STAGES OF RECOVERY Drug Court Conference Normal OK September 2014 Matrix Institute on Addictions Sam Minsky MA LMFT 2006 Matrix Institute THE STAGES OF RECOVERY A ROADMAP Roadmap for Recovery ID: 761168
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STAGES OF RECOVERY Drug Court Conference Normal, OK. September, 2014 Matrix Institute on Addictions, Sam Minsky , MA , LMFT
© 2006 Matrix InstituteTHE STAGES OF RECOVERY A ROADMAP
Roadmap for Recovery Withdrawal Early Abstinence/Honeymoon Protracted Abstinence/The Wall Adjustment/Resolution
STAGES OF RECOVERY © 2006 Matrix Institute OVERVIEW Withdrawal Honeymoon The Wall Adjustment Resolution DAY 0 DAY 15 DAY 45 DAY 120 DAY 180
© 2006 Matrix Institute Stages of Recovery - Stimulants WITHDRAWAL STAGE DAY 0 DAY 15 Medical Problems Alcohol Withdrawal Depression Difficulty Concentrating Severe Cravings Contact with Stimuli Excessive Sleep PROBLEMS ENCOUNTERED
MATRIX MODEL TREATMENT Primary Manifestation of Withdrawal Stage Behavioral Cognitive Relationship Emotional Behavioral Inconsistency Confusion Inability to Concentrate Depression/Anxiety- Self-Doubt Mutual Hostility- Fear
© 2006 Matrix Institute 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 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
MATRIX MODEL Primary Manifestation of Honeymoon Stage Behavioral Cognitive Relationship Emotional High Energy- Unfocused Behavior Inability to Prioritize Overconfidence/ Feeling Cured Denial of Addiction Disorder
MATRIX MODEL Primary Manifestation of the Wall Stage Behavioral Cognitive Relationship Emotional Sluggish Low Energy/Inertia Relapse Justification Depression/Anhedonia Irritability/ Mutual Blaming/Impatience
© 2006 Matrix Institute MATRIX MODEL TREATMENT Relapse Factors - Honeymoon Stage Overconfidence Secondary alcohol or other drug use Discontinuation of structure Resistance to behavior change Return to a chemical influenced lifestyle Inability to prioritize Periodic paranoia
© 2006 Matrix Institute 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
“The Wall” One Patient’s Account © 2006 Matrix Institute 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.”
“The Wall” One Patient’s Account © 2006 Matrix Institute 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.”
“The Wall” One Patient’s Account © 2006 Matrix Institute 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.”
© 2006 Matrix Institute
THE BENEFITS OF EXERCISE Aerobic/Cardio seems to be the best for reducing or in some cases eliminating Post Acute Withdrawal Syndrome (Wall) 20 or more minutes a day Increase respiration Increase pulse rate Light sweat Increases endorphin production which may help stabilize neurotransmitter regulation
© 2006 Matrix Institute Stages of Recovery - Stimulants Adjustment/Resolution Stage DAY 180 Anger Guilt Isolation Boredom PROBLEMS ENCOUNTERED Vocational Dissatisfaction Relationship Problems Overconfidence Lack of Goals Underlying Psychopathology resurfaces DAY 120
MATRIX MODEL Primary Manifestation of Adjustment Stage Behavioral Cognitive Relationship Emotional Sloppiness Regarding Limits Drifting From Commitment to Recovery Experiencing Normal Emotions Surfacing of Long-Term Issues
© 2006 Matrix Institute Stages of Recovery Relapse Factors - Adjustment Stage Secondary alcohol or other drug use Relaxation of structure Struggle over acceptance of addiction Maintenance of recovery momentum/commitment I feel cured syndrome Re-emergence of underlying pathology
Traditional View of Psychotherapy for Substance Abuse Until 1960 psychodynamic oriented psychotherapy was the primary professional approach to substance abuse treatment. Assumed that substance abuse behavior was a manifestation of underlying psychopathology. If resolution of underlying psychopathology could be achieved, substance abuse would be lessened.
MATRIX MODEL DIFFERENCES Focus on feelings Emotional catharsis as a means to gain sobriety Addiction or abstinence may or may not be discussed Unmotivated clients are not pursued Behavioral focus a priority CBT as a means to laying foundation for recovery Abstinence is highlighted and tools are discussed Ambivalent or unmotivated clients are accepted and the norm Matrix Model © 2006 Matrix Institute General Psychotherapy
© 2006 Matrix Institute MATRIX TREATMENT MODEL Different from General Therapy Focus on behavior vs. feelings Visit frequency results in strong bonding with the counselor and the group This bonding encouraged and utilized Goal is stability (vs. emotional catharsis)
© 2006 Matrix Institute MATRIX TREATMENT MODEL Different from General Therapy Focus is on abstinence Bottom line is always continued abstinence Therapist frequently pursues less motivated clients The behavior is more important than the reason behind it
MANUALIZED TREATMENT The Matrix Model Reduces therapist differences Ensures uniform set of services Enhances training capabilities Facilitates research to practice Can be more easily evaluated © 2006 Matrix Institute MATRIX
EVIDENCE BASED THERAPIES (EBT’S) THAT ARE INCORPORATED IN THE MATRIX MODEL © 2006 Matrix Institute
© 2006 Matrix Institute Program Schedule A sample schedule for the Matrix IOP program is illustrated in the following table: INTENSIVE OUTPATIENT PROGRAM SCHEDULE Week Monday Tues. Wed. Thurs. Friday Saturday & Sunday Weeks 1 Through 4 6-7 PM Early Recovery Skills 7-8:30 PM Relapse Prevention 12-step Meeting Or other community participation 7-8:30 PM Family Education Group 12-step Meeting Or other community participation 6-7 PM Early Recovery Skills 7-8:30 PM Relapse Prevention 12-Step/ Spiritual Meetings and Other Recovery Activities Weeks 5 Through 16 7-8:30 PM Relapse Prevention Group 7-8:30 PM Family Education Group or Social Support 7-8:30 PM Relapse Prevention Group Weeks 17 Through 52 7-8:30 PM Social Support Urine testing and breath-alcohol testing conducted weekly Ten individual sessions during the first 16 weeks
MATRIX MODEL Organizing Principals © 2006 Matrix Institute STRUCTURE Create explicit structure and expectations Establish positive, collaborative relationship w/ clients Teach information and cognitive-behavioral concepts Positively reinforce positive behavior change Provide corrective feedback when necessary Educate family regarding substance abuse recovery Introduce and encourage self-help participation Use urinalysis to monitor drug use
MATRIX MODEL Organizing Principals STYLE Nonjudgmental, supportive attitude Engagement & Retention Strong bond with individual counselor or group Minimal use of confrontation Use of recovering role models in group Ability to work with relapse
COGNITIVE BEHAVIORAL THERAPY Key Concepts Encouraging and reinforcing behavior change Recognizing and avoiding high risk settings Behavioral planning (scheduling) Coping skills Conditioned “triggers” Understanding and dealing with craving Understanding basic psychopharmacology principles Self-efficacy (MI Concept) © 2006 Matrix Institute
TRIGGERS AND CRAVINGS & ROADMAP TO RECOVERY Foundation of the Matrix Model & are 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 language of the model and integrating it into their recovery Classical Conditioning & Cognitive Behavior Therapy Brain Chemistry and Functioning Stages of Recovery