CORE TRAINING IN THE MATRIX MODEL OF OUTPATIENT TREATMENT FOR SUBSTANCE ABUSE AND CHEMICAL DEPENDENCY

1. CORE TRAINING IN THE MATRIX MODEL OF OUTPATIENT TREATMENT FOR SUBSTANCE ABUSE AND CHEMICAL DEPENDENCY SAM MINSKY, MA, MFT MATRIX INSTITUTE ON ADDICTIONS LOS ANGELES, CA. MM PART 3 © 2006 Matrix Institute

2. Stages of ChangeProchaska & DiClemente Precontemplation Contemplation Maintenance Preparation Action © 2006 Matrix Institute

3. Four Principles ofMotivational Interviewing 1. Express empathy 2. Develop discrepancy 3. Avoid argumentation 4. Support self-efficacy © 2006 Matrix Institute

4. 1. Express Empathy • Acceptance facilitates change • Skillful reflective listening is fundamental • Ambivalence is normal © 2006 Matrix Institute

5. 2. Develop Discrepancy • Awareness of consequences is important • Discrepancy between present behaviors and goals motivates change • Have client present reasons for change • Elicit Pros and Cons of behavior change versus status quo (helps client explore own ambivalence) © 2006 Matrix Institute

6. 3. Avoid Argumentation • Resistance is signal to change strategies • Resistance is an interpersonal phenomena • Labeling is unnecessary • Elicit client's stated concerns • Clients’ attitudes shaped by their own words © 2006 Matrix Institute

7. 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 • Built on past successes © 2006 Matrix Institute

8. Triggers and CravingsStimulant Users • Alcohol Use • Drug Using Friends • Environmental Cues • Money • ATM • Freeway Exits • Neighborhoods • Stimulant - Sex Connection • Boredom © 2006 Matrix Institute

9. Triggers and CravingsOpiate and Heroin Users • Stress • Secondary Drug/Alcohol Use • Analgesic Use • Anhedonia, Anxiety, Depression • Environmental Cues • Discontinuation of Treatment, Self-Help Groups, Naltrexone © 2006 Matrix Institute

10. Triggers and CravingsAlcohol Users • Negative Affective States - Especially Anger and Depression • Discontinuation of AA Involvement • Social Availability of Alcohol • Relationship Disruptions • Situational Issues • Happy Hour • Airplane Trips • Holidays © 2006 Matrix Institute

11. Triggers and CravingsPrescription Drugs • Extended Withdrawal Symptoms • Insomnia • Anxiety • Panic • Alcohol Use • Pain • MD Offices/Pharmacies/Medicine Cabinets © 2006 Matrix Institute

12. Triggers and CravingsMarijuana Users • Anxiety/Irritability, Insomnia • Using Friends • Social Situations • Paraphernalia • Liquor Stores/Headshops • Concerts © 2006 Matrix Institute

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

14. STAGES OF RECOVERY - STIMULANTS OVERVIEW DAY 180 DAY 0 DAY 15 DAY 45 DAY 120 Adjustment Honeymoon The Wall Withdrawal Resolution © 2006 Matrix Institute

15. Stages of Recovery - Stimulants WITHDRAWAL STAGE DAY 0 DAY 15 • Medical Problems • Alcohol Withdrawal • Depression • Difficulty Concentrating • Severe Cravings PROBLEMS ENCOUNTERED • Contact with Stimuli • Excessive Sleep © 2006 Matrix Institute

16. MATRIX MODEL TREATMENT Relapse Factors - Withdrawal Stage • Unstructured time • Proximity of triggers • Alcohol/marijuana use • Powerful cravings • Paranoia • Depression • Disordered sleep patterns © 2006 Matrix Institute

17. Stages of Recovery - Stimulants HONEYMOON STAGE DAY 15 DAY 45 • Over-involvement With Work • Overconfidence • Inability to Initiate Change • Inability to Prioritize • Alcohol Use • Episodic Cravings • Treatment Termination PROBLEMS ENCOUNTERED © 2006 Matrix Institute

18. MATRIX MODEL TREATMENT Relapse Factors - Honeymoon Stage • Overconfidence • Secondary alcohol or other drug use • Discontinuation of structure • Resistance to behavior change • Return to addict lifestyle • Inability to prioritize • Periodic paranoia © 2006 Matrix Institute

19. 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 PROBLEMS ENCOUNTERED © 2006 Matrix Institute

20. “The Wall” 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.” One Patient’s Account © 2006 Matrix Institute

21. “The Wall” 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.” One Patient’s Account © 2006 Matrix Institute

22. “The Wall” 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.” One Patient’s Account © 2006 Matrix Institute

23. Stages of Recovery - Stimulants Adjustment/Resolution Stage DAY 180 DAY 120 • Anger • Guilt • Isolation • Boredom PROBLEMS ENCOUNTERED • Vocational Dissatisfaction • Relationship Problems • Overconfidence • Lack of Goals © 2006 Matrix Institute

24. Stages of RecoveryRelapse Factors - Adjustment Stage • Secondary alcohol or other drug use • Relaxation of structure • Struggle over acceptance of addiction • Maintenance of recovery momentum/commitment • Six-month syndrome • Re-emergence of underlying pathology © 2006 Matrix Institute