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Matrix Model of Outpatient Treatment for Substance Dependence PowerPoint Presentation
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Matrix Model of Outpatient Treatment for Substance Dependence

Matrix Model of Outpatient Treatment for Substance Dependence

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Matrix Model of Outpatient Treatment for Substance Dependence

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  1. Matrix Model of OutpatientTreatment 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

  2. 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.

  3. Drugs Sedatives Stimulants Opioids Alcohol Medical Treatment Yes No Yes Yes Treatment Medical & Behavioral Behavioral Treatment Yes Yes Yes Yes

  4. www.drugabuse.gov

  5. Manuals in Psychosocial Treatment • Reduce therapist differences • Ensure uniform set of services • Can more easily be evaluated • Enhance training capabilities • Facilitate research to practice

  6. Matrix ModelAn Integrated, Empirically-based, Manualized Treatment Program

  7. What Research Tells Usabout Addiction People with drug and alcohol dependencies do not have unique personalities

  8. What Research Tells Usabout 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

  9. What Research Tells Usabout Treatment Patient drug use, compliance, and outcome are powerfully influenced by therapist characteristics and environment Direct confrontation yields poorer compliance and outcomes

  10. Assumptions in Working with Mandated Clients

  11. 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.

  12. 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.

  13. Motivational Goals • Increase Motivation • Decrease Resistance • Increase retention • Better outcomes

  14. Four Principles ofMotivational Interviewing 1. Express empathy 2. Develop discrepancy 3. Avoid argumentation 4. Support self-efficacy

  15. 1. Express Empathy Acceptance facilitates change Skillful reflective listening is fundamental Ambivalence is normal

  16. 2. Develop Discrepancy Awareness of consequences is important Discrepancy between behaviors and goals motivates change Have the client present reasons for change

  17. 3. Avoid Argumentation Resistance is signal to change strategies Labeling is unnecessary Shift perceptions Clients attitudes shaped by their words, not yours

  18. 4. Support Self-Efficacy Belief that change is possible is important motivator Client is responsible for choosing and carrying out actions to change There is hope in the range of alternative approaches available

  19. MATRIX MODEL TREATMENT INFORMATION/EDUCATION

  20. Triggers & Cravings

  21. 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.

  22. Triggers and Cravings Pavlov’s Dog

  23. Cognitive Process During Addiction IntroductoryPhase Relief From Depression Anxiety Loneliness Insomnia Euphoria Increased Status Increased Energy Increased Sexual/Social Confidence Increased Work Output Increased Thinking Ability May Be Illegal May Be Expensive Hangover/Feeling Ill May Miss Work AOD

  24. 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

  25. Food School Sports TV Hobbies Girlfriend Job AOD Family Parties Exercise Development of Obsessive ThinkingIntroductory Phase

  26. Development of Craving Response Introductory Phase EnteringUsing Site Use of AODs AOD Effects Heart/Pulse Rate Respiration Adrenaline Energy Taste

  27. Cognitive Process During Addiction Abuse Phase Vocational Disruption Relationship Concerns Financial Problems Beginnings of Physiological Dependence Depression Relief Confidence Boost Boredom Relief Sexual Enhancement Social Lubricant

  28. 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

  29. Development of Obsessive Thinking Abuse Phase Food School AOD TV Hobbies Girlfriend Job AOD Family Parties Exercise

  30. 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

  31. 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

  32. 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

  33. Development of Obsessive Thinking Addiction Phase Food AOD AOD TV AOD Girlfriend Job AOD Family Parties AOD

  34. 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 AODs AOD Effects  Heart Rate  Breathing Rate  Energy  Adrenaline Effects Heart Blood Pressure Energy

  35. 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

  36. Conditioning Process During Addiction Severe Dependency Phase 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

  37. AOD AOD AOD AOD AOD AOD AOD AOD AOD AOD AOD Development of Obsessive ThinkingSevere Dependency Phase

  38. Development of Craving Response Severe Dependency Phase Thoughts of AOD Using Place Powerful Physiological Response  Heart Rate  Breathing Rate  Energy  Adrenaline Effects

  39. IMPLEMENTINGMATRIX MODELOUTPATIENT TREATMENT

  40. 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)

  41. 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

  42. 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)

  43. 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

  44. 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

  45. 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

  46. COMPONENTS OF THE MATRIX MODELGroups • Early Recovery • Relapse Prevention • Family Education Lectures

  47. COMPONENTS OF THE MATRIX MODELOther • Social Support • Conjoint Sessions • Urine Testing • Relapse Analysis

  48. 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