The Matrix Model®

in the New Healthcare World:

Implementing EBPs
Ahndrea Weiner M.S., LMFT, LPCC
Director of Training
Matrix Institute on Addictions

© 2016 Matrix Institute on Addictions

 History of The Matrix Model

© 2016 Matrix Institute on Addictions

 Traveling Back to the 1980’s

© 2016 Matrix Institute on Addictions

 The Cocaine Epidemic

Development of The Matrix Model began in the 1980’s in

response to the cocaine epidemic

Credit: Wikimedia Commons

© 2016 Matrix Institute on Addictions

 Treatment in the Early 1980’s

● Drug Treatment was primarily for heroin users.

● “Treatment” was primarily medication (methadone).

● Alcohol treatment was usually 12-Step based and

insight-oriented.
● The 28-day program.
● Alcoholics were older with long histories.

© 2016 Matrix Institute on Addictions

 “Not Ready for Treatment”

Repeated Treatment Failures:

● They were “resistant,” “in
denial,” “not ready.”
● Treatment failure was their
fault.

● Cocaine users were ready for

treatment.
● The treatment system was not
ready for them.

© 2016 Matrix Institute on Addictions

 A New Kind of Addiction

● Cocaine users had brief histories of use in

contrast to alcohol users.
● There were periods of abstinence and
relapse.
● They weren’t in denial; they were confused.

© 2016 Matrix Institute on Addictions

 The Development of Matrix Model®
● Guided by research-based approaches.
● The utility of each session content was evaluated with
regard to:
● Relevance to the patient
● Clinical outcome
● “Keepers” were written down to use again
● Over time, shaped into a standard content, delivered in
a structured program, to all drug or alcohol users.

© 2016 Matrix Institute on Addictions

 NIDA’s List of Evidence-Based Practices (EBP’s)
for Addiction Treatment
1. Cognitive/Behavioral Therapy-CBT

1. Contingency Management-CM

1. Community Reinforcement Approach Plus

Vouchers

1. Motivational Enhancement Therapy

1. 12-Step Facilitation

1. Family Behavior Therapy

1. Matrix Model® of Outpatient Treatment

© 2016 Matrix Institute on Addictions

 The Matrix Model®
Empirically-Supported and
Recommended by NIDA*
● Multiple Weekly Sessions for at
least 120 days
● 3 visits per week minimum
● Family involvement important
● 12-step facilitation and participation
valuable
● Drug and breath alcohol testing
● Medications for some clients

© 2016 Matrix Institute on Addictions

 Evidence-Based Status
● Research was needed to indentify
an effective methamphetamine
treatment.
● CSAT-funded, multi-site study;
1998-2002.
● 978 Methamphetamine users
seeking treatment.
● Matrix Model vs Treatment as
Usual.
● Matrix Model had superior
treatment response.

© 2016 Matrix Institute on Addictions

 Matrix Model vs. Treatment As Usual -
Rawson et al., 2004, Addiction
● 978 Methamphetamine users seeking treatment
● CSAT multi-site study; 1998-2002
● Costa Mesa; San Diego; Hayward; Concord;
San Mateo; Billings; Honolulu
● Matrix Model® vs Treatment as Usual
● Random assignment

© 2016 Matrix Institute on Addictions

 Matrix Model® vs. Treatment As Usual
(Rawson et al., 2004, Addiction)

© 2016 Matrix Institute on Addictions

 Matrix Model vs. Treatment As Usual
(Rawson et al., 2004, Addiction)

© 2016 Matrix Institute on Addictions

 U.S. Surgeon General’s Report on Alcohol,
Drugs, and Health, 2016
“The Matrix Model is a structured, multi-component behavioral treatment
that consists of evidence- based practices, including relapse prevention,
family therapy, group therapy, drug education, and self-help, delivered in a
sequential and clinically coordinated manner. The model consists of 16 weeks
of group sessions held three times per week, which combine CBT, family
education, social support, individual counseling, and urine drug testing.

Several randomized controlled trials over the past 20 years have

demonstrated that the Matrix Model is effective at reducing substance
misuse and associated risky behaviors. For example, one study demonstrated
the model’s effectiveness in producing sustained reductions in sexual risk
behaviors among individuals who use methamphetamines, thus decreasing
their risk of getting or transmitting HIV. The Matrix Model has also been
adapted to focus more on relationships, parenting, body image, and sexuality
in order to improve women’s retention in treatment and facilitate recovery.”

© 2016 Matrix Institute on Addictions

 EVIDENCE BASED THERAPIES (EBP’S)
THAT ARE INCORPORATED IN THE MATRIX MODEL

Cognitive
Behavioral Matrix Motivational
Interviewing
Therapy Model

Contingency Family
Management Therapies

12-Step
Facilitation

© 2014 by Matrix Institute

 Organizing Principals
Structure Style (Spirt Of MI)
 Teach information and cognitive-  Nonjudgmental supportive
behavioral concepts attitude
 Positively reinforce positive  Engagement and retention
behavior change  Strong bond individual counselor
 Provide corrective feedback or group
when necessary  Former clients used as peer
 Introduce and encourage self- mentors (co-leaders)
help participation  Ability to work with relapse
 Use urinalysis or other methods  Meeting the client where they
to monitor drug use are at
 Establish positive, collaborative
relationship w/ clients
 Educate Family members
© 2014 by Matrix Institute
 Matrix Model
CBT Concepts
 Encouraging and reinforcing behavior change
 Recognizing and avoiding high risk settings
 Behavioral planning (scheduling)
 Coping skills
 Identifying conditioned “triggers”
 Understanding and dealing with craving
 Understanding basic psychopharmacology
principles
 Self-efficacy (MI Concept)
 Identifying distorted thinking (addictive thinking)
© 2014 by Matrix Institute
 Matrix Model
Spirit of Motivational Interviewing Concepts

 Client-centered approach
 Promotes autonomy
 Non-judgmental
 Client paced
 Avoids arguing or wrestling with resistance
 Meets the client where they are

© 2014 by Matrix Institute

 STAGES OF CHANGE : Prochaska &DiClemente

© 2014 by Matrix Institute

© 2014 by Matrix Institute
 Myth about Motivation
MYTH FACT
Punishment is the • There is no empirical
evidence to support the use
only way to really of excessive confrontation,
motivate long- pain or shame in order to
term change. make lifestyle changes.
* If they feel bad
• Shame, humiliation and
enough, they will
character assassination are
change.
not primary catalysts for
* People need to change. The individual
really suffer has to VALUE change
before they will intrinsically.
change.
© 2014 by Matrix Institute
 Not in the Spirit of Motivational Interviewing

 threats
 saying “Just do it because I said so.”
 persuading with logic
 arguing
 control
 shame and ridicule

It is important to learn how to respect the individual,

but at the same time, to set appropriate boundaries.
© 2014 by Matrix Institute
Basic Concepts of The Matrix Model®
● Treatment is based on research-proven
methods
● The “Spirit of MI” is used to meet the person
where they are in the stages of change
● CBT tools are used, based on Relapse
Prevention
● Contingency Management (incentives) are
encouraged

© 2016 Matrix Institute on Addictions

 Basic Concepts of The Matrix Model®
● Family involvement is an integral part of
treatment
● Drug testing is a clinical tool to provide
accountability and rewards, not punishment
● Peer support by using graduates as co-leaders
(peer mentors)
● On going continuing care

© 2016 Matrix Institute on Addictions

 Matrix Model® Manualized Treatment
(Hazelden Revised 2nd Edition)
Early Recovery Group Individual Sessions
Relapse Prevention Family Education Groups
Family/Conjoint Sessions Social Support
Medicated Assisted Treatment Random Drug/Alcohol Testing
Peer Mentors (Co-leaders)

Criminal Justice Matrix Teen Matrix

All the above and: All the above but:
Adjustment group Separate Teen Education &
Crimonigenic Mind Parent Education
ERS 3 times a week No MAT Section
Up to 52 week long program All Groups 1 hour
(except Parent Group)
© 2014 by Matrix Institute
 The Matrix Model Components

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 THERAPIST MANUAL
 Importance of the Therapist Manual
 How to Use the Manual
 Value of the Therapist Manual for the counselor

© 2014 by Matrix Institute

 Components of the Matrix Model®
● Individual Sessions
● Early Recovery Groups
● Relapse Prevention Groups
● Family Education Group
● 12-Step Meetings
● Social Support Groups
● Relapse Analysis (One on One Sessions)
● Drug Testing

© 2016 Matrix Institute on Addictions

 Program Schedule
A sample schedule for the Matrix IOP program:
INTENSIVE OUTPATIENT PROGRAM SCHEDULE

Week Monday Tues. Wed. Thurs. Friday Saturday

& Sunday

Weeks 6-7 PM 12-step 7-8:30 PM 12-step 6-7 PM 12-Step/

1 Early Meeting Family Meeting Early Spiritual
Through Recovery Education Recovery Meetings
4 Skills Group Skills and Other
7-8:30 PM 7-8:30 PM Recovery
Relapse Relapse Activities
Prevention Prevention

Weeks 7-8:30 PM 7-8:30 PM 7-8:30 PM

5 Relapse Family Relapse
Through Prevention Education Prevention
16 Group Group Group
or
Social
Support

Weeks 7-8:30 PM
17 Social
Through Support
52
Urine testing and breath-alcohol testing conducted weekly
Ten individual sessions during the first 16 weeks

© 2014 by Matrix Institute

 DISCUSSION AND EDUCATION ON THE BRAIN MODEL
TRIGGERS AND CRAVINGS & ROADMAP TO RECOVERY

• Back bone of the Matrix Model

• Represent 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 model
and integrating it into their recovery

© 2014 by Matrix Institute

 movement sensation

judgment

vision

reward

memory

coordination
pain

© 2014 by Matrix Institute

 STAGES OF RECOVERY
OVERVIEW

DAY
DAY DAY DAY DAY
180
0 15 45 120

© 2014 Matrix Institute

© 2014 by Matrix Institute
 Early Recovery Groups
● Generally conducted twice a week for the first month of
treatment
● Smaller groups accommodate individual scheduling and basic
concept development
● Group revolves around topics in the patient manual.
● Client learning recovery tools then practicing outside of the
clinic
● Group is didactic rather than a “process” group. The group
leader is educating, gathering information and teaching
recovery tools. The focus is on the “here and now”

© 2016 Matrix Institute on Addictions

 Early Recovery Groups
● Can be co-lead by clients
who are later in recovery and
doing well
● Can be used to stabilize
relapsing patients who are
later in treatment

© 2016 Matrix Institute on Addictions

 Relapse Prevention Groups
● Primary group in the
treatment model
● Last for 2 to 4 months -
manuals have content for four
months.
● Group revolves around topics
in the patient manual.
● Not run like a “process” group

© 2016 Matrix Institute on Addictions

 Relapse Prevention Groups
● To present specific relapse
prevention material.
● To allow co-leader to share long
term sobriety experience.
● To produce group cohesion
among clients
● Clients to benefit from
participating in a long-term
group experience.

© 2016 Matrix Institute on Addictions

 RELAPSE PREVENTION GROUP
Sample Topics
 Alcohol -The Legal Drug  Total Abstinence
 Boredom  Sex and Recovery
 Avoiding Relapse  Trust
Drift/Mooring Lines  Be Smart; Not Strong
 Guilt and Shame  Defining Spirituality
 Motivation for Recovery  Relapse Justification
 Truthfulness  Reducing Stress
 Work and Recovery  Managing Anger
 Staying Busy  Compulsive Behaviors
 Relapse Prevention  Repairing Relationships
 Dealing with Feelings
© 2014 by Matrix Institute
 Family Education Groups

● Family Education most flexible part of the Matrix Model

● Encouraged to use relevant materials to meet the needs
of the client, family and community as a whole.
● Focus on education, not a therapy group
● Families, significant others, or AA/NA sponsor may attend
● Great to have families attend, but important for patients
to attend, whether their families attend or not.
© 2016 Matrix Institute on Addictions
 Family Education Groups

● The three lectures that are critical to understanding the

entire Model of treatment are:
● Triggers and Cravings
● Roadmap for Recovery
● Families in Recovery

© 2016 Matrix Institute on Addictions

 Social Support Groups

● Co-lead lead by graduates of the program with some

supervision from clinical staff
● Usually graduated patients can come in and out of these
meetings on an “as needed” basis except in the first
month.
● This serves as an unofficial “alumni support group” for
patients. On going continuing care

© 2016 Matrix Institute on Addictions

 Relapse Analysis

● Developed to assess relapses for those who have had a

period of sobriety, with relapses on a regular periodic
basis
● Should serve as an individual session when indicated

© 2016 Matrix Institute on Addictions

 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.

Personal Treatment Drug/Alcohol Behavioral Relapse Health

Career Events Events Events Related Patters Cognitions Habits/Status

Feelings Relative to Above Events

What changes do you need to make to prevent further AOD use?

© 2014 by Matrix Institute
 Drug Testing
• Both urine and breath-alcohol testing

• Weekly testing on a random schedule

• Positive results require increased

structure in program

• Testing is done for clinical reasons (see

Therapist Guide) rather than punitive.

• Not a substitute for forensic testing

© 2016 Matrix Institute on Addictions
 Implementation of the Matrix Model®

Trainers and Key Supervisors are Central to Matrix Model®

Dissemination
● Trainers and Key Supervisors serve very different
functions and have very different qualifications
● Qualities that make a great trainer are not the same as
those that make a good supervisor and change agent

© 2016 Matrix Institute on Addictions

 Implementation of the Matrix Model®:
Training
● Matrix trainers are people who have
extensive experience using the model and
adapting it to various populations and
situations
● They are people who have excellent training
skills and extensive training experience
● Matrix does not employ a train-the-trainer
model for delivering training, but use select
experienced trainers who we update
regularly with materials
© 2016 Matrix Institute on Addictions
Implementation of the Matrix Model®:
Matrix Key Supervisors
● They are responsible for assuring fidelity to
the model.
● No program can be certified without a Key
Supervisor on staff
● Key supervisors also have the responsibility
for training new staff at their site.
● Change Agent

© 2016 Matrix Institute on Addictions

 Characteristics of an Ideal
Key Supervisor
● Respected clinical leader who is both
credible to clinicians and savvy about
organizational dynamics
● Possess excellent communication and
clinical skills
● Is committed to actively working to
implement the Matrix Model® with fidelity
and good results

© 2016 Matrix Institute on Addictions

 THERAPIST COMPETENCY
Matrix Model
First 6 months Requires much support, guidance, structure, modelling,
practice & feedback with regards to the model

Confident of skills but occasionally overwhelmed by

6-12 months complexity/difficulty of AOD work; supervision may
focus on feelings & coping with impediments

Assured in Matrix skills; supervision largely an

1—2 Years exploratory exchange of ideas for further development

2 Years + Functions autonomously and knows his/her limits; will

largely set the supervision agenda to increase self-
reflective practice

© 2014 by Matrix Institute

 Fidelity Monitoring Instruments
Structural Elements
Minute by Minute Elements

© 2016 Matrix Institute on Addictions

 Fidelity Monitoring
● Able to explain rationale for strategies and
interventions
● Able to demonstrate and instruct on delivery
of the Matrix Model® using Motivational
Interviewing techniques
● Employs Motivational Interviewing during
the course of supervision

© 2016 Matrix Institute on Addictions

 FIDELITY INSTRUMENTS

© 2014 by Matrix Institute

 Fidelity Monitoring: Certification
Matrix Model Certification

The Matrix Model Certification

process is designed to identify
those treatment programs that
are implementing the Model with
fidelity.

© 2016 Matrix Institute on Addictions

 Summary
● The Matrix Model is an evidence-based intensive
outpatient treatment for addiction.
● Can be used with for all Substance Use Disorders
● Has been modified for residential treatment as well
● Can be adapted to fit your needs
● Training in the Matrix Model consists of
● 2-Day Basic Training
● Key Supervisor Training

© 2016 Matrix Institute on Addictions

 AHNDREA WEINER M.S., LMFT, LPCC
Director of Training & Clinical Supervisor

Matrix Institute on Addictions

310-478-6006
www.matrixinstitute.org
For Training:
[email protected]
877-422-2353
© 2016 Matrix Institute on Addictions