An intensive outpatient approach for cocaine abuse treatment. The Matrix model.

The Matrix model of outpatient treatment was developed during the 1980s in response to an overwhelming demand for cocaine abuse treatment services. The model was constructed using components based upon empirically supported findings from the substance abuse research field. Over the course of development, data were collected on the treatment model and the model was modified based upon empirical evaluation. A pilot study comparing the Matrix outpatient model with an inpatient hospital treatment program produced preliminary support for the clinical utility of the model. An open trial comparing publicly and privately funded patients demonstrated that patients with fewer resources were more difficult to engage and retain in this model of outpatient treatment. In a controlled trial, a clear positive relationship was documented between duration and amount of treatment involvement in the Matrix model and positive outcome at 1 year. Due to a variety of methodological issues, the study was not able to answer definitively the question of clinical efficacy. In all of these studies, patients treated with the Matrix model demonstrated statistically significant reductions in drug and alcohol use and improvements in psychological indicators. This body of work, along with the public acceptance the model has received in the treatment community, support the usefulness of this intensive outpatient approach for cocaine abuse. Further research is underway to provide additional controlled information on the value of this treatment approach.

The Matrix model of outpatient stimulant abuse treatment: evidence of efficacy.

The current study examined the effectiveness of Matrix outpatient stimulant treatment. We associated 146 subjects' in-treatment abstinence data, treatment lengths, and weekly treatment activities to their 6-month abstinence outcomes as part of an interim analysis of a NIDA treatment demonstration project. Results indicated that the pretreatment subject characteristics of ethnicity and drug of choice significantly associated with treatment outcome using Matrix model treatment. Findings also demonstrated a treatment dose/abstinence response such that those who received longer Matrix treatment episodes demonstrated better abstinence outcomes. Further, in-treatment abstinence status and treatment length significantly associated with drug use status at follow-up. This set of findings provides evidence for the value of Matrix treatment and allows for these outcome data to be compared with reports on recent psychosocial treatments for stimulant dependence. This study also provides direction for evaluating longer term effectiveness for these types of drug treatments.

Psychological approaches for the treatment of cocaine dependence--a neurobehavioral approach.

A variety of psychological approaches have been utilized for the treatment of cocaine dependence. Most information has been presented in case report format. However, several investigations have established integrated outpatient approaches which are currently being systematically evaluated. One of these approaches, the neurobehavioral model of cocaine dependency treatment establishes a clear timetable for cocaine recovery and focusses attention on four discreet areas of functioning. Strategies for addressing these areas of functioning include relapse prevention methods as well as individual therapy procedures, family systems materials, educational information, 12 step involvement and urine testing. The model constructs a comprehensive framework for facilitating involvement in recovery activities which promote positive behavior change. Use of this standardized treatment format allows for the evaluation of the treatment model. In an open trial with 486 cocaine users, a majority of subjects were retained in treatment for a clinically significant period of time and while in treatment provided urine samples indicating substantial periods of cocaine abstinence. Current research is underway to evaluate: (1) subject factors which appear to be related to successful outcome with this treatment model; (2) a controlled clinical trial to evaluate the treatment model with cocaine users using random assignment; (3) a double-blind evaluation of desipramine versus placebo and versus no medication as an adjunct to the support provided by the model.

Substance abuse treatment for "hazardous users": an early intervention.

A six-session cognitive behavioral protocol has been developed for substance abusers who meet the description "hazardous users." This category includes individuals evidencing mild to moderate use of alcohol or other drugs, whose lifestyles are minimally disrupted, or who are displaying signs of problem use or abuse, but are unwilling to enter intensive treatment. The treatment model is nonconfrontational and is designed to motivate the individual to recognize the problems associated with his or her substance use and initiate treatment-seeking behavior. The intervention may be particularly useful in situations where employees have tested positive for substances but deny having a problem, where friends or family members report help is needed but the individual denies any problem, or where an alcohol or other drug problem is clearly evidenced but the individual doesn't acknowledge a problem. A positive outcome is indicated by the client taking action which is consistent with an increased awareness of the problem as conceptualized by Prochaska and DiClemente (1982). This model is an alternative to the traditional confrontational models of "breaking through denial." The philosophies employed by William Miller and associates and by the Matrix treatment models form the basis of the intervention.

History of sexual assault and the treatment of substance abuse disorders.

A treatment outcome study of adult patients treated for substance abuse disorders was conducted in which 80% of the participants were successfully contacted for follow-up six months post discharge. Analyses focused on baseline and outcome comparisons of patients with histories of sexual assault and patients with no history of sexual assault. The prevalence of assault in the sample was 15%. Baseline measures indicated that patients in the assaulted group were more likely to have a history of suicide planning and demonstrated greater psychiatric symptom severity as measured by the Brief Symptom Inventory. Outcome measures indicated that treatment was effective for both groups in psychiatric symptom reduction and in reduction of alcohol and other drug use. Results are discussed in terms of specific treatment needs for substance abuse patients with sexual assault histories.

Neurobehavioral treatment for cocaine dependency.

Relapse prevention techniques have recently been incorporated into some nonpharmacologic models of chemical dependency treatment. The neurobehavioral model of cocaine dependency treatment establishes a clear timetable for recovery from cocaine dependency and focuses on four distinct areas of functioning. Strategies for addressing these areas of functioning include the use of relapse prevention methods and individual therapy procedures, family systems materials, 12-Step involvement, and urine testing. The model constructs a comprehensive framework for facilitating involvement in recovery activities that promote positive behavior change. The relapse prevention group component of the model is described, the use of a systematic relapse analysis procedure is presented, and an outline of plans for evaluating the model is discussed. The development of a comprehensive outpatient treatment model for treating cocaine dependency provides a standardized structure within which other treatment interventions (e.g., medication, acupuncture) could be evaluated.

The matrix model of outpatient stimulant abuse treatment: history and description.

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.

Addiction treatment in the mid-1990s.

The rapid and dramatic changes now transforming the American healthcare system are also being felt in the addiction treatment field. How this change will be manifested in the structure, content and financing of substance abuse treatment over the next three to five years is described in the following article.

Neurobehavioral treatment for cocaine dependency: a preliminary evaluation.

The treatment of cocaine dependency in the 1980s has required the use of a broad range of strategies. Although there are some promising approaches for treating certain aspects of the cocaine withdrawal syndrome, there is no empirical evidence that provides a clear direction to the future development of a comprehensive treatment approach. The neurobehavioral model is an initial attempt to structure information, support, and encouragement across a series of stages that are experienced by cocaine abusers as they progress through the first 6 months of their recovery. This model attempts to sequence strategies in a way that will correspond to an expected timetable of problem emergence during recovery from cocaine dependency. Individual sessions with trained therapists are used extensively to move clients through the recovery process. Relapse prevention techniques have been used extensively within a relapse prevention group format and in a standardized relapse analysis procedure. This model has been standardized into a manual that allows for replication and evaluation. Current research efforts are under way to assess the usefulness of this model as an independent treatment approach and as a framework for evaluating other potentially useful cocaine dependency treatment strategies.

Cocaine treatment outcome: cocaine use following inpatient, outpatient, and no treatment.

Based upon a sample of 83 cocaine users self-selected into one of 3 programs, several conclusions seem possible. There seems to be little difference in Ss populations who choose hospital, outpatient or self-help/no treatment. Current hospital aftercare programs may not be appropriately oriented for cocaine users. It appears the hospital program in this study retained fewer than 30% of the Ss in aftercare. Outpatient treatment for cocaine dependency is a viable form of treatment which Ss will participate in for up to 6 months on a fee for service basis. Only about 20% of the Ss who were referred to self-help groups attended more than one meeting. Preliminary outcome data suggest that outpatient treatment may result in a lower relapse rate to cocaine than hospital or no treatment. However, this conclusion is extremely guarded due to a large number of methodological issues and the short follow-up period. Relapse to cocaine use is higher among Ss who returned to alcohol or marijuana.

Cocaine abuse treatment: a review of current strategies.

The treatment of cocaine abusers is a newly emerging discipline. Many of the strategies that are being developed for this purpose have been adapted from the drug and alcoholism treatment systems. These include use of established programs that are only minimally modified for cocaine abusers, such as the 28-day inpatient hospital, therapeutic community, and 12-step programs. Other approaches have created specific techniques to meet particular clinical needs of cocaine abusers, such as behavioral, pharmacologic, and nontraditional interventions. Finally, several attempts have been made to create integrated outpatient approaches that address the multiple needs of the cocaine abusers. Many of the clinical researchers conducting research on these modalities feel optimistic about the value of treatment for cocaine abusers. Many of the methods appear to have considerable promise. However, only recently have well-controlled research efforts begun to provide the information necessary for empirically based decision-making. During the next several years, outcome studies should provide an excellent set of data to guide treatment efforts. This paper reviews the treatment efforts that have been conducted, overviews the research data available, and describes some of the outcome research in progress.