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Journal of Psychoactive Drugs

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The Matrix Model of Outpatient Stimulant Abuse

Treatment: History and Description
a b a b b c
Jeanne L. Obert , Michael J. McCann , Patricia Marinelli-Casey , Ahndrea Weiner
b a b d b
, Sam Minsky , Paul Brethen & Richard Rawson
a
Matrix Institute on Addictions, Los Angeles
b
CSAT Methamphetamine Treatment Project
c
Matrix Institute on Addictions, San Fernando Valley, California
d
Matrix Institute on Addictions, Rancho Cucamonga, California

To cite this article: Jeanne L. Obert , Michael J. McCann , Patricia Marinelli-Casey , Ahndrea Weiner , Sam Minsky , Paul
Brethen & Richard Rawson (2000): The Matrix Model of Outpatient Stimulant Abuse Treatment: History and Description,
Journal of Psychoactive Drugs, 32:2, 157-164

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 The Matrix Model of Outpatient
Stimulant Abuse Treatment:
History and Description?

Jeanne L. Obert, M.F.T., M.S.M.*; Michael J. McCann, M.A.**;

Patricia Marinelli-Casey, Ph.D.***; Ahndrea Weiner, M.S.*** *;
Downloaded by [National Cheng Kung University] at 14:36 10 April 2013

Sam Minsky, M.A.*****; Paul Brethen, M.A.****** & Richard Rawson, Ph.D.*******

Abstract-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.

Keywords-addiction, methamphetamine, outcome, treatment

The cocaine epidemic, as it first appeared in the United
States in the early 1980s, emerged as a problem impacting
middle-class Americans and the private treatment system.
The influx of these patients into the private treatment sys-
tem contrasted sharply with the waves of public sector
patients swept into community-based, drug-free counseling
clinics and methadone treatment programs by earlier drug
epidemics. Treatment interventions that were appropriate
?This research was supported by grants # TI 11440-01, TI 11427-
01, TI 11425-01, TI 11443-01, TI 11484-01,TI 11441-01,TI 11410-01,
and TI 11411-01 from the Center for Substance Abuse Treatment,
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services. Center for Substance Abuse
Treatment. Contents are solely the responsibility of the authors and do
not necessarily represent the official views of the Center for Substance
Abuse Treatment.
*Executive Director, Matrix Institute on Addictions, Los Angeles;
Director of Clinical Training, CSAT Methamphetamine Treatment Project.
**Director of Research, Matrix Institute on Addictions, Los Angeles;
Principal Investigator, Costa Mesa Site, CSAT Methamphetamine
Treatment Project.
***Project Director, CSAT Methamphetamine Treatment Project.
for private, primarily alcoholic patients in the traditional
28-day hospital programs and in the offices of mental health
professionals were ineffective for these stimulant abusers.
Traditional inpatient treatment was not medically neces-
sary and traditional outpatient psychotherapy was neither
effective nor relevant.
The Matrix model was one of the integrated outpatient
substance abuse treatment programs that developed in
response to these new patients. These programs sought to
****Clinical Director, Matrix Institute on Addictions, San Fernando
Valley, California; Clinical Trainer, CSAT Methamphetamine Treatment
Project.
*****Clinical Research Trainer, Matrix Institute on Addictions, Los
Angeles; Clinical Trainer, CSAT Methamphetamine Treatment Project.
******Administrative Director, Matrix Institute on Addictions,
Rancho Cucamonga, California.
********Associate Director, UCLA Integrated Substance Abuse
Programs; Co-Prinicipal Investigator, CSAT Methamphetamine Treatment
Project.
Please address correspondence and reprint requests to Jeanne L.
Obert, M.F.T., M.S.M., the Matrix Institute on Addictions, 12304 Santa
Monica Blvd., Suite 200, Los Angeles, California 90025.

Journal of Psychoactive Drugs Volume 32 (2), April -June 2000

 Obert et al.
incorporate materials from numerous disciplines into treat-
ment protocols that addressed the specific needs of stimulant
abusers in outpatient treatment settings.
The developers of the Matrix model were committed
to using empirically-based findings as the basis for choos-
ing which interventions would be incorporated into the
treatment model. In addition, treatment approaches were
evaluated with regard to practical utility as opposed to theo-
retical or ideological considerations.
ELEMENTS OF EFFECTIVE
OUTPATIENT TREATMENT
Engagement and Retention
The relationship between the patient and the therapist
is central to the success of therapy. One cannot success-
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fully treat drug users on an outpatient basis if they cease
coming into the clinic. Therapists are trained to conduct
treatment sessions in a way that promotes the patient's self-
esteem, dignity, and self-worth. Establishing and
maintaining a positive relationship in a model that relies
primarily on a group therapy modality requires skill and
therapeutic sophistication. Therapists who are recovering
themselves andlor who rely primarily on their own inpatient
or residential recovery experiences need training to be able
to create a truly nonjudgmental, nurturing recovery rela-
tionship. Maintaining a professional, supportive attitude in
the face of a relapsing patient is not an easy job but it is
essential to delivering effective outpatient treatment. In the
Matrix treatment model the therapist functions simulta-
neously as teacher and coach, fostering a positive,
encouraging relationship with the patient and using that
relationship to reinforce positive behavior change. The
interaction between the therapist and the patient is realistic
and direct but not confrontational or parental.
Structure
Time planning and scheduling during early recovery
serve several purposes. In addition to eliminating blocks of
free time and helping patients stay busy, the process of
scheduling also allows patients to evaluate activities for their
relapse potential prior to engaging in them. When the sched-
uling activity is done in group, it allows the therapist to see
what life outside the therapy office is like for any individual
patient and whether the chosen activities create a safe and
balanced lifestyle at any given point in the recovery pro-
cess. Patients are asked to record on a schedule card or sheet
of paper exactly what they plan to do for each portion of
the next day. Simplified schedules can be used in instances
where the skill of scheduling is new and unfamiliar.
Patients should not be asked to schedule more than two or
three days at a time and therapists should follow up with
those learning the skill to see whether they were able to
follow the plan. This exercise needs to be presented as a
Journal of Psychoactive Drugs
The Matrix Model of Outpatient Stimulant Abuse Treatment
skill to be learned not just for present use but also for
future use during stressful or dangerous periods.
Information
Methamphetamine users often enter treatment feeling
and acting very paranoid and sometimes psychotic. They
do not associate these feelings or the feelings of anger,
impulsivity, hostility, sexual compulsivity or cognitive
impairment with their drug use. The overwhelming condi-
tioned cravings that develop from methamphetamine abuse
result in patients feeling completely out of control of the
situation and of their lives. They are frightened, defensive
and often deeply ashamed. The intervention that can pro-
vide the most immediate relief from all of the above is the
imparting of information. Initially that process needs to
occur in short, simple sentences. During the first few days
and weeks of MA abstinence, more comprehensive expla-
nations cannot be tolerated or understood. As the drug's
effects begin to diminish, patients can benefit from more
complicated and detailed explanations of how the addic-
tion may have occurred and what effects the drug might
have had. The Matrix model has standard psychoeducational
lectures that explain those processes in terms that patients
and their families can understand.
Relapse Prevention
Originally developed by Alan Marlatt and Thomas
Gordon (1985) relapse prevention techniques teach patients
to recognize high-risk situations for substance use, to imple-
ment coping strategies when confronted with high-risk
events, and to apply strategies to prevent a full-blown
relapse should an episode of substance use occur. This
approach also allows staff and patients to identify and
react to signs of impending relapse. Recovering co-
leaders and group members who are doing well can share
their experiences with those patients who are struggling
with relapse issues.
Family Involvement
Family systems research indicates that if you have not
engaged the system and do not have it working with you,
it will work against you (Kaufman 1994). The involve-
ment and attitudes of the patient's significant friends and
family members will either enhance or interfere with the
therapeutic effort. The more family members understand
the processes of addiction and of recovery, the more real-
istic their attitudes and expectations will become. Engaging
significant others in the treatment process is often diffi-
cult. Patients rarely see the benefit of such involvement
and will often sabotage any efforts in that direction. Fam-
ily members are often angry and tired of struggling with
the addiction. They are either relieved to feel that the prob-
lem now belongs to the therapist and they no longer have
to be involved or they fear that the addict will outsmart the
Volume 32 (2). April - June 2001
 Obert et al.
therapist and so make every effort to prevent that by
attempting to control the recovery process. Either of these
extremes will result in a diminished prognosis for a long-
term recovery. The therapist who is able to engage the
family in the appropriate parts of the program while main-
taining rapport with the patient will earn and maintain the
family's trust and optimize the chance of a successful
recovery.
Self Help Involvement
In actual practice, the reality is that professional treat-
ment is time limited. AA meetings are widely available,
are free of charge, and provide a place where recovering
people can meet others who are dealing with many of the
same issues. It makes sense for patients to use the meet-
ings as an ongoing resource if they find them beneficial.
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Treatment providers who encourage patients to access this
resource and who provide interventions that may serve to
make the meetings more palatable are doing patients a ser-
vice. The Matrix model subscribes to this approach, and
the protocols include topics designed to familiarize patients
with this resource.
Urinalysis/Breath Testing
Random urine testing conducted weekly is an impor-
tant part of the structure in any outpatient treatment
program. The issue of whether or not the therapist trusts
the patient is irrelevant here. Trusting that relapse won't or
couldn't happen is being nai've about the realities of drug
abuse treatment. It is not unusual for patients to have diffi-
culty being forthright about slips and relapses even though
there are no punitive responses to positive tests in this
model. The addition of urine testing provides the therapist,
family members and the patient with tangible proof that
relapse has not occurred. Positive tests should be viewed
as indicators that the treatment plan needs adjusting, rather
than serving as proof of treatment failure. Referral sources,
family members, and patients entering treatment need to
be educated about the role of urinalysis and breath testing
in an outpatient setting. Breath-alcohol tests are recom-
mended because of the tendency of stimulant users to also
use alcohol or marijuana.
MATRIX MODEL PROTOCOLS-
DEVELOPMENT AND COMPONENTS
The original Matrix protocol for outpatient stimulant
abuse treatment was developed in the early eighties in
response to an overwhelming demand for cocaine abuse
treatment. The development of the written protocol was
funded by a Small Business Innovative Research grant
offered through the National Institute on Drug Abuse
(Rawson et al. 1989). The design of the program started
with six months of active treatment, during which the
Journal of Psychoactive Drugs
The Matrix Model of Outpatient Stimulant Abuse Treatment
patient attended the clinic three to four times each week.
Those visits consisted of 56 individual sessions (including
conjoint sessions with family members), a weekly relapse
prevention group, a weekly family education group, drug
and alcohol testing, and family groups for family mem-
bers. The cocaine-specific treatment manual was followed
by compatible versions for primary alcohol and opiate
users (Rawson, Obert & McCann 1995; Rawson et al. 1992;
Rawson et al. 1991a). Due to compelling economic pres-
sures to shorten the intensive phase of treatment, the
treatment protocol was revised to a program of 16 weeks
duration with increased group sessions, decreased indi-
vidual sessions and no family groups (although the family
education group was retained as a central component). The
schedule of the 16-week program is delineated in Figure 1.
This treatment model is presently being evaluated in a na-
tional, collaborative, multisite clinical trial by the Center
for SubstanceAbuse Treatment (as described in this issue).
Individual Sessions
The individual sessions were once the primary treat-
ment component of the Matrix model. While they are now
limited to three full 45-minute sessions in a 16-week treat-
ment episode, they remain critical to the development of
the crucial relationship between the patient and the thera-
pist. The content of the individual sessions is primarily
concerned with setting and checking on the progress of the
patient's individual goals. These sessions can be combined
with conjoint sessions, including significant others in the
treatment planning. Extra sessions are sometimes neces-
sary during times of crisis to change the treatment plan.
These individual sessions are the glue that ensures the con-
tinuity of the primary treatment dyad and, thereby, retention
of the patient in the treatment process.
Early Recovery Groups
With the elimination of some of the individual ses-
sions from the treatment protocol, there was a need for early
skill-building sessions done in relatively small groups. The
early recovery groups were born out of this need. People
who are in the first month of recovery or who need extra
tutoring in how to stop using are able to attend these groups.
The purpose of the group is to teach patients (1) how to use
cognitive tools to reduce craving, (2) how to schedule their
time, and (3) about the need to discontinue use of second-
ary substances, and also (4) to connect patients with
community support services necessary for a successful re-
covery. The reduced size of the groups allows the therapist
to spend more individual time with each patient who is
learning these critical early skills and tasks. Patients who
destabilize during treatment are often encouraged to return
to the early recovery group until they restabilize. When
possible, the therapist will invite patients with longer-term
sobriety to serve as coleaders in this group to share their
Volume 32 (2). April -June 2000
 Obert et al. The Matrix Model of Outpatient Stimulant Abuse Treatment

FIGURE 1
Intensive Outpatient Program Schedule

Week Monday 'hesday Wednesday Thursday Friday Saturday

& Sunday
Weeks 6-7 pm I 7-8:30 pm I 6-7 pm
1 Early I Family I Early
Through Recovery I Education I Recovery
4 Skills I Group I Skills 12-Step

7-8:30 pm I I 7-8:30 pm
Relapse I I Relapse Meetings
Prevention I I Prevention
Group I I Group

and Other
Weeks 7-8:30 pm 12-Step 7-8:30 pm 12-Step 7-8:30 pm
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5 Relapse Meeting Family Meeting Relapse

Through Prevention Education Group I Prevention
16 Group I or I Group Recovery
Transition I
Group I

Weeks I 7-8:30 pm I Activities

17 I Social I
Through I Support I
52 I I
Urine testing and breath-alcohol testing are conducted weekly.
One individual session is included in each of the program phases.

experience and hope with those who are just beginning the
process.
Relapse Prevention Groups
As indicated in Figure 1, the relapse prevention groups
occur at the beginning and end of each week from the be-
ginning of treatment through Week 16. They are the central
component of the Matrix treatment package. They are open
groups run with a very specific format for a very specific
purpose. Most patients who have attempted recovery will
agree that stopping use of a drug is not that difficult; it is
staying stopped that makes the difference. These groups
are the means by which patients are taught how to stay in
sobriety.
The purpose of the relapse prevention groups is to pro-
vide a setting where information about relapse can be
learned and shared. Thirty-two topics have been included
in the protocols to be used in this setting. The topics are
focused on behavior change, changing the patient's cogni-
tivetaffective orientation, and dealing with connecting
patients with 12-Step support systems. Each group is struc-
tured with a consistent format during which: (1) patients
are introduced if there are new members; (2) patients give
an up-to-the-moment report on their progress in recovery;
(3) patients read the topic of the day and relate it to their
own experience; and (4) patients share their schedules,
plans, and commitment to recovery from the end of group
until the group meets again. Input and encouragement from
other group members is solicited but the group leader does
not relinquish control of the group or promote cross talk
about how each member feels about what the others have
said. The therapist maintains control and keeps the groups
topic-centered and positive, with a strong educational ele-
ment. Care is taken not to allow group members to share
graphic stories of their alcohol and other drug use. Thera-
pists specifically avoid allowing the groups to become
confrontational or extremely emotional. Whenever possible
the use of a coleader who has at least six months of recov-
ery is employed. The coleader serves as a peer support
person who can share his or her own recovery experiences.
Family Education Sessions
The 12-week series is presented to patients and their
families in a group setting using slide presentations, vid-
eotapes, panels, and group discussions. The educational
component includes such program topics as: (a) the biology
of addiction, describing concepts such as neurotransmit-
ters, brain structure and function and drug tolerance;
(b) conditioning and addiction, including concepts such
as conditioned cues, extinction, and conditioned abstinence;

Journal of Psychoactive Drugs 160 Volume 32 (2), April - June 200(

 Obert et al.
(c) medical effects of stimulants on the heart, lungs, repro-
ductive system and brain; and (d) addiction and the family,
describing how relationships are affected during addiction
and recovery. Successfully engaging families in this com-
ponent of treatment can significantly improve the probability
of retaining the primary patient in treatment for the entire
16 weeks.
12-Step Meetings
The optimal arrangement is to have a 12-Step meeting
on site at the treatment center one night each week. This
meeting does not have to be an official meeting. Rather, the
patients presently in treatment and graduated members can
conduct an "Introduction to 12-Step Meetings" using the
same format as an outside meeting, with the purpose of ori-
enting patients unfamiliar to the meetings in a safe setting
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with people they already know. Attending these meetings
often makes going to an outside meeting for the first time
much easier and less anxiety-provoking. These meetings,
along with outside 12-Step meetings chosen by patients and
the social support group provide strong continuing support
for graduated group members.
Social Support Group
Designed to help patients establish new nondrug-re-
lated friends and activities, these groups are less structured
and topic-focused than the relapse prevention groups.
Patients begin the groups during the last month in treat-
ment at the end of the family education series, in order to
ensure that they feel connected before they graduate from
the relapse prevention groups. The content of the groups is
determined by the needs of those Members attending. If
patients have relapsed, relapse prevention work may be in
order, unstable patients are given direction to help stabilize
them and patients moving successfully through the stages
of recovery are aided and encouraged to continue with the
lifestyle changes that they are making.
Relapse Analysis
A specific exercise is included in the Matrix protocol
to be used when a patient relapses unexpectedly or repeat-
edly and does not seem to understand the causes of the
relapses. The optional exercise and forms are designed to
help the therapist and the patient understand the issues and
events that occurred preceding the relapse(s) in order to
help prevent future relapses. This exercise is typically con-
ducted during an individual session with the patient and
possibly a significant other.
Urine Tests
Urine testing is done randomly on a weekly basis. Posi-
tive urine tests revealing previously undisclosed drug use
serve as points of discussion rather than incrimination.
Patients struggling with secondary drug or alcohol use
should also be tested for those substances.
Journal of Psychoactive Drugs
The Matrix Model of Outpatient Stimulant Abuse Trratment
EVALUATIONS OF THE MATRIX MODEL
Pilot Study
Several evaluations of the Matrix model have been
conducted over the past 15 years. These range from open
trials with few controls to controlled clinical trials. The
earliest of these was a pilot study conducted in 1985 which
documented the clinical progress of 83 cocaine abusers at
eight months following treatment admission (Rawson et
al. 1986). During an evaluation session, patients self-
selected either: no formal treatment (with voluntary
involvement in Alcoholics Anonymous, Cocaine Anony-
mous, or Narcotics Anonymous); 28-day inpatient
treatment; or the Matrix model outpatient treatment. An
independent research assistant was hired to conduct tele-
phone follow-up interviews inquiring into drug and alcohol
use and participation in aftercare and self-help.
There were no demographic or drug use differences
among the patients prior to beginning treatment.'The hos-
pital patients received 26.5 of 28 days of treatment and the
Matrix patients received 21.6 of 26 weeks. By contrast,
only 20% of the no formal treatment patients ever attended
more than one self-help meeting. The most noteworthy
finding of this pilot study were reports of significantly less
cocaine use by the Matrix patients at eight months after
treatment admission. The number of patients reporting a
return to monthly or more frequent cocaine use in the
Matrix group was four of 30, compared to 10 of 23 in the
inpatient group, and 14 of 30 in the no formal treatment
group.
Another finding from this study was that patients in
all conditions were significantly more likely to return to
cocaine use if they continued to drink alcohol (of those
who drank alcohol, 50% relapsed to cocaine use; of those
who did not drink, only 6% relapsed; x2=10.70, d&2,
p<.05). Similarly, there was a 59% relapse rate among
marijuana smokers compared to 20% among nonsmokers.
Although the quasi-experimental nature of this evaluation
and the small numbers of subjects per cell limit the degree
to which strong conclusions may be drawn, the findings
did provide some support for the Matrix model and also
were a basis for altering treatment materials to prescribe
total abstinence as a necessary tactic for preventing relapse
to cocaine.
Open Trial Study
In two of the Matrix offices in Southern California an
open trial was conducted with 486 cocaine users who
received treatment between 1986 and 1990 (Rawson et al.
1991b). Patients were in treatment either in Beverly Hills
(n=314) or in Rancho Cucamonga (n=172). In the Beverly
Hills office, which had a mainly middle class population,
the source of funding for treatment was out of pocket or
insurance for 85%. By contrast, in the Rancho Cucamonga
only 20% self-paid or used insurance, while 80% were
Volume 32 (2). April - June 2000
 Obert et al.
funded under a contract with San Bernardino County. The
most striking differences between the two patient groups
were average annual income ($27,900 in Beverly Hills ver-
sus $16,700 in Rancho Cucamonga) and primary route of
administration (5 1% intranasal in Beverly Hills, 65%
smoked in Rancho Cucamonga).
In each location, 88% of weekly urinelself-reports were
negative for stimulants during the six-month intensive treat-
ment phase. Although similar urinalysis results were seen
across sites, there were substantial differences in treatment
retention. The Beverly Hills patients averaged over five
months (21.0 weeks) in treatment and 48% completed the
program, while the Rancho Cucamonga patients averaged
three months (13.2 weeks) and only 22% completed the
program. One of the causes for this difference was that 20%
in Rancho Cucamonga dropped out during the first two
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weeks, whereas in Beverly Hills only 8% dropped out dur-
ing this initial period.
This open trial with a relatively large number of
cocaine users further supported the results from the pilot
study, which found that the Matrix model was a viable treat-
ment approach that could retain patients for substantial
treatment episodes. There was a tentative connection be-
tween the duration of treatment and drug use status through
six months of treatment. Further, although there appeared
to be a positive association between patients' socioeconomic
status and treatment retention, this was confounded by a
number of variables including route of administration,
employment status and access to transportation.
The Controlled Trial
Through a funding mechanism called the Small Busi-
ness Innovative Research Program the protocol for the
Matrix model was formalized into a 300-page treatment
manual. After completion of the manual, a controlled trial
of the model was conducted over a two-year period (Rawson
et al. 1995). In this study 100 cocaine-dependent subjects
were randomly assigned to a six-month Matrix treatment
condition or they were referred to "other available com-
munity resources." Subjects assigned to the community
resource group were given detailed information on treat-
ment alternatives in the area and were given a referral and
an appointment time to receive an evaluation at a commu-
nity treatment location. Subjects in both conditions were
scheduled for three, six, and 12-month follow-up evalua-
tions and were paid $25 for each completed follow-up.
Compared to previous Matrix patient samples, these
subjects were more ethnically diverse (27% were African-
American, 23% were Hispanic, and the remainder were
Caucasian). Most (84%) smoked cocaine as the primary
route of administration. At three- and six-month follow-
ups, 40% of the community resource subjects reported
involvement in some formal treatment ranging from out-
patient to hospital treatment. (This treatment condition
proved not to be a useful experimental control because of
Journul cf Psychoactive Drugs
The Matrix Model of Outpatient Stimulant Abuse Treatment
the tremendous heterogeneity of treatment experiences of
these subjects.) Matrix subjects in this trial had a treatment
completion rate (24%) similar to the Rancho Cucamonga
patients in the open trial (22%). These data reinforced the
conclusion that lower income crack smokers are more dif-
ficult to retain in treatment than intranasal cocaine users
with greater social stability and resources.
Both groups of subjects reported significant reductions
in cocaine use over the 12-month study period but there
was not a difference in main effect between the two groups.
However, there was a strong positive relationship between
the amount of treatment received and the percent of
cocaine-negative urine results for the Matrix subjects, but
not for the community resources subjects. Similarly, greater
amounts of treatment participation for the Matrix subjects
were associated with improvement on the AS1 employment
and family scales, and on a depression scale. These post
hoc analyses supported the clinical impression of the coun-
seling staff of an orderly dose-response association between
amount of Matrix treatment and outcome status.
This study supported the Matrix model's clinical util-
ity, but the results did not provide definitive empirical
confirmation of its efficacy. The variability of community
resource subjects' treatments made differential treatment
outcomes undetectable. In addition, failure to employ a
pre-randomization "lead-in" period to screen out applicants
resulted in high rates of attrition in both treatment groups.
This reduced the number of subjects receiving a meaning-
ful dose of treatment and further impaired the identification
of differential treatment outcomes.
Comparison of MA and Cocaine Users' Response
to Matrix Treatment
A review was done of the charts of 500 MA- and 224
cocaine-abusing patients who were treated at the Matrix
Rancho Cucamonga office between 1988 and 1995 i n
order to describe these two patient groups and compare
their responses to Matrix model treatment (Huber et al.
1997). Although there were substantial demographic and
drug history differences, the amount of treatment services
received and the duration of treatment participation, as well
as the frequency of stimulant use (as measured by urinaly-
sis) were virtually identical for the two groups of stimulant
users. Cocaine users remained in treatment an average of
18.0 weeks compared to 17.1 weeks for the MA users. The
percentage of urinalyses positive for the primary drug was
13.3% for cocaine users and 19.3% for MA users (the dif-
ference was not significant). The tentative conclusions from
this chart review were that the Matrix model was equally
well received by cocaine and MA users and both groups
had a very favorable response to treatment.
Follow-up Study on MA Users
A nonrandomly-selected convenience sample of the
first 114 patients located out of the 500 referred to in the
162 Volume 32 (2). April - J u n e 200C
 Obert et al.
report by Huber and colleagues (1997) was followed at two
to five years after treatment (see Rawson et al. In press). In
this CSAT-funded study, 437 potential study candidates were
telephoned by research assistants and asked to come to the
clinic for a follow-up interview. Candidates were informed
that the interview would take approximately 90 minutes and
they would receive $25 in grocery scrip as compensation.
When necessary the interview was performed at a neutral
offsite location, and as a last resort it was done by phone.
Of the total pool of 437, 183 (42%) were located, contacted
and asked to participate. Of the 183, 114 agreed to partici-
pate in the follow-up interview. Data from patient charts
indicated participants were similar to the nonparticipants
on demographics; however they remained in treatment
almost twice as long and gave more MA-free urine samples
during the course of treatment.
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In the follow-up sample there was a significant change
in self-reported MA use in the 30 days prior to treatment
(86% reported use), and 30 days prior to follow-up (17.5%
reported use). The only predictor of nonuse at follow-up
was marital status, with married patients more likely to be
MA nonusers at follow-up. Urine samples were collected
on 46 individuals, and only three (6.5%) were positive for
MA. Of the 54 who had reported daily use at baseline, 39
(72.2%) were abstinent at follow-up.
At treatment admission 26% of the follow-up sample
were employed compared to 62% employed at follow-up.
There was significant reduction in the percentages of par-
ticipants reporting paranoia, however there was not a
reduction in complaints of depression (more than 60%) and
headaches (38.9Y0at baseline and 44.1% at follow-up).
The limitations of the study methodology preclude
conclusions about the specific impact of the Matrix
treatment, and the 114 patients who were followed
were not representative of the entire initial sample of
437. However, despite these limitations, it was dem-
onstrated that many MA users are able to discontinue
MA use following treatment with the Matrix model. Al-
though the empirical evidence in this study was
uncontrolled and descriptive, the promise of the approach
(and lack of empirical evidence for any other methods)
has resulted in a CSAT-sponsored multisite project to
replicate and evaluate the Matrix model treatment with
MA users. This study will compare the outcome of the
REFE
Huber, A,; Ling, W.; Shoptaw, S.J.; Gulati, V.; Brethen, P. & Rawson,
R.A. 1997. Integrating treatments for methamphetamine abuse: A
psychosocial perspective.Journal of Addichve Diseases 16: 41-50.
Kaufman, E. 1994. Family therapy: Other drugs. In: M. Galanter & H.D.
Kleber (Eds.) Textbook of Substance Abuse Treatment. Washington,
D.C.:American Psychiatric Press.
Marlatt, B.A. & Gordon, J.R. 1985. Relapse Prevention. New York:
Guilford Press.
Journal of Psychoactive Drugs
The Matrix Model of Outpatient Stimulant Abuse Treatment
Matrix treatment to "treatment as usual" in community
clinic settings.
SUMMARY AND FUTURE DIRECTIONS
The Matrix model was developed in response to the
cocaine epidemic of the 1980s. The treatment system at
that time offered no relevant and appropriate option to
stimulant users, who generally did not need inpatient treat-
ment and could not relate to alcohol-targeted treatments.
The Matrix model incorporated empirically-supported
treatment elements, including relapse prevention, educa-
tion, and family involvement into a manualized,
nonconfrontational, structured, cognitive/behavioral pro-
gram. The treatment components are relapse prevention
groups, individual counseling sessions, family education
groups, and urine and breathlalcohol testing. Group meet-
ings are guided by written topics and focus on current issues
and activities. The model was broadened to treat alcohol
and opioid dependencies, and manuals were developed
which targeted the specific problems and goals of these
substance use disorders.
Evaluations of the Matrix model have not definitively
established its efficacy, but a review of these studies justi-
fies support for this approach. Cocaine and MA users
benefit from the Matrix model treatment. They respond
positively during treatment and appear, in at least some
cases, to sustain gains for periods of more than two years.
The current multisite trial of the model may provide more
information regarding the its efficacy in general and with
specific patient populations (NativeAmericans, Hawaiians,
women, and drug court patients). As more becomes known
regarding MA-related cognitive impairment, treatment
materials might be modified to accommodate the intellec-
tual and perceptual levels of these patients. For example,
there is some evidence that MA use may result in cogni-
tive impairment that is more pronounced for verbal versus
pictorial memory (Simon et al. In press). Thus, treatment
materials might be more beneficial if they included pic-
tures with the text. Finally, the complement of psychosocial
treatment along with some yet-to-be-determined medica-
tion may result in reduced craving, mood elevation, or
better cognitive functioning, and therefore improved re-
tention and better response to the Matrix model.
Rawson, R.A.; Obert, J.L. & McCann, M.J. 1995. The Matrix Intensive
Outpatient Program Therapist Manual. Los Angeles, California:
The Matrix Center, Inc.
Rawson, R.A.; Huber, A,; Brethen, P.R.;Obert, J.L.;Gulati, V.; Shoptaw,
S.J. & Ling, W. In press. Status of methamphetamine users 2-5
years after outpatient treatment. Journal of Addictive Diseuses.
Rawson, R.A.; Shoptaw, S.J.;Obert, J.L.;McCann, M.J.; Hasson, A.L.;
Marinelli-Casey, P.J.;Brethen, P.R. & Ling. W. 1995. An intensive
Volume 32 (2), April - June 2000
 Obert et al.
outpatient approach for cocaine abuse treatment: The Matrix model.
Journal of Substance Abuse Treatment 12: 117-27.
Rawson, R.A.; Obert, J.L.; McCann, M.J. & Ling,W. 1992. The Matrix
Model for the Treatment of Opioid Addiction with Naltrexone. Los
Angeles, California: The Matrix Center.
Rawson, R.A.; Obert, J.L.; McCann, M.J. &Ling, W. 1991a. The Matrix
Model for the Outpatient Treatment of Alcohol Related Problems.
Los Angeles, California: The Matrix Center.
Rawson, R.A.; Obert, J.L.; McCann, M.J. & Ling, W. 1991b.
Psychological approaches to the treatment of cocaine dependency.
Journal of Addictive Diseases 11: 97-120.
Rawson, R.A.; Obert, J.L.; McCann, M.J.; Smith, D.P. & Scheffey, E.H.
1989. The Neurobehavioral Treatment Manual. Beverly Hills,
California: The Matrix Center.
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Rawson, R.A.; Obert, J.L.; McCann, M.J. & Mann, A.J. 1986. Cocainc
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Monograph No. 67. DHHS Pub. No. (ADM) 86-1448. Rockville
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Simon, S.L.; Domier, C.P.; Carnell, J.; Brethen, P.R.; Rawson, R.A. 8
Ling. W. In press. Cognitive impairment in individuals currentl:
using methamphetamine. The American Journal on Addictions.
Volume 32 (2). April - June 20