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Journal of Psychoactive Drugs

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The Matrix Model of Outpatient Stimulant Abuse

Treatment: History and Description
a b a b b c
Jeanne L. Obert , Michael J. McCann , Patricia Marinelli-Casey , Ahndrea Weiner
b a b d b
, Sam Minsky , Paul Brethen & Richard Rawson
a
Matrix Institute on Addictions, Los Angeles
b
CSAT Methamphetamine Treatment Project
c
Matrix Institute on Addictions, San Fernando Valley, California
d
Matrix Institute on Addictions, Rancho Cucamonga, California

To cite this article: Jeanne L. Obert , Michael J. McCann , Patricia Marinelli-Casey , Ahndrea Weiner , Sam Minsky , Paul
Brethen & Richard Rawson (2000): The Matrix Model of Outpatient Stimulant Abuse Treatment: History and Description,
Journal of Psychoactive Drugs, 32:2, 157-164

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 The Matrix Model of Outpatient
Stimulant Abuse Treatment:
History and Description?

Jeanne L. Obert, M.F.T., M.S.M.*; Michael J. McCann, M.A.**;

Patricia Marinelli-Casey, Ph.D.***; Ahndrea Weiner, M.S.*** *;
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Sam Minsky, M.A.*****; Paul Brethen, M.A.****** & Richard Rawson, Ph.D.*******

Abstract-The Matrix model was originally developed in response to the cocaine epidemic of the
1980s. The program consists of relapse prevention groups, education groups, social support groups,
individual counseling, and urine and breath testing delivered in a structured manner over a 16-week
period. The treatment is a directive, nonconfrontational approach which focuses on current issues
and behavior change. Several evaluations of the model have supported its usefulness and efficacy
with methamphetamine (MA) users. Methamphetamine users appear to respond to treatment similarly
to cocaine users and many continue to show improvements at follow-up.

Keywords-addiction, methamphetamine, outcome, treatment

The cocaine epidemic, as it first appeared in the United for private, primarily alcoholic patients in the traditional
States in the early 1980s, emerged as a problem impacting 28-day hospital programs and in the offices of mental health
middle-class Americans and the private treatment system. professionals were ineffective for these stimulant abusers.
The influx of these patients into the private treatment sys- Traditional inpatient treatment was not medically neces-
tem contrasted sharply with the waves of public sector sary and traditional outpatient psychotherapy was neither
patients swept into community-based, drug-free counseling effective nor relevant.
clinics and methadone treatment programs by earlier drug The Matrix model was one of the integrated outpatient
epidemics. Treatment interventions that were appropriate substance abuse treatment programs that developed in
response to these new patients. These programs sought to
?This research was supported by grants # TI 11440-01, TI 11427-
01, TI 11425-01, TI 11443-01, TI 11484-01,TI 11441-01,TI 11410-01, ****Clinical Director, Matrix Institute on Addictions, San Fernando
and TI 11411-01 from the Center for Substance Abuse Treatment, Valley, California; Clinical Trainer, CSAT Methamphetamine Treatment
Substance Abuse and Mental Health Services Administration, U.S. Project.
Department of Health and Human Services. Center for Substance Abuse *****Clinical Research Trainer, Matrix Institute on Addictions, Los
Treatment. Contents are solely the responsibility of the authors and do Angeles; Clinical Trainer, CSAT Methamphetamine Treatment Project.
not necessarily represent the official views of the Center for Substance ******Administrative Director, Matrix Institute on Addictions,
Abuse Treatment. Rancho Cucamonga, California.
*Executive Director, Matrix Institute on Addictions, Los Angeles; ********Associate Director, UCLA Integrated Substance Abuse
Director of Clinical Training, CSAT Methamphetamine Treatment Project. Programs; Co-Prinicipal Investigator, CSAT Methamphetamine Treatment
**Director of Research, Matrix Institute on Addictions, Los Angeles; Project.
Principal Investigator, Costa Mesa Site, CSAT Methamphetamine Please address correspondence and reprint requests to Jeanne L.
Treatment Project. Obert, M.F.T., M.S.M., the Matrix Institute on Addictions, 12304 Santa
***Project Director, CSAT Methamphetamine Treatment Project. Monica Blvd., Suite 200, Los Angeles, California 90025.

Journal of Psychoactive Drugs Volume 32 (2), April -June 2000

 Obert et al. The Matrix Model of Outpatient Stimulant Abuse Treatment

incorporate materials from numerous disciplines into treat- skill to be learned not just for present use but also for
ment protocols that addressed the specific needs of stimulant future use during stressful or dangerous periods.
abusers in outpatient treatment settings.
The developers of the Matrix model were committed Information
to using empirically-based findings as the basis for choos- Methamphetamine users often enter treatment feeling
ing which interventions would be incorporated into the and acting very paranoid and sometimes psychotic. They
treatment model. In addition, treatment approaches were do not associate these feelings or the feelings of anger,
evaluated with regard to practical utility as opposed to theo- impulsivity, hostility, sexual compulsivity or cognitive
retical or ideological considerations. impairment with their drug use. The overwhelming condi-
tioned cravings that develop from methamphetamine abuse
ELEMENTS OF EFFECTIVE result in patients feeling completely out of control of the
OUTPATIENT TREATMENT situation and of their lives. They are frightened, defensive
and often deeply ashamed. The intervention that can pro-
Engagement and Retention vide the most immediate relief from all of the above is the
The relationship between the patient and the therapist imparting of information. Initially that process needs to
is central to the success of therapy. One cannot success- occur in short, simple sentences. During the first few days
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fully treat drug users on an outpatient basis if they cease and weeks of MA abstinence, more comprehensive expla-
coming into the clinic. Therapists are trained to conduct nations cannot be tolerated or understood. As the drug's
treatment sessions in a way that promotes the patient's self- effects begin to diminish, patients can benefit from more
esteem, dignity, and self-worth. Establishing and complicated and detailed explanations of how the addic-
maintaining a positive relationship in a model that relies tion may have occurred and what effects the drug might
primarily on a group therapy modality requires skill and have had. The Matrix model has standard psychoeducational
therapeutic sophistication. Therapists who are recovering lectures that explain those processes in terms that patients
themselves andlor who rely primarily on their own inpatient and their families can understand.
or residential recovery experiences need training to be able
to create a truly nonjudgmental, nurturing recovery rela- Relapse Prevention
tionship. Maintaining a professional, supportive attitude in Originally developed by Alan Marlatt and Thomas
the face of a relapsing patient is not an easy job but it is Gordon (1985) relapse prevention techniques teach patients
essential to delivering effective outpatient treatment. In the to recognize high-risk situations for substance use, to imple-
Matrix treatment model the therapist functions simulta- ment coping strategies when confronted with high-risk
neously as teacher and coach, fostering a positive, events, and to apply strategies to prevent a full-blown
encouraging relationship with the patient and using that relapse should an episode of substance use occur. This
relationship to reinforce positive behavior change. The approach also allows staff and patients to identify and
interaction between the therapist and the patient is realistic react to signs of impending relapse. Recovering co-
and direct but not confrontational or parental. leaders and group members who are doing well can share
their experiences with those patients who are struggling
Structure with relapse issues.
Time planning and scheduling during early recovery
serve several purposes. In addition to eliminating blocks of Family Involvement
free time and helping patients stay busy, the process of Family systems research indicates that if you have not
scheduling also allows patients to evaluate activities for their engaged the system and do not have it working with you,
relapse potential prior to engaging in them. When the sched- it will work against you (Kaufman 1994). The involve-
uling activity is done in group, it allows the therapist to see ment and attitudes of the patient's significant friends and
what life outside the therapy office is like for any individual family members will either enhance or interfere with the
patient and whether the chosen activities create a safe and therapeutic effort. The more family members understand
balanced lifestyle at any given point in the recovery pro- the processes of addiction and of recovery, the more real-
cess. Patients are asked to record on a schedule card or sheet istic their attitudes and expectations will become. Engaging
of paper exactly what they plan to do for each portion of significant others in the treatment process is often diffi-
the next day. Simplified schedules can be used in instances cult. Patients rarely see the benefit of such involvement
where the skill of scheduling is new and unfamiliar. and will often sabotage any efforts in that direction. Fam-
Patients should not be asked to schedule more than two or ily members are often angry and tired of struggling with
three days at a time and therapists should follow up with the addiction. They are either relieved to feel that the prob-
those learning the skill to see whether they were able to lem now belongs to the therapist and they no longer have
follow the plan. This exercise needs to be presented as a to be involved or they fear that the addict will outsmart the

Journal of Psychoactive Drugs Volume 32 (2). April - June 2001

 Obert et al. The Matrix Model of Outpatient Stimulant Abuse Treatment

therapist and so make every effort to prevent that by patient attended the clinic three to four times each week.
attempting to control the recovery process. Either of these Those visits consisted of 56 individual sessions (including
extremes will result in a diminished prognosis for a long- conjoint sessions with family members), a weekly relapse
term recovery. The therapist who is able to engage the prevention group, a weekly family education group, drug
family in the appropriate parts of the program while main- and alcohol testing, and family groups for family mem-
taining rapport with the patient will earn and maintain the bers. The cocaine-specific treatment manual was followed
family's trust and optimize the chance of a successful by compatible versions for primary alcohol and opiate
recovery. users (Rawson, Obert & McCann 1995; Rawson et al. 1992;
Rawson et al. 1991a). Due to compelling economic pres-
Self Help Involvement sures to shorten the intensive phase of treatment, the
In actual practice, the reality is that professional treat- treatment protocol was revised to a program of 16 weeks
ment is time limited. AA meetings are widely available, duration with increased group sessions, decreased indi-
are free of charge, and provide a place where recovering vidual sessions and no family groups (although the family
people can meet others who are dealing with many of the education group was retained as a central component). The
same issues. It makes sense for patients to use the meet- schedule of the 16-week program is delineated in Figure 1.
ings as an ongoing resource if they find them beneficial. This treatment model is presently being evaluated in a na-
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Treatment providers who encourage patients to access this tional, collaborative, multisite clinical trial by the Center
resource and who provide interventions that may serve to for SubstanceAbuse Treatment (as described in this issue).
make the meetings more palatable are doing patients a ser-
vice. The Matrix model subscribes to this approach, and Individual Sessions
the protocols include topics designed to familiarize patients The individual sessions were once the primary treat-
with this resource. ment component of the Matrix model. While they are now
limited to three full 45-minute sessions in a 16-week treat-
Urinalysis/Breath Testing ment episode, they remain critical to the development of
Random urine testing conducted weekly is an impor- the crucial relationship between the patient and the thera-
tant part of the structure in any outpatient treatment pist. The content of the individual sessions is primarily
program. The issue of whether or not the therapist trusts concerned with setting and checking on the progress of the
the patient is irrelevant here. Trusting that relapse won't or patient's individual goals. These sessions can be combined
couldn't happen is being nai've about the realities of drug with conjoint sessions, including significant others in the
abuse treatment. It is not unusual for patients to have diffi- treatment planning. Extra sessions are sometimes neces-
culty being forthright about slips and relapses even though sary during times of crisis to change the treatment plan.
there are no punitive responses to positive tests in this These individual sessions are the glue that ensures the con-
model. The addition of urine testing provides the therapist, tinuity of the primary treatment dyad and, thereby, retention
family members and the patient with tangible proof that of the patient in the treatment process.
relapse has not occurred. Positive tests should be viewed
as indicators that the treatment plan needs adjusting, rather Early Recovery Groups
than serving as proof of treatment failure. Referral sources, With the elimination of some of the individual ses-
family members, and patients entering treatment need to sions from the treatment protocol, there was a need for early
be educated about the role of urinalysis and breath testing skill-building sessions done in relatively small groups. The
in an outpatient setting. Breath-alcohol tests are recom- early recovery groups were born out of this need. People
mended because of the tendency of stimulant users to also who are in the first month of recovery or who need extra
use alcohol or marijuana. tutoring in how to stop using are able to attend these groups.
The purpose of the group is to teach patients (1) how to use
MATRIX MODEL PROTOCOLS- cognitive tools to reduce craving, (2) how to schedule their
DEVELOPMENT AND COMPONENTS time, and (3) about the need to discontinue use of second-
ary substances, and also (4) to connect patients with
The original Matrix protocol for outpatient stimulant community support services necessary for a successful re-
abuse treatment was developed in the early eighties in covery. The reduced size of the groups allows the therapist
response to an overwhelming demand for cocaine abuse to spend more individual time with each patient who is
treatment. The development of the written protocol was learning these critical early skills and tasks. Patients who
funded by a Small Business Innovative Research grant destabilize during treatment are often encouraged to return
offered through the National Institute on Drug Abuse to the early recovery group until they restabilize. When
(Rawson et al. 1989). The design of the program started possible, the therapist will invite patients with longer-term
with six months of active treatment, during which the sobriety to serve as coleaders in this group to share their

Journal of Psychoactive Drugs Volume 32 (2). April -June 2000

 Obert et al. The Matrix Model of Outpatient Stimulant Abuse Treatment

FIGURE 1
Intensive Outpatient Program Schedule

Week Monday 'hesday Wednesday Thursday Friday Saturday

& Sunday
Weeks 6-7 pm I 7-8:30 pm I 6-7 pm
1 Early I Family I Early
Through Recovery I Education I Recovery
4 Skills I Group I Skills 12-Step

7-8:30 pm I I 7-8:30 pm
Relapse I I Relapse Meetings
Prevention I I Prevention
Group I I Group

and Other
Weeks 7-8:30 pm 12-Step 7-8:30 pm 12-Step 7-8:30 pm
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5 Relapse Meeting Family Meeting Relapse

Through Prevention Education Group I Prevention
16 Group I or I Group Recovery
Transition I
Group I

Weeks I 7-8:30 pm I Activities

17 I Social I
Through I Support I
52 I I
Urine testing and breath-alcohol testing are conducted weekly.
One individual session is included in each of the program phases.

experience and hope with those who are just beginning the own experience; and (4) patients share their schedules,
process. plans, and commitment to recovery from the end of group
until the group meets again. Input and encouragement from
Relapse Prevention Groups other group members is solicited but the group leader does
As indicated in Figure 1, the relapse prevention groups not relinquish control of the group or promote cross talk
occur at the beginning and end of each week from the be- about how each member feels about what the others have
ginning of treatment through Week 16. They are the central said. The therapist maintains control and keeps the groups
component of the Matrix treatment package. They are open topic-centered and positive, with a strong educational ele-
groups run with a very specific format for a very specific ment. Care is taken not to allow group members to share
purpose. Most patients who have attempted recovery will graphic stories of their alcohol and other drug use. Thera-
agree that stopping use of a drug is not that difficult; it is pists specifically avoid allowing the groups to become
staying stopped that makes the difference. These groups confrontational or extremely emotional. Whenever possible
are the means by which patients are taught how to stay in the use of a coleader who has at least six months of recov-
sobriety. ery is employed. The coleader serves as a peer support
The purpose of the relapse prevention groups is to pro- person who can share his or her own recovery experiences.
vide a setting where information about relapse can be
learned and shared. Thirty-two topics have been included Family Education Sessions
in the protocols to be used in this setting. The topics are The 12-week series is presented to patients and their
focused on behavior change, changing the patient's cogni- families in a group setting using slide presentations, vid-
tivetaffective orientation, and dealing with connecting eotapes, panels, and group discussions. The educational
patients with 12-Step support systems. Each group is struc- component includes such program topics as: (a) the biology
tured with a consistent format during which: (1) patients of addiction, describing concepts such as neurotransmit-
are introduced if there are new members; (2) patients give ters, brain structure and function and drug tolerance;
an up-to-the-moment report on their progress in recovery; (b) conditioning and addiction, including concepts such
(3) patients read the topic of the day and relate it to their as conditioned cues, extinction, and conditioned abstinence;

Journal of Psychoactive Drugs 160 Volume 32 (2), April - June 200(

 Obert et al. The Matrix Model of Outpatient Stimulant Abuse Trratment

(c) medical effects of stimulants on the heart, lungs, repro- EVALUATIONS OF THE MATRIX MODEL
ductive system and brain; and (d) addiction and the family,
describing how relationships are affected during addiction Pilot Study
and recovery. Successfully engaging families in this com- Several evaluations of the Matrix model have been
ponent of treatment can significantly improve the probability conducted over the past 15 years. These range from open
of retaining the primary patient in treatment for the entire trials with few controls to controlled clinical trials. The
16 weeks. earliest of these was a pilot study conducted in 1985 which
documented the clinical progress of 83 cocaine abusers at
12-Step Meetings eight months following treatment admission (Rawson et
The optimal arrangement is to have a 12-Step meeting al. 1986). During an evaluation session, patients self-
on site at the treatment center one night each week. This selected either: no formal treatment (with voluntary
meeting does not have to be an official meeting. Rather, the involvement in Alcoholics Anonymous, Cocaine Anony-
patients presently in treatment and graduated members can mous, or Narcotics Anonymous); 28-day inpatient
conduct an "Introduction to 12-Step Meetings" using the treatment; or the Matrix model outpatient treatment. An
same format as an outside meeting, with the purpose of ori- independent research assistant was hired to conduct tele-
enting patients unfamiliar to the meetings in a safe setting phone follow-up interviews inquiring into drug and alcohol
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with people they already know. Attending these meetings use and participation in aftercare and self-help.
often makes going to an outside meeting for the first time There were no demographic or drug use differences
much easier and less anxiety-provoking. These meetings, among the patients prior to beginning treatment.'The hos-
along with outside 12-Step meetings chosen by patients and pital patients received 26.5 of 28 days of treatment and the
the social support group provide strong continuing support Matrix patients received 21.6 of 26 weeks. By contrast,
for graduated group members. only 20% of the no formal treatment patients ever attended
more than one self-help meeting. The most noteworthy
Social Support Group finding of this pilot study were reports of significantly less
Designed to help patients establish new nondrug-re- cocaine use by the Matrix patients at eight months after
lated friends and activities, these groups are less structured treatment admission. The number of patients reporting a
and topic-focused than the relapse prevention groups. return to monthly or more frequent cocaine use in the
Patients begin the groups during the last month in treat- Matrix group was four of 30, compared to 10 of 23 in the
ment at the end of the family education series, in order to inpatient group, and 14 of 30 in the no formal treatment
ensure that they feel connected before they graduate from group.
the relapse prevention groups. The content of the groups is Another finding from this study was that patients in
determined by the needs of those Members attending. If all conditions were significantly more likely to return to
patients have relapsed, relapse prevention work may be in cocaine use if they continued to drink alcohol (of those
order, unstable patients are given direction to help stabilize who drank alcohol, 50% relapsed to cocaine use; of those
them and patients moving successfully through the stages who did not drink, only 6% relapsed; x2=10.70, d&2,
of recovery are aided and encouraged to continue with the p<.05). Similarly, there was a 59% relapse rate among
lifestyle changes that they are making. marijuana smokers compared to 20% among nonsmokers.
Although the quasi-experimental nature of this evaluation
Relapse Analysis and the small numbers of subjects per cell limit the degree
A specific exercise is included in the Matrix protocol to which strong conclusions may be drawn, the findings
to be used when a patient relapses unexpectedly or repeat- did provide some support for the Matrix model and also
edly and does not seem to understand the causes of the were a basis for altering treatment materials to prescribe
relapses. The optional exercise and forms are designed to total abstinence as a necessary tactic for preventing relapse
help the therapist and the patient understand the issues and to cocaine.
events that occurred preceding the relapse(s) in order to
help prevent future relapses. This exercise is typically con- Open Trial Study
ducted during an individual session with the patient and In two of the Matrix offices in Southern California an
possibly a significant other. open trial was conducted with 486 cocaine users who
received treatment between 1986 and 1990 (Rawson et al.
Urine Tests 1991b). Patients were in treatment either in Beverly Hills
Urine testing is done randomly on a weekly basis. Posi- (n=314) or in Rancho Cucamonga (n=172). In the Beverly
tive urine tests revealing previously undisclosed drug use Hills office, which had a mainly middle class population,
serve as points of discussion rather than incrimination. the source of funding for treatment was out of pocket or
Patients struggling with secondary drug or alcohol use insurance for 85%. By contrast, in the Rancho Cucamonga
should also be tested for those substances. only 20% self-paid or used insurance, while 80% were

Journal of Psychoactive Drugs Volume 32 (2). April - June 2000

 Obert et al. The Matrix Model of Outpatient Stimulant Abuse Treatment

funded under a contract with San Bernardino County. The the tremendous heterogeneity of treatment experiences of
most striking differences between the two patient groups these subjects.) Matrix subjects in this trial had a treatment
were average annual income ($27,900 in Beverly Hills ver- completion rate (24%) similar to the Rancho Cucamonga
sus $16,700 in Rancho Cucamonga) and primary route of patients in the open trial (22%). These data reinforced the
administration (5 1% intranasal in Beverly Hills, 65% conclusion that lower income crack smokers are more dif-
smoked in Rancho Cucamonga). ficult to retain in treatment than intranasal cocaine users
In each location, 88% of weekly urinelself-reports were with greater social stability and resources.
negative for stimulants during the six-month intensive treat- Both groups of subjects reported significant reductions
ment phase. Although similar urinalysis results were seen in cocaine use over the 12-month study period but there
across sites, there were substantial differences in treatment was not a difference in main effect between the two groups.
retention. The Beverly Hills patients averaged over five However, there was a strong positive relationship between
months (21.0 weeks) in treatment and 48% completed the the amount of treatment received and the percent of
program, while the Rancho Cucamonga patients averaged cocaine-negative urine results for the Matrix subjects, but
three months (13.2 weeks) and only 22% completed the not for the community resources subjects. Similarly, greater
program. One of the causes for this difference was that 20% amounts of treatment participation for the Matrix subjects
in Rancho Cucamonga dropped out during the first two were associated with improvement on the AS1 employment
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weeks, whereas in Beverly Hills only 8% dropped out dur- and family scales, and on a depression scale. These post
ing this initial period. hoc analyses supported the clinical impression of the coun-
This open trial with a relatively large number of seling staff of an orderly dose-response association between
cocaine users further supported the results from the pilot amount of Matrix treatment and outcome status.
study, which found that the Matrix model was a viable treat- This study supported the Matrix model's clinical util-
ment approach that could retain patients for substantial ity, but the results did not provide definitive empirical
treatment episodes. There was a tentative connection be- confirmation of its efficacy. The variability of community
tween the duration of treatment and drug use status through resource subjects' treatments made differential treatment
six months of treatment. Further, although there appeared outcomes undetectable. In addition, failure to employ a
to be a positive association between patients' socioeconomic pre-randomization "lead-in" period to screen out applicants
status and treatment retention, this was confounded by a resulted in high rates of attrition in both treatment groups.
number of variables including route of administration, This reduced the number of subjects receiving a meaning-
employment status and access to transportation. ful dose of treatment and further impaired the identification
of differential treatment outcomes.
The Controlled Trial
Through a funding mechanism called the Small Busi- Comparison of MA and Cocaine Users' Response
ness Innovative Research Program the protocol for the to Matrix Treatment
Matrix model was formalized into a 300-page treatment A review was done of the charts of 500 MA- and 224
manual. After completion of the manual, a controlled trial cocaine-abusing patients who were treated at the Matrix
of the model was conducted over a two-year period (Rawson Rancho Cucamonga office between 1988 and 1995 i n
et al. 1995). In this study 100 cocaine-dependent subjects order to describe these two patient groups and compare
were randomly assigned to a six-month Matrix treatment their responses to Matrix model treatment (Huber et al.
condition or they were referred to "other available com- 1997). Although there were substantial demographic and
munity resources." Subjects assigned to the community drug history differences, the amount of treatment services
resource group were given detailed information on treat- received and the duration of treatment participation, as well
ment alternatives in the area and were given a referral and as the frequency of stimulant use (as measured by urinaly-
an appointment time to receive an evaluation at a commu- sis) were virtually identical for the two groups of stimulant
nity treatment location. Subjects in both conditions were users. Cocaine users remained in treatment an average of
scheduled for three, six, and 12-month follow-up evalua- 18.0 weeks compared to 17.1 weeks for the MA users. The
tions and were paid $25 for each completed follow-up. percentage of urinalyses positive for the primary drug was
Compared to previous Matrix patient samples, these 13.3% for cocaine users and 19.3% for MA users (the dif-
subjects were more ethnically diverse (27% were African- ference was not significant). The tentative conclusions from
American, 23% were Hispanic, and the remainder were this chart review were that the Matrix model was equally
Caucasian). Most (84%) smoked cocaine as the primary well received by cocaine and MA users and both groups
route of administration. At three- and six-month follow- had a very favorable response to treatment.
ups, 40% of the community resource subjects reported
involvement in some formal treatment ranging from out- Follow-up Study on MA Users
patient to hospital treatment. (This treatment condition A nonrandomly-selected convenience sample of the
proved not to be a useful experimental control because of first 114 patients located out of the 500 referred to in the

Journul cf Psychoactive Drugs 162 Volume 32 (2). April - J u n e 200C

 Obert et al. The Matrix Model of Outpatient Stimulant Abuse Treatment

report by Huber and colleagues (1997) was followed at two Matrix treatment to "treatment as usual" in community
to five years after treatment (see Rawson et al. In press). In clinic settings.
this CSAT-funded study, 437 potential study candidates were
telephoned by research assistants and asked to come to the SUMMARY AND FUTURE DIRECTIONS
clinic for a follow-up interview. Candidates were informed
that the interview would take approximately 90 minutes and The Matrix model was developed in response to the
they would receive $25 in grocery scrip as compensation. cocaine epidemic of the 1980s. The treatment system at
When necessary the interview was performed at a neutral that time offered no relevant and appropriate option to
offsite location, and as a last resort it was done by phone. stimulant users, who generally did not need inpatient treat-
Of the total pool of 437, 183 (42%) were located, contacted ment and could not relate to alcohol-targeted treatments.
and asked to participate. Of the 183, 114 agreed to partici- The Matrix model incorporated empirically-supported
pate in the follow-up interview. Data from patient charts treatment elements, including relapse prevention, educa-
indicated participants were similar to the nonparticipants tion, and family involvement into a manualized,
on demographics; however they remained in treatment nonconfrontational, structured, cognitive/behavioral pro-
almost twice as long and gave more MA-free urine samples gram. The treatment components are relapse prevention
during the course of treatment. groups, individual counseling sessions, family education
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In the follow-up sample there was a significant change groups, and urine and breathlalcohol testing. Group meet-
in self-reported MA use in the 30 days prior to treatment ings are guided by written topics and focus on current issues
(86% reported use), and 30 days prior to follow-up (17.5% and activities. The model was broadened to treat alcohol
reported use). The only predictor of nonuse at follow-up and opioid dependencies, and manuals were developed
was marital status, with married patients more likely to be which targeted the specific problems and goals of these
MA nonusers at follow-up. Urine samples were collected substance use disorders.
on 46 individuals, and only three (6.5%) were positive for Evaluations of the Matrix model have not definitively
MA. Of the 54 who had reported daily use at baseline, 39 established its efficacy, but a review of these studies justi-
(72.2%) were abstinent at follow-up. fies support for this approach. Cocaine and MA users
At treatment admission 26% of the follow-up sample benefit from the Matrix model treatment. They respond
were employed compared to 62% employed at follow-up. positively during treatment and appear, in at least some
There was significant reduction in the percentages of par- cases, to sustain gains for periods of more than two years.
ticipants reporting paranoia, however there was not a The current multisite trial of the model may provide more
reduction in complaints of depression (more than 60%) and information regarding the its efficacy in general and with
headaches (38.9Y0at baseline and 44.1% at follow-up). specific patient populations (NativeAmericans, Hawaiians,
The limitations of the study methodology preclude women, and drug court patients). As more becomes known
conclusions about the specific impact of the Matrix regarding MA-related cognitive impairment, treatment
treatment, and the 114 patients who were followed materials might be modified to accommodate the intellec-
were not representative of the entire initial sample of tual and perceptual levels of these patients. For example,
437. However, despite these limitations, it was dem- there is some evidence that MA use may result in cogni-
onstrated that many MA users are able to discontinue tive impairment that is more pronounced for verbal versus
MA use following treatment with the Matrix model. Al- pictorial memory (Simon et al. In press). Thus, treatment
though the empirical evidence in this study was materials might be more beneficial if they included pic-
uncontrolled and descriptive, the promise of the approach tures with the text. Finally, the complement of psychosocial
(and lack of empirical evidence for any other methods) treatment along with some yet-to-be-determined medica-
has resulted in a CSAT-sponsored multisite project to tion may result in reduced craving, mood elevation, or
replicate and evaluate the Matrix model treatment with better cognitive functioning, and therefore improved re-
MA users. This study will compare the outcome of the tention and better response to the Matrix model.

REFE

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