I will remind myself that I am choosing to be here and to help. I know that I am not being coerced into staying. © 2006 Matrix Institute

  14. BEGINNING HELPING CHECKLIST ____ 8. I will decide with you whom to tell about this and when. ____ 9. I will try to remember that none of our other problems are as important right now as dealing with this addiction. ____10. I am willing to attend treatment sessions when I am invited. ____11. I will allow you to have activities and appointments that do not include me without being anxious. ____12. I am willing to practice talking about issues instead of ignoring them or arguing. ____13. I will encourage continuing treatment above all else. ____14. I will try to be angry at the addiction, not at you, the addicted person. ____15. Other © 2006 Matrix Institute

  15. CO-LEADER Reminders Every group must have a co-leader • Co-leaders help translate material into real life situations. • Co-leaders provide role models for people in early recovery. • Co-leaders can be more directly confrontational by using their own experience © 2006 Matrix Institute

  16. CO-LEADER Reminders Every group must have a co-leader (continued) • Co-leaders need to be clear about not giving advice or being “junior therapists.” • Co–leaders must be briefed prior to group and following group. • Recruitment for co-leaders begins at the start of each person’s treatment episode. © 2006 Matrix Institute

  17. Co-Leader Agreement • To Abstain from using illicit drugs or alcohol and from abusing prescription drugs. • To respect and to maintain client confidentiality with respect to information disclosed in groups. • To participate in regular pre-group and post-group meetings • To be on time for scheduled groups. If unable to attend I will call 24 hours in advance. • To avoid becoming involved socially, sexually or economically with clients. © 2006 Matrix Institute

  18. Co-Leader Agreement • To abide by the Matrix protocol for avoiding dual relationships with clients • To actively participate in some form of ongoing recovery support or treatment. I am entering this agreement on a strictly volunteer basis. There is no monetary remuneration. • That any departure from the above conditions will result in my termination from the co-leadership position. © 2006 Matrix Institute

  19. Group Rules • Meetings will start on time. If you will be late or absent, attempt to inform the group leader before group. • All information disclosed in group is confidential and should not be shared with any one outside of group. • There will be no cross talk, only one person speaking at a time. • Avoid telling what others in the group should or should not do, share from your own experience, i.e. “this is what I found to be helpful for me.” • I will respect differences of opinions and support other group members. • No drug or alcohol war stories will be allowed in group. No graphic descriptions of drug or alcohol use. • Sexual, romantic or business relationships between group members are strictly off limits. © 2006 Matrix Institute

  20. MATRIX MODEL TREATMENT Triggers - People • Drug-using friends/dealer • Voices of drug friends/dealer • Absence of significant other • Sexual partners in illicit sex • Groups discussing drug use © 2006 Matrix Institute

  21. MATRIX MODEL TREATMENT Triggers - Places • Drug dealer’s home • Bars and clubs • Drug use neighborhoods • Freeway offramps • Worksite • Street corners © 2006 Matrix Institute

  22. 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 © 2006 Matrix Institute

  23. 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 © 2006 Matrix Institute

  24. 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 © 2006 Matrix Institute

  25. Thought Stopping Trigger Thought Continued Thoughts Cravings Use MATRIX MODEL TREATMENT Key Concept: Thought Stopping • Prevents the thought from developing into an overpowering craving • Requires practice © 2006 Matrix Institute

  26. MATRIX MODEL TREATMENT Relapse Factors - Sexual Behavior • Concern about sexual dysfunction • Concern over sexual abstinence • Concern over sexual disinterest • Loss of intensity of sexual enjoyment • Shame/guilt about sexual behavior • Sexual arousal producing craving • Sexual behavior and intimacy • Sobriety and monogamy © 2006 Matrix Institute

  27. MATRIX MODEL TREATMENT Relapse Factors - Alcohol/Marijuana • Cortical disinhibition • Stimulant craving induction • Pharmacologic coping method • 12-Step philosophy conflict • Abstinence violation effect • Marijuana amotivational syndrome • Interferes with new behaviors © 2006 Matrix Institute

  28. MATRIX MODEL TREATMENT Relapse Factors - Time Periods • Unstructured time • Transition periods • Protracted abstinence • Holidays • Chronic stress, fatigue, or boredom • Anniversary dates • Periods of emotional turmoil © 2006 Matrix Institute

  29. MATRIX MODEL TREATMENT Relapse Factors - Addict Behavior • Lying/stealing • Having extramarital/illicit sex • Using secondary substances • Returning to bars/drug friends • Being unreliable/irresponsible • Behaving compulsively/impulsively • Isolating © 2006 Matrix Institute

  30. MATRIX MODEL TREATMENT Relapse Factors - Addict Thinking • Paranoia • Relapse justifications: • “I’m not an addict anymore” • “I’m testing myself” • “I need to work” • “Other drugs/alcohol are OK” • “Catastrophic events” • “Negative emotional states” © 2006 Matrix Institute

  31. Goals To provide structured place for new patients to learn about recovery skills and self-help programs. Introduce patients to basic tools of recovery. To introduce outside involvement and create an expectation of participation as part of Matrix treatment. EARLY RECOVERY GROUP © 2006 Matrix Institute

  32. Goals Help patients adjust to participating in groups at Matrix and outside. Allow the patient co-leader to provide a model for gaining initial abstinence. Provide the patient co-leader with increased self-esteem and reinforce his or her progress. EARLY RECOVERY GROUP © 2006 Matrix Institute

  33. Topics Scheduling and Calendars Triggers Questionnaires and Chart 12 Step Introduction Alcohol Issues Thoughts Emotions and Behaviors KISS (and other 12-step slogans) EARLY RECOVERY GROUP © 2006 Matrix Institute

  34. EARLY RECOVERY GROUP MOCK GROUP © 2006 Matrix Institute

  35. Goals To allow clients to interact with other people in recovery. To present specific relapse prevention material. To allow co-leader to share long term sobriety experience. RELAPSE PREVENTION GROUP © 2006 Matrix Institute

  36. RELAPSE PREVENTION GROUP Goals (continued) • To produce some groups cohesion among clients • To allow group leader to witness interpersonal interaction of clients. • To allow clients to benefit from participating in a long-term group experience. © 2006 Matrix Institute

  37. RELAPSE PREVENTION GROUP Reminders • Beginning and ending on time will demonstrate how important the therapist views being on time. • Paying attention to time allotted to each client and to keeping the group safe will make clients feel the therapist is in control and be less anxious. © 2006 Matrix Institute

  38. RELAPSE PREVENTION GROUP Reminders • Groups are organized around topics (unlike therapy groups). • Therapist has to control energy level of group; raise level of flat group, calm excessively high energy group. • Therapist should be aware of space and seating influences © 2006 Matrix Institute

  39. RELAPSE PREVENTION GROUP Reminders • Focus of the group needs to always be relapse prevention. • Unstable or new members may be asked to listen only. • Plan should exist for handling unexpected intoxicated client who shows up for group. © 2006 Matrix Institute

  40. 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 RELAPSE PREVENTION GROUP Sample Topics © 2006 Matrix Institute

  41. Family Education Group • Twelve topics: 3 discussion, 9 videos • Meet once per week • For both the client and family members to attend • Each topic has handouts to review and discuss • This is an important group which is often neglected • After completing the twelve weeks of Family Education group, clients can start attending the Social Support Group © 2006 Matrix Institute

  42. MATRIX MODEL TREATMENT Relapse Factors - Relationships • Addict must deal with family’s: • Extreme anger and blaming • Unwillingness to change/trust • Hypervigilance - excessive monitoring • Sexual anxieties • Adjustment to non-victim status • Conflict with recovery activities © 2006 Matrix Institute

  43. MATRIX MODELRELAPSE ANALYSIS • Session to be done when relapse occurs after a period of sobriety • Continued drug use is better addressed with Early Recovery topics • Relapse should be framed as learning experience for client • This exercise serves as basis for treatment plan adjustment © 2006 Matrix Institute

  44. Relapse Analysis Chart Name:________________________________________ Date of Relapse:___________________________ A relapse episode does not begin when drug/alcohol ingestion occurs. Frequently there are pre-use events that occur, which are indicative of the beginning of a relapse episode. Identifying your individual pre-use patterns will allow you to interrupt the relapse episode before the actual drug/alcohol use and to make adjustments to avoid the full relapse. Using the chart below, note events occurring during the week immediately preceding the relapse being analyzed. CAREER PERSONAL TREATMENT DRUG/ALCOHOL BEHAVIORAL RELAPSE HEALTH EVENTS EVENTS EVENTS RELATED PATTERNS COGNITIONS HABITS STATUS BEHAVIORS FEELINGS RELATIVE TO ABOVE EVENTS What changes do you need to make to prevent further AOD use? © 2006 Matrix Institute

  45. Aging Anger Co-dependency Commitment Compulsions Cravings Emotions Fear Friendships Guilty Honesty Intimacy Isolation Masks Overwhelmed Trust Social Support GroupsSample One Word Topics © 2006 Matrix Institute

  46. MATRIX MODELSELF-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 © 2006 Matrix Institute

  47. MATRIX MODELURINALYSIS AND BREATH TESTING Method for Monitoring Treatment Progress Treatment Accountability Assistance for Patient Reduce Arguments and Capriciousness Provides Data for Family or Employer (Be careful!) © 2006 Matrix Institute

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