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Behavioral Therapies Development Program - Effective Drug Abuse Treatment Approaches

The Matrix Model

The Matrix Model (Rawson et al., 1995) of outpatient treatment was developed during the 1980s in response to an overwhelming demand for stimulant abuse treatment services. The intent was to create an outpatient model responsive to the needs of stimulant-abusing patients while constructing a replicable protocol that could be evaluated. Treatment materials draw heavily upon published literature pertaining to the areas of relapse prevention (Marlatt and Gordon,1985), family and group therapies, drug education, self help participation and drug abuse monitoring. The clinical materials have been selected as a result of a behavioral analysis of the type of problems encountered by cocaine and methamphetamine users as they proceed through a period of cocaine abstinence.

Over 5000 cocaine addicts and over 1000 methamphetamine users have been treated with the method. The experience of these patients has been the source of the data used in developing and modifying this integrated therapeutic model. The treatment model has been extended to address the clinical needs of alcohol users and opiate dependent individuals.

The goal of the Matrix Model has been to provide a framework within which stimulant abusers can achieve the following: (a) cease drug use, (b) retain in treatment, (c) learn about issues critical to addiction and relapse, (d) receive direction and support from a trained therapist, (e) receive education for family members affected by the addiction, (f)become familiar with the self-help programs, and (g) receive monitoring by urine testing.

The Matrix model requires that the therapists use a combination of skills required to function simultaneously as teacher and coach. The therapist fosters a positive, encouraging relationship with the patient and uses that relationship to reinforce positive behavior change. The interaction between the therapist and the patient is realistic and direct but not confrontational or parental. Therapists are trained to view the treatment process as an exercise that will promote self-esteem, dignity, and self-worth. A positive relationship between patient and therapist is a critical element for patient retention.

The treatment materials contained in detailed treatment manuals include work sheets for individual sessions, family educational groups, early recovery skills groups, relapse prevention groups, conjoint sessions, urine tests, 12 step programs, relapse analysis, and social support groups. A pilot study comparing the Matrix outpatient model with an inpatient hospital treatment program produced preliminary support for the clinical utility of the model for the treatment of cocaine dependence (Rawson, 1986). A number of NIDA-funded projects have demonstrated that participants treated with the Matrix model demonstrate statistically significant reductions in drug and alcohol use, improvements in psychological indicators and reduced risky sexual behaviors associated with HIV transmission (Rawson et al,1995, Shoptaw et al, 1994, Shoptaw et al 1997). These reports, along with evidence suggesting comparable treatment response between methamphetamine users and cocaine users, (Huber, et al, 1997) and demonstrated efficacy in enhancing naltrexone treatment of opiate addiction (Rawson et al, under review) provides a body of empirical support for the use of the model.

The fact that the Matrix model materials have been manualized into systematic treatment protocols with instructions for use, has tremendously facilitated the dissemination of this approach. Currently, projects are being conducted in 12 states and 4 countries employing this approach in treatment settings for stimulant, opiate and alcohol users.

Rawson, R.A., Obert, J.L. McCann, M.J. and Mann. A.J (1986) Cocaine treatment outcome: Cocaine use following inpatient, outpatient and no treatment. CPDD NIDA Res. Monograph, 67, 271-277.

Rawson, R., Shoptaw, S., Obert, J.L., McCann, M, Hasson, A.,Marinelli-Casey, P., Brethen , P. & Ling, W. (1995). An intensive outpatient approach for cocaine abuse: the Matrix model. Journal of Substance Abuse Treatment, 12 (2), 117-127.

Shoptaw, S. Rawson, R.A., McCann, M.J. and Obert, J.L. (1994). The Matrix model of stimulant abuse treatment: Evidence of efficacy. Journal of Addictive Diseases, 13, 129-141.

Shoptaw, S., Frosch, D., Rawson, R., & Ling, W. (1997). Cocaine abuse counseling as HIV prevention. Journal of AIDS Education & Prevention, 9, 511-520.

Huber, A., Ling, W., Shoptaw, S., Gulati, V. Brethen, P. and Rawson, R. (1997) Integrating treatments for methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases, 16, 41-50.

Rawson, R., McCann, M.J., Shoptaw, S., Miotto, K. Frosch, D., Obert, J.L. and Ling, W. (under review) Naltrexone fore opiate addiction: Evaluation of a manualized psychosocial protocol to enhance treatment response.

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