STAGES OF RECOVERY Drug Court Conference Normal OK

STAGES OF RECOVERY Drug Court Conference Normal, OK. September, 2014 Matrix Institute on Addictions, Sam Minsky, MA, LMFT

THE STAGES OF RECOVERY A ROADMAP © 2006 Matrix Institute

Roadmap for Recovery Withdrawal Early Abstinence/Honeymoon Protracted Abstinence/The Wall Adjustment/Resolution

STAGES OF RECOVERY OVERVIEW DAY DAY 0 15 45 120 tm t n io ut en ol © 2006 Matrix Institute dj us s Re n l al oo al e. W dr aw Th ne ym ith 180 A Ho W DAY

Stages of Recovery - Stimulants WITHDRAWAL STAGE PROBLEMS ENCOUNTERED DAY 0 15 • Medical Problems • Alcohol Withdrawal • Depression • Difficulty Concentrating • Severe Cravings © 2006 Matrix Institute • Contact with Stimuli • Excessive Sleep

MATRIX MODEL TREATMENT Primary Manifestation of Withdrawal Stage Behavioral Cognitive Behavioral Inconsistency Confusion Inability to Concentrate Emotional Relationship Depression/Anxiety. Self-Doubt Mutual Hostility. Fear

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 45 • Over-involvement With PROBLEMS Work ENCOUNTERED • Overconfidence • Inability to Initiate Change © 2006 Matrix Institute • Inability to Prioritize • Alcohol Use • Episodic Cravings • Treatment Termination

MATRIX MODEL Primary Manifestation of Honeymoon Stage Behavioral High Energy. Unfocused Behavior Emotional Overconfidence/ Feeling Cured Cognitive Inability to Prioritize Relationship Denial of Addiction Disorder

MATRIX MODEL Primary Manifestation of the Wall Stage Behavioral Cognitive Sluggish Low Energy/Inertia Relapse Justification Emotional Relationship Depression/Anhedonia Irritability/ Mutual Blaming/Impatience

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 45 120 • Inertia • Depression PROBLEMS • Return to Cocaine Stimuli ENCOUNTERED • Relapse Justification • Cognitive Rehearsal • Treatment Termination © 2006 Matrix Institute • Alcohol Use • Relapse

“The Wall” One Patient’s Account 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. ” © 2006 Matrix Institute

“The Wall” One Patient’s Account 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. ” © 2006 Matrix Institute

“The Wall” One Patient’s Account 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

© 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

Stages of Recovery - Stimulants Adjustment/Resolution Stage DAY 120 180 • Anger PROBLEMS • Guilt ENCOUNTERED • Isolation • Boredom • Vocational Dissatisfaction • Relationship Problems • Overconfidence • Lack of Goals • Underlying Psychopathology resurfaces © 2006 Matrix Institute

MATRIX MODEL Primary Manifestation of Adjustment Stage Behavioral Sloppiness Regarding Limits Cognitive Drifting From Commitment to Recovery Emotional Relationship Experiencing Normal Emotions Surfacing of Long-Term Issues

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 © 2006 Matrix Institute

Traditional View of Psychotherapy for Substance Abuse q Until 1960 psychodynamic oriented psychotherapy was the primary professional approach to substance abuse treatment. q Assumed that substance abuse behavior was a manifestation of underlying psychopathology. q If resolution of underlying psychopathology could be achieved, substance abuse would be lessened.

MATRIX MODEL DIFFERENCES General Psychotherapy q Focus on feelings q Emotional catharsis as a means to gain sobriety q Addiction or abstinence may or may not be discussed q Unmotivated clients are not pursued Matrix Model q Behavioral focus a priority q CBT as a means to laying foundation for recovery q Abstinence is highlighted and tools are discussed q Ambivalent or unmotivated clients are accepted and the norm © 2006 Matrix Institute

MATRIX TREATMENT MODEL Different from General Therapy 1. Focus on behavior vs. feelings 2. Visit frequency results in strong bonding with the counselor and the group 3. This bonding encouraged and utilized 4. Goal is stability (vs. emotional catharsis) © 2006 Matrix Institute

MATRIX TREATMENT MODEL Different from General Therapy 6. Focus is on abstinence 7. Bottom line is always continued abstinence 8. Therapist frequently pursues less motivated clients 9. The behavior is more important than the reason behind it © 2006 Matrix Institute

MATRIX MANUALIZED TREATMENT The Matrix Model q Reduces therapist differences q Ensures uniform set of services q Enhances training capabilities q Facilitates research to practice q Can be more easily evaluated © 2006 Matrix Institute

EVIDENCE BASED THERAPIES (EBT’S) THAT ARE INCORPORATED IN THE MATRIX MODEL Cognitive Behavioral Therapy Family Therapies MATRIX MODEL 12 - Step Facilitation Community Participation © 2006 Matrix Institute Motivational Interviewing Contingency Management

Program Schedule A sample schedule for the Matrix IOP program is illustrated in the following table: INTENSIVE OUTPATIENT PROGRAM SCHEDULE Week Monday Tues. Weeks 1 Through 4 6 -7 PM Early Recovery Skills 7 -8: 30 PM Relapse Prevention 12 -step Meeting Or other community participation Weeks 5 Through 16 7 -8: 30 PM Relapse Prevention Group Weeks 17 Through 52 Wed. 7 -8: 30 PM Family Education Group or Social Support Thurs. Friday Saturday & Sunday 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 7 -8: 30 PM Relapse Prevention Group 7 -8: 30 PM Social Support Urine testing and©breath-alcohol testing conducted weekly 2006 Matrix Institute Ten individual sessions during the first 16 weeks

MATRIX MODEL Organizing Principals STRUCTURE q. Create explicit structure and expectations q. Establish positive, collaborative relationship w/ clients q. Teach information and cognitive-behavioral concepts q. Positively reinforce positive behavior change q. Provide corrective feedback when necessary q. Educate family regarding substance abuse recovery q. Introduce and encourage self-help participation q. Use urinalysis to monitor drug use © 2006 Matrix Institute

MATRIX MODEL Organizing Principals STYLE q Nonjudgmental, supportive attitude q Engagement & Retention q Strong bond with individual counselor or group q Minimal use of confrontation q Use of recovering role models in group q Ability to work with relapse

COGNITIVE BEHAVIORAL THERAPY Key Concepts q. Encouraging and reinforcing behavior change q. Recognizing and avoiding high risk settings q. Behavioral planning (scheduling) q. Coping skills q. Conditioned “triggers” q. Understanding and dealing with craving q. Understanding basic psychopharmacology principles q. Self-efficacy (MI Concept) © 2006 Matrix Institute

TRIGGERS AND CRAVINGS & ROADMAP TO RECOVERY q. Foundation of the Matrix Model & are 2 of the FAM ED topics q. Material needs to be learned by the counselor so they can teach it to the clients. q. Information is woven through all the topics q. Clients will begin speaking the language of the model and integrating it into their recovery ning o i t c n nd Fu a y r t hemis C n i a Br Class ic Cond al it Cogn ioning & it Beha ive vi Thera or py Stages of Recovery