The Matrix model of substance abuse treatment is a multifaceted treatment program designed to help substance abusers stop drug and alcohol use and maintain their sobriety through education and monitoring.
The Matrix model, while originally designed as a therapeutic approach to treating abuse of such stimulants as cocaine and methamphetamines, has subsequently been applied to the treatment of opiate and alcohol abuse.
The Matrix model treatment system was created in the 1980s when cocaine abuse became rampant among members of the middle and upper-middle classes. The Matrix Institute on Addictions is a nonprofit organization based in California. Founded in 1984 to develop the program that became the Matrix model of substance abuse treatment, the Institute itself has several southern California locations. Other private treatment programs are also using the Matrix model, which has the distinct advantage over some treatment programs of having complete and established written treatment protocols as well as a growing body of research supporting its efficacy.
Prior to the early 1980s, cocaine and methamphetamine (MA) treatment programs generally followed one of two courses: community-based outpatient drug treatment programs for low-income users; or high-cost, private inpatient institutional treatment programs for those who could afford them. When middle-income drug abuse became epidemic, there was a need for an effective outpatient program that could address the needs of thousands of drug abusers who were neither wealthy nor living on the street.
The 28-day hospital-based treatment programs typically formulated for private health-care treatment of alcoholism were not seen as useful for cocaine users, who rarely needed inpatient programs. Similarly, psychotherapy alone has not been universally effective in helping people stop cocaine use or in preventing relapse . The Matrix model was designed to treat drug abuse using multiple modalities in as cost-efficient a manner as possible. Its underlying concept was to serve as an outpatient based on a reputable, evaluable protocol. Beginning with cocaine abuse, the Matrix model was extended to cover methamphetamines and other stimulant abuse treatment. Development and subsequent research on the Matrix model has been funded by grants from the National Institute on Drug Abuse, the Center for Substance Abuse Treatment, the Substance Abuse and Mental Health Services Administration, and the U.S. Department of Health and Human Services.
The developers of the Matrix model, rather than engaging in the defense of a single theory, used strategies based on several practical approaches that had been shown to work in drug treatment. By using a matrix design rather than a single methodology, the program designers targeted the multiple factors affecting an individual’s chances for recovery. Social influences, education for patient and family members, cognitive-behavioral techniques, support groups , individual sessions, and urine and breath testing were all included in the treatment model. The goal of this model was to help stimulant abusers 1) stop their drug use, 2) stay in treatment, 3) learn about issues critical to addiction and relapse, 4) receive direction and support from a trained therapist, 5) educate family members affected by the patient’s addiction, 6) introduce self-help programs to the addicted persons for continued support and 7) continue monitoring with urine testing. The program lasts 16 weeks, and the program administrators conducted several studies to measure the efficacy of the Matrix model for different users, under different conditions and compared to other treatment methods.
The Matrix model recognizes several factors needed for an effective and lasting treatment. The therapeutic relationship, although not as intensive as traditional psychological therapy (only three 45-minute sessions are scheduled over 16 weeks) is used for engaging the patient in a way that will encourage continued participation and engagement in the program. Although the original program consisted of a greater number of individual sessions, they were soon abandoned in favor of additional group sessions, making the program more cost-effective without reducing its efficacy.
Dissemination of information, by way of patient group meetings, helps individuals understand the physiological and psychological effects of drug use. Family-systems theory has shown that, even in cases where change is in the best interest of the family and the patient, family members consciously and unconsciously resist the efforts of any one member who attempts to change. Education of family members in a group setting helps to educate everyone involved, reducing the risk of family dynamics sabotaging the recovery of the patient.
Planning is considered a vital part of relapse prevention : patients are taught to schedule their days to stay busy as well as to think about the ways their daily schedule might contribute to sobriety or relapse. Used as a part of the outpatient treatment program, planning promotes positive activity and helps prevent relapse; it is also needed after a patient has completed the program and needs to rebuild a life in which daily activities are not based on drug-addictive behaviors.
Timing is recognized as an important factor in the process of recovery: education sessions are scheduled so as not to interfere with the early stages of treatment, when patients are detoxifying and cannot comprehend much information beyond their own discomfort and shame. As their recovery continues, the program provides more complex information in a set of standardized lectures. Educating patients is part of a cognitive-behavioral approach that teaches them to notice, challenge, and change irrational or unhelpful thought processes, replacing old habits of thought with more productive and positive ones.
Co-occurring dependency is so common in addiction that no comprehensive treatment program should address a single addiction. The Matrix program recognizes that stimulant users often also use alcohol and marijuana. Program research shows significantly greater relapse rates for people who continue using other drugs. Patients are expected to quit all drugs and alcohol. As part of the Matrix model, breath testing and urinalysis address the possibility that some patients may continue drug or alcohol use, and reveal that this contingency needs to be addressed. Urinalysis and breath testing were made part of the Matrix treatment primarily as a way to validate patients in their recovery as well as providing an early warning of difficulty. Testing works with scheduling and other program components to let patients take responsibility for their recovery. There is room in the approach for response to relapse during treatment, and physiological tests will reveal temporary defeat, whereas patients sometimes cannot.
Although one could argue that the Matrix model is focused primarily on relapse prevention, particular coping skills and behaviors are taught to patients to help them identify situations that may test their sobriety. Called “relapse prevention,” these established techniques are part of the program and provide social support. In leading relapse-prevention groups, staff members may also be alerted to patients whose behavior in the group may signal a potential relapse.
A vital component of the Matrix model is the recognition that 12-step programs are widely useful for people in aftercare. Substance abuse treatment is notably more effective when patients have resources for maintaining a drug-free lifestyle after leaving treatment. 12-step meetings are held at the Matrix treatment centers, attended by patients who are advancing in their treatment. The Matrix developers realized that some patients would opt out of 12-step meetings because of their format and emphasis on embracing a higher power and spiritual
Matrix —In statistics, variables that may influence a particular outcome are placed into a grid, either in columns or in rows. Statistical calculations can be performed that assign different weights to each variable, and the differential weighting of variables can be seen to affect the outcome. In the Matrix model of drug abuse, the variables that affect a positive outcome (such as behavioral techniques, family education or urinalysis testing) are all considered as important parts of a unified treatment plan.
Drug abuse —When an individual’s repeated use of controlled substances, prescription or over-the-counter drugs, or alcohol causes damage to their health, thought processes, relationships, or functioning at work or school, they can be said to be practicing drug abuse. Using a substance for purposes other than which it is intended (such as inhaling gasoline fumes recreationally) can also be considered drug abuse.
authority: the Matrix program addresses potential resistance by helping patients find ways to reconcile their personal beliefs with the structure of Alcoholics Anonymous, Narcotics Anonymous, or other self-help programs. This serves several purposes. Patients who might otherwise avoid such meetings after leaving the program may choose instead to attend, increasing their chances of maintaining a drug-free lifestyle; patients learn the format and 12-step “rules” while still in a more fully supportive milieu; and patients have a structured system to enter after leaving the program.
The overall expectation of this therapeutic intervention is that patients will leave the program drug free and with enough internal and external resources to maintain a life free of drugs and alcohol. Research comparing the Matrix model to other treatment approaches has found that patients who complete the Matrix treatment programs have statistically higher abstinence rates and lower positive results on drug tests than patients who participate in traditional 28-day in-hospital programs.
Sorensen, James L., Richard A. Rawson, and Joseph R. Guydish, eds. Drug Abuse Treatment Through Collaboration: Practice and Research Partnerships That Work.Washington D.C.: American Psychological Association, 2003.
Obert, Jeanne L., and others.“The Matrix Model of Outpatient Stimulant Abuse Treatment.” Journal of Psy-choactive Drugs 32.2 (April–June 2000): 157–64.
“Program Helps Patients Reduce, Discontinue Metham-phetamine Use.” The Brown University Digest of Addiction Theory and Application 21.4 (April 2002): 1–3.
Lorena S. Covington, MA