Counselor's Treatment Manual - SAMHSA
Counselor’sTreatmentManualMatrix Intensive OutpatientTreatment for People WithStimulant Use Disorders
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Counselor’s TreatmentManualMatrix Intensive Outpatient Treatment forPeople With Stimulant Use DisordersU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services AdministrationCenter for Substance Abuse Treatment1 Choke Cherry RoadRockville, MD 20857
AcknowledgmentsNumerous people contributed to this document, which is part of the Methamphetamine Treatment Project (MTP).The document was written by Jeanne L. Obert, M.F.T., M.S.M.; Richard A. Rawson, Ph.D.; Michael J. McCann,M.A.; and Walter Ling, M.D. The MTP Corporate Authors provided valuable guidance and support on this document.This publication was developed with support from the University of California at Los Angeles (UCLA) CoordinatingCenter through Grant No. TI11440. MTP was funded by the Center for Substance Abuse Treatment (CSAT),Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and HumanServices (HHS). The research was conducted from 1998 to 2002 in cooperation with the following institutions:County of San Mateo, San Mateo, CA (TI11411); East Bay Recovery Project, Hayward, CA (TI11484); FriendsResearch Institute, Inc., Concord, CA (TI11425); Friends Research Institute, Inc., Costa Mesa, CA (TI11443); SaintFrancis Medical Center of Hawaii, Honolulu, HI (TI11441); San Diego Association of Governments, San Diego, CA(TI11410); South Central Montana Regional Mental Health Center, Billings, MT (TI11427); and UCLA CoordinatingCenter, Los Angeles, CA (TI11440). The publication was produced by JBS International, Inc. (JBS), underKnowledge Application Program (KAP) contract numbers 270-99-7072 and 270-04-7049 with SAMHSA, HHS.Christina Currier served as the CSAT Government Project Officer. Andrea Kopstein, Ph.D., M.P.H., served as theDeputy Government Project Officer. Cheryl Gallagher, M.A., served as CSAT content advisor.DisclaimerThe views, opinions, and content of this publication are those of the authors and do not necessarily reflect theviews, opinions, or policies of SAMHSA or HHS.Public Domain NoticeAll materials appearing in this publication except those taken from copyrighted sources are in the public domainand may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source isappreciated. However, this publication may not be reproduced or distributed for a fee without the specific, writtenauthorization of the Office of Communications, SAMHSA, HHS.Electronic Access and Printed CopiesThis publication may be ordered or downloaded from SAMHSA’s Publications Ordering Web page athttp://store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).Recommended CitationCenter for Substance Abuse Treatment. Counselor’s Treatment Manual: Matrix Intensive Outpatient Treatment forPeople With Stimulant Use Disorders. HHS Publication No. (SMA) 13-4152. Rockville, MD: Substance Abuse andMental Health Services Administration, 2006.Originating OfficeQuality Improvement and Workforce Development Branch, Division of Services Improvement, Center for SubstanceAbuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville,MD 20857.HHS Publication No. (SMA) 13-4152First Printed 2006Reprinted 2007, 2008, 2009, 2010, 2011, 2013, and 2014
ContentsI. Introduction to the Matrix Intensive Outpatient Treatment for PeopleWith Stimulant Use Disorders Approach and Package . . . . . . . . . . . . . . . . . . . 1Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Matrix IOP Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2The Role of the Counselor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Working With Client Co-Leaders and Client–Facilitators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7The Matrix IOP Package . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Introduction to the Counselor’s Treatment Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9II. The Role of Drug and Breath-Alcohol Testing in Matrix IOP . . . . . . . . . . . . . . 11Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Addressing a Positive Urine Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12III. Individual/Conjoint Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Session 1: Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Session 2: Client Progress/Crisis Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Session 3: Continuing Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Handouts for Individual/Conjoint Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22IV. Early Recovery Skills Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Session 1: Stop the Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Session 2: Identifying External Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Session 3: Identifying Internal Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Session 4: Introducing 12-Step or Mutual-Help Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Session 5: Body Chemistry in Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Session 6: Common Challenges in Early Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50Session 7: Thinking, Feeling, and Doing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Session 8: 12-Step Wisdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55iii
Counselor’s Treatment Manual: Matrix Intensive Outpatient TreatmentHandouts for Early Recovery Skills Group Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56V. Relapse Prevention Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Session 1: Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92Session 2: Boredom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Session 3: Avoiding Relapse Drift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Session 4: Work and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Session 5: Guilt and Shame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100Session 6: Staying Busy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102Session 7: Motivation for Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Session 8: Truthfulness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106Session 9: Total Abstinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Session 10: Sex and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Session 11: Anticipating and Preventing Relapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112Session 12: Trust. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Session 13: Be Smart, Not Strong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116Session 14: Defining Spirituality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118Session 15: Managing Life; Managing Money . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120Session 16: Relapse Justification I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Session 17: Taking Care of Yourself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Session 18: Emotional Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Session 19: Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Session 20: Recognizing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130Session 21: Relapse Justification II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133Session 22: Reducing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136Session 23: Managing Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138Session 24: Acceptance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140Session 25: Making New Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142Session 26: Repairing Relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144Session 27: Serenity Prayer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146Session 28: Compulsive Behaviors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148iv
ContentsSession 29: Coping With Feelings and Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Session 30: 12-Step and Mutual-Help Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Session 31: Looking Forward; Managing Downtime. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156Session 32: One Day at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Elective Session A: Client Status Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160Elective Session B: Holidays and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162Elective Session C: Recreational Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Handouts for Relapse Prevention Group Sessions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165VI. Social Support Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233Social Support Group Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234AppendicesAppendix A. The Methamphetamine Treatment Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243Appendix B. Notes on Group Facilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245Appendix C. Sample Agreement for Co-Leaders and Client–Facilitators . . . . . . . . . . . . . . . 247Appendix D. Acronyms and Abbreviations List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249Appendix E. Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251Appendix F. Field Reviewers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253Appendix G. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255Appendix H. Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257v
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I. Introduction to the Matrix IntensiveOutpatient Treatment for PeopleWith Stimulant Use DisordersApproach and PackageThe Matrix Intensive Outpatient Treatment forPeople With Stimulant Use Disorders (IOP) pack age provides a structured approach for treatingadults who abuse or are dependent on stimulantdrugs. The approach followed in the treatmentpackage was developed by the Matrix Institute inLos Angeles, California, and was adapted for thistreatment package by the Knowledge ApplicationProgram of the Center for Substance AbuseTreatment of the Substance Abuse and MentalHealth Services Administration (SAMHSA). TheMatrix IOP package comprises five components: Counselor’s Treatment Manual (thisdocument) Counselor’s Family Education Manual CD-ROM that accompanies theCounselor’s Family Education Manual Client’s Handbook Client’s Treatment CompanionThe Matrix IOP model and this treatment pack age based on that model grew from a need forstructured, evidence-based treatment for clientswho abuse or are dependent on stimulant drugs,particularly methamphetamine and cocaine. Thiscomprehensive package provides substanceabuse treatment professionals with an intensiveoutpatient treatment model for these clients andtheir families: 16 weeks of structured program ming and 36 weeks of continuing care.BackgroundThe Matrix IOP method was developed initially inthe 1980s in response to the growing numbersof individuals entering the treatment system withcocaine or methamphetamine dependence astheir primary substance use disorder. Many tradi tional treatment models then in use were devel oped primarily to treat alcohol dependence andwere proving to be relatively ineffective in treatingcocaine and other stimulant dependence (Obert etal. 2000).To create effective treatment protocols forclients dependent on stimulant drugs, treatmentprofessionals at the Matrix Institute drew fromnumerous treatment approaches, incorporatinginto their model methods that were empiricallytested and practical. Their treatment modelincorporated elements of relapse prevention,cognitive–behavioral, psychoeducation, andfamily approaches, as well as 12-Step programsupport (Obert et al. 2000).The effectiveness of the Matrix IOP approach hasbeen evaluated numerous times since its incep tion (Rawson et al. 1995; Shoptaw et al. 1994).SAMHSA found the results of these studies prom ising enough to warrant further evaluation (e.g.,Obert et al. 2000; Rawson et al. 2004).In 1998, SAMHSA initiated a multisite study oftreatments for methamphetamine dependenceand abuse, the Methamphetamine Treatment1
Counselor’s Treatment Manual: Matrix Intensive Outpatient TreatmentProject (MTP). The study compared the clinicaland cost effectiveness of a comprehensivetreatment model that follows a manual developedby the Matrix Institute with the effectivenessof treatment approaches in use at eightcommunity-based treatment programs, includingsix programs in California, one in Montana, andone in Hawaii. Appendix A provides moreinformation about MTP.Matrix IOP ApproachOverviewThe Matrix IOP approach provides a structuredtreatment experience for clients with stimulantuse disorders. Clients receive information, assis tance in structuring a substance-free lifestyle,and support to achieve and maintain abstinencefrom drugs and alcohol. The program specificallyaddresses the issues relevant to clients who aredependent on stimulant drugs, particularly meth amphetamine and cocaine, and their families.For 16 weeks, clients attend several intensiveoutpatient treatment sessions per week. Thisintensive phase of treatment incorporatesvarious counseling and support sessions: Individual/Conjoint family sessions(3 sessions) Early Recovery Skills group sessions(8 sessions) Relapse Prevention group sessions(32 sessions) Family Education group sessions(12 sessions) Social Support group sessions(36 sessions)2Clients may begin attending Social Supportgroups once they have completed the 12 session Family Education group but are stillattending Relapse Prevention group sessions.Overlapping Social Support group attendancewith the intensive phase of treatment helpsensure a smooth transition to continuing care.The Matrix IOP method also familiarizes clientswith 12-Step programs and other support groups,teaches clients time management and schedul ing skills, and entails conducting regular drugand breath-alcohol testing. A sample schedule oftreatment activities is shown in Figure I-1.Program ComponentsThis section describes the logistics and philosophyof each of the five types of counseling sessionsthat are components of the Matrix IOP approach.Detailed agendas and instructions for conduct ing each type of group and individual sessionare provided in the designated sections of thismanual and in the Counselor’s Family EducationManual.The Matrix materials use step-by-step descriptionsto explain how sessions should be conducted.The session descriptions are methodical becausethe treatment model is intricate and detailed.Counselors who use these materials may wantadditional training in the Matrix approach, butthese materials were designed so that counselorscould implement the Matrix treatment approacheven without training. The Matrix materials donot describe intake procedures, assessments,or treatment planning. Programs should use theprocedures they have in place to perform thesefunctions. If the guidelines presented in thismanual conflict with the requirements of fundersor credentialing or certifying bodies, programsshould adapt the guidelines as necessary. (Forexample, some States require that sessions lasta full 60 minutes to be funded by Medicaid.)
I. IntroductionFigure I-1. Sample Matrix IOP aySaturday andSundayIntensive TreatmentWeeks 1 through 4*6:00–6:50 p.m.Early Recovery Skills7:15–8:45 p.m.Relapse Prevention12-Step/mutual-helpgroup meetings7:00–8:30 p.m.Family Education12-Step/mutual-helpgroup meetings6:00–6:50 p.m.Early Recovery Skills7:15–8:45 p.m.Relapse Prevention12-Step/mutual-helpgroup meetingsIntensive TreatmentWeeks 5 through 16†Continuing CareWeeks 13 through 487:00–8:30 p.m.Relapse PreventionNothing scheduled12-Step/mutual-helpgroup meetings12-Step/mutual-helpgroup meetings7:00–8:30 p.m.Family Educationor7:00–8:30 p.m.Social Support7:00–8:30 p.m.Social Support12-Step/mutual-helpgroup meetings12-Step/mutual-helpgroup meetings7:00–8:30 p.m.Relapse PreventionNothing scheduled12-Step/mutual-helpgroup meetings12-Step/mutual-helpgroup meetings* 1 Individual/Conjoint session at week 1† 2 Individual/Conjoint sessions at week 5 or 6 and at week 16All Matrix IOP groups are open ended, meaningthat clients may begin the group at any pointand will leave that group when they have com pleted the full serie
Relapse Prevention group sessions (32 sessions) Family Education group sessions (12 sessions) Social Support group sessions (36 sessions) Clients may begin attending Social Support groups once they have completed the 12 session Family Education group but are still attending Relapse Prevention group sessions.
Mrs. Rebecca Heinzmann, School Counselor A-Coh Mrs. Christina Head, School Counselor Coi-Go Mrs. Rebecca Heinzmann, School Counselor Gr-K and AICE Mr. Michael Esposita, School Counselor L-Odr Mrs. Holly Arnaud, School Counselor Oe-Sek Ms. Angela Jackson-Miller, School Counselor Sel-Z Mrs. Laura Brewer, School Counselor Moving of Tassels
SAMHSASubstance Abuse and Mental Health Services Administration www.samhsa.gov 1-877-SAMHSA-7 (1-877-726-4727) . www.integration.samhsa.gov Prepared for: SAMHSA-HRSA Center for Integrated Health Solutions Prepared by: . of primary care and behavioral health clinicians, working together wi
SAMHSA Behavioral Health Spanish-Language Resources A chart of selected SAMHSA resources available in English and/or Spanish for Hispanic/Latino populations compiled by SAMHSA’s Office of Behavioral Health Equity October 20, 2020 Name Language Website Contact Options (Phone/Text) Descri
2016 URS Reporting Instructions 1 P a g e Fiscal Year 2016 SAMHSA Uniform Reporting System: Guidelines for Tables Scope of Reporting: Based on the recommendations of the SAMHSA Scope of Reporting Workgroup (comprised of SAMHSA, SMHA, and NRI staff) and input provided b
In an effort to continue the exploration of treatment options for people with OUD, SAMHSA/CSAT, in partnership with NIDA, held a Clinical Advances in Non-Agonist Therapies Meeting at the SAMHSA headquarters on May 11, 2016. It was a
SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. 1-877-SAMHSA-7 (1-877-726-4727) 1-800-487-4889 (TDD) WWW.SAMHSA.GOV. ADVISORY. Crisis interventions are cost-effective, help prevent hospitalizations, and ensure the use of the least
Treatment. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services www.samhsa.gov. . (SAMHSA) by the New Hampshire-Dartmouth Psychiatric Research Center under contract number 280-00-8049 and Westat under contract number 270-03-6005, with SAMHSA, U.S. Department
Recruitment Counselor Guide Recruitment Counselor Implementation Timeline, 8 Recruitment Counselor Implementation Timeline The most successful recruitments are planned far in advance, and the recruitment counselor program is a big aspect of the overall recruitment preparation. Every campus is unique, but the following timeline should help give the
