Finding Help: The Matrix Model

Finding Help: The Matrix Model

by | Jul 8, 2024 | Articles, Counselling, Therapeuo, Treatment Modalities

The Matrix Model is a highly structured 16 week program originally developed in the 80’s to treat stimulant dependent users. It was originally developed as a response to the growing problem of cocaine addiction and is still one of the most effective approaches in the treatment of stimulant (eg. cocaine and methamphetamine) abuse. During a time where most rehabilitation programs and centers were geared towards addressing heroin and alcohol abuse, focusing on 28 day in patient programs and relying heavily on the twelve step fellowships, the Matrix model was thought to be a more targeted approach to benefit this new group of users who had started showing up at treatment facilities all over Southern California.

Built on empirical evidence from clinical studies this mode of treatment has been proven to be effective in reducing the use of alcohol and substance abuse as well as improvements in psychological indicators.

Where many other treatment plans find their basis in a singular psychological orientation, the Matrix Model is an integrative approach which makes use of a variety of treatment styles and methods.

This includes CBT (Cognitive Behavioral Therapy), motivational interviewing, behaviorism, supportive person centred therapy, family/couples/marriage counseling, group therapy with an emphasis on social skills and twelve step fellowship meetings.

Being highly integrative and adaptable the Matrix Model can be customized to suit the individual client. Incorporating the most effective tools and facets of various approaches this treatment model is proven to be highly successful in treating those who are new to recovery and those who have not found other approaches helpful.

The methods are tried and tested for their appropriateness and effectiveness in the population being treated.

The focus of this treatment model is to teach individuals about addiction and recovery, to prevent relapse and to teach social skills, especially within a drug-free environment. This approach also encourages family members to participate in the recovery of their loved through education and counseling – whether group, family, marriage or individual counseling.

Relapse prevention and contingency management is often prioritized. In contrast to alcoholics, those who use cocaine or other stimulants often have shorter histories of use, experience periods of abstinence followed by relapse and are generally not in denial of their addiction. Since the craving the client experiences for the stimulant in question can be so overwhelming contingency management and relapse prevention is a key issue in this approach to therapy.

To encourage participation and program compliance this outpatient program also includes weekly drug testing over the course of the 16 week period to monitor and assess recovery progress.

The most common incarnation of this treatment model is as an outpatient program meaning that clients will come in weekly to the treatment facility or provider and then return home.

Some studies have observed:

  • A 1985 pilot study found that users who chose the Matrix Model program over a 28-day inpatient hospital program or a 12-step group showed lower rates of cocaine use 8 months after they were treated, compared to those who participated in those other types of treatment.
  • Another study of methamphetamine users who were treated using the Matrix Model found that this group had significantly reduced their meth and other drug use 2 to 5 years after treatment. Many of these people also had also become gainfully employed and stayed out of jail.
  • A 48-session alternative Matrix Model program for gay and bisexual men who abused methamphetamines found those who participated were less likely engage in risky sexual behaviors (due to their reductions in drug use), an important factor in preventing the spread of HIV.

The Matrix model can also, as previously asserted, be adapted to treat other substance use disorders as well.

A Matrix Model therapist must be properly acquainted and familiar with a variety of styles and therapeutic methods while also being adaptable.

The most appropriate kind of therapist/counselor would be someone who is experienced in CBT, motivational interviewing and the physiology as well as pharmacology of addiction.

Since this treatment model is non-confrontational the therapist will often take on the role of a teacher or coach, and it will be his/her duty to create a safe space – free of judgement – an environment based on openness and positivity. Empathy and a solid understanding of the clients needs is of the utmost importance.

The therapist facilitates group, individual and family counseling sessions, encourages attendance and participation in 12 step groups, engages the client in notions of CBT to understand connections between thoughts, feelings and behaviors as well as coordinating with other therapists and social services to see to the needs of the client.

The therapist is also there to praise and reward desired behavior and to provide consistency and structure to the client’s recovery journey.

Since this is an intensive program it would require that the client participates daily – attending formal therapy more or less three days a week and informal treatment like fellowship meetings on every other day.

The main components of the program are as follows:

Individual Therapy Sessions: These sessions often involve treatment planning and checking in to assess the client’s progress in the program. It may also invole family members or significant others.

Early Recovery Groups: These groups are for individuals in the first few months of sobriety and aims to build a support community for the recovering addict while also teaching valuable social skills and coping mechanisms.

Relapse Prevention Groups: In these sessions users focus on learning strategies to maintain their sobriety. These groups are very organized and the curriculum includes 32 different topics on preventing relapse. Such as changing behavioral patterns, altering ways of thinking and getting involved in 12 step fellowships.

Family Education: Usually facilitated as a therapeutic group, these sessions take place over the course of 12 weeks and teach family members about the physiology of addiction, the health affects of drugs, the conditioning of addiction and the effects of addiction on the family.

Social Support Groups: In the last month of treatment the client will attend these group sessions to focus on finding drug-free activities and healthier drug-free relationships.

Twelve Step Meetings: An integral part of most approaches to the treatment of SUD is introducing participants to the 12 steps and encouraging them to attend meetings. Some programs even have onsite meetings.

CBT/Cognitive Behavioral Therapy: CBT is a type of therapy which aims to help users understand how their thoughts influence their behavior. They learn how to replace negative thoughts that can lead to self-destructive behaviors with positive thoughts and healthier behaviors.

Motivational Interviewing: A counseling technique which is used to identify the users motivation for getting clean and make positive changes in their life. The therapist/client relationship is a partnership, and this technique is used to bolster rapport, overcome their resistance to quiting drugs and to encourage the client to engage in their recovery.

Contingency Management: This strategy rewards drug free behavior – such as attending 12 step meetings – or withholding rewards or even implementing consequences for drug-using behaviors – for example, failing a drug test or not taking prescribed medication.

Progress in terms of the program is monitored through goals set during individual sessions as well as random weekly drug testing. The drug testing is imperative to keeping the client accountable and to reward sobriety – it is never used to punish or break down a user.

A failed drug test may indicate the need for more structure in the program.

As stated before, this program is highly adaptable and can be used in a variety of settings and circumstances to provide the appropriate treatment for the individual.

If you need help finding a facility or treatment center you can contact us today.

We are always willing to help you find the right help.

You are not alone.

If you or a loved one is struggling with drug or alcohol addiction phone us today on 0653703806.

 

Stages of Change: The Transtheoretical Model

Stages of Change: The Transtheoretical Model

by | Jun 10, 2024 | Counselling, Therapeuo, Treatment Modalities

Change does not happen over night – it is usually a process.

Developed by Prochaska, Di Clemente and colleagues first proposed the Transtheoretical model in the late 1970’s and drew from various theories and schools of psychotherapy. It evolved as they studied and compared the experiences of smokers who quit on their own and those who required further treatment. It was an attempt to understand why certain individuals were capable of quitting on their own.

In the end it was established that people quit smoking when they are ready to do so.

The Transtheoretical Model focuses on the processes and stages involved in the decision making of the individual. It can be seen as a model of intentional change.

The assumption is that people do not just wake up one morning and change behaviors or thinking patterns – there is no quick fix and decisions often take some time. Change occurs, especially in terms of habitual behaviour, over time through a continuous, cyclical process.

The Transtheoretical Model, or TTM, has proven effective in helping with smoking cessation, treatment of alcohol abuse and the reduction of domestic violence. It has also been used to encourage compliance in hypertension mediation, and in regards to condom use under at risk populations, organ donation and needlesharing.

This model is highly adaptable and therefore has been used in a variety of settings. It can be adapted to the needs of the individual.

It is used by health promotion organizations, hospitals, addiction programs and corporate settings. TTM is considered the dominant model in the field of behaviour change, although it has received some criticism. These criticisms do seem to be more in regards to the more practical applications of the model, but for our purposes – that is to understand the decision making process of the addict or alcoholic, it proves sufficient.

The model relies on four key core constructs, self-efficacy, decisional balance, the stages of change and the processes of change.

For an individual to progress through the changes of stage the following needs to happen:

Self-Efficacy – The individual must have confidence that they can in fact make and maintain the change in situations where the temptation of relapse exists.

Decisional Balance – the individual must have a growing awareness that the advantages of the target behavior outweigh the disadvantages thereof.

Processes of Change – Strategies to help the individual make and maintain the change.

Stages of Change

In the Transtheoretical model change is considered a process involving progress through various stages. (Prochaska, 1997)

This means an individual will move from one stage to the next until action is eventually taken and maintained. Although researchers have tried to quantify this progression in terms of a time-frame it is often the most critiqued facet of the model. Because some individuals can take longer in making a decision, or act quicker, it is near impossible to accurately put a time-frame to the process.

The Stages of Change as proposed by Prochaska are:

  • Precontemplation (“not ready”) – “People are not intending to take action in the foreseeable future, and can be unaware that their behaviour is problematic”
  • Contemplation (“getting ready”) – “People are beginning to recognize that their behaviour is problematic, and start to look at the pros and cons of their continued actions”
  • Preparation (“ready”) – “People are intending to take action in the immediate future, and may begin taking small steps toward behaviour change”
  • Action – “People have made specific overt modifications in modifying their problem behaviour or in acquiring new healthy behaviours”
  • Maintenance – “People have been able to sustain action for at least six months and are working to prevent relapse”
  • Termination – “Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping”

The Preparation and Termination stages were originally excluded but added later, and relapse was originally considered one of the stages as well, but later came to be a return from Action or Maintenance to an earlier stage.

Prochaska and his colleagues concluded that interventions to change behaviour are more effective when they are ‘stage-matched’ – that is to say, appropriately matched to the individual’s stage of change.

Self-Efficacy

Self-Efficacy can be described as “the situation-specific confidence people have that they can cope with high-risk situations without relapsing to their unhealthy or high risk-habit”. (Prochaska, 1997)

According to Bandura self-efficacy refers to an individual’s belief in his or her capacity to execute behaviors necessary to produce specific performance attainments (Bandura, 1977, 1986, 1997).

It affects every area of human endeavour. It determines the beliefs we hold regarding our power to affect or change situations – and therefore influences the power a person has to face challenges competently as well as the choices we are likely to make.

Individuals with a strong sense of self-efficacy tend to see challenges in life as something to be mastered – eg. grabbing the bull by the horns – rather than a threat to avoi, or rather, running away from the “bull” altogether.

A strong sense of self-efficacy leads to a more positive outlook on life, fosters a sense of accomplishment and a better sense of personal well-being. People with a high level of self-efficacy are more resilient and recover from failure easier. They tend to handle setbacks like molehills rather than mountains. They are also more likely to attribute failure to a lack of effort, approaching even threatening situations with a belief that it is within their control. These characteristics have been linked to lower levels of stress and lower vulnerability to depression.

People with lower levels of self-efficacy tend to lose faith in their own abilities after failure or a setback. They tend to look at the skills they don’t have rather than the skills they do have, and difficult tasks are often taken as personal threats and avoided.

Self-efficacy plays a role in our decision making process – it determines whether or not we are ready to take action to facilitate the necessary change in our lives.

Higher levels of self-efficacy do not necessarily imply success – for example, the student who believes he is ‘good at languages’ and can be described as over-efficacious will be likely to study less and even fail in an academic setting. Where self-efficacy is important is not in its ability to lead to success, but to change.

Greater levels of self-efficacy lead to greater changes in behaviour.

It measures the confidence a person has to act and change a harmful or problem behaviour.

Decisional Balance

Decisions are not always simple and easy. There might be a lot of things to consider – one desicion could have both positive and negative impacts on your life.

Irving Janis and Leon Mann introduced the phrase ‘decisional balance sheet’ in 1959 and used the concept to look at decision making. It was later used by Prochaska in the development of TTM and suggested that, in general, for people to succeed at changing their behavior, the advantages of the change should outweigh the disadvantages before they move from Precontemplation to the action stage.

In TTM the Decisional Balance sheet is not only an informal measure of readiness for change but also an aid for decision making.

When dealing with an alcoholic, for example, the concept of decisional balance can lead to personal insight. Asking the alcoholic what they might see as the pros of drinking versus the cons is often more effective than bluntly asking them to think about the negative aspects of the problem behaviour as this might foster psychological resistance later in treatment.

In weighing the pros and cons of a behaviour, or future change, we are forced to really examine what would be best for us and the ideal self we are striving towards.

The more the advantages outweigh the disadvantages the more likely the individual is to make the necessary change.

It is therefore then counselors job to help the client understand the pros and the cons of a decision and lead them to action to quit, replace or abstain from harmful behaviour and engage in more positive behaviour.

As the individual moves through the different stages of change we see a gradual change in attitude before the person acts. Most of the processes of change are aimed at evaluating and reevaluating as well as reinforcing specific elements of current and target behaviors.

Processes of Change

Defined as the covert and overt activities and experiences that those attempting to modify problem behaviors engage in, the processes of change are broad categories encompassing multiple techniques, methods and interventions.

For example Stimulus Control which is the control of situational and other triggers which might cause relapse includes multiple interventions such as adding stimuli that encourage alternative behaviors, restructuring the environment, avoiding high risk cues, or fading techniques.

As with the rest of the model, the processes are drawn from various disciplines and theories and adapted to the individual.

Although there were only 10 processes originally, as proposed by Prochaska et al, helath researchers have extended the original with 21 additional processes.

The original 10 are outlined below:

  1. Consciousness-raising (Get the facts)

  2. Dramatic relief (Pay attention to feelings)

  3. Self-reevaluation (Create a new self-image)

  4. Environmental reevaluation (Notice your effect on others)

  5. Social liberation (Notice public support)

  6. Self-liberation (Make a commitment)

  7. Helping relationships (Get support)

  8. Counterconditioning (Use substitutes)

  9. Reinforcement management (Use rewards)

  10. Stimulus control (Manage your environment)

These processes are used by those wanting to effect change in their lives in various ways and in various combinations, adapted to the individual.

As a whole, drawing from a multitude of theories, schools of thought and approaches to therapy, the Transtheoretical Model provides us with a framework to not only understand the driving factors behind decision making and change, but also a place from which to offer hope and encouragement towards a new way forward.

The Processes of Change

The Processes of Change

by | Jun 10, 2024 | Articles, Counselling, Therapeuo, Treatment Modalities

The Processes of Change

The processes of change, conceptualized and developed by Prochaska et al, describes the overt and covert activities that the individual engages in when trying to change a negative behavior, unlearn a bad habit or facilitate change in their lives.

These processes can be seen as broad categories of action and can consist of various interventions, techniques and methods to get where you are going.

Although adapted by Bartholomew et al, the original 9 are still the standard and a short description and examples of application will be given of each.

The ten processes of change are:

  1. consciousness raising,
  2. counterconditioning,
  3. dramatic relief,
  4. environmental reevaluation,
  5. helping relationships,
  6. reinforcement management,
  7. self-liberation,
  8. self-reevaluation,
  9. social-liberation,
  10. and stimulus control.

These were adapted and added to over the last few decades, but the original 10 do give us a good base to work from.

Consciousness Raising

Consciousness raising implies an increasing awareness and insight about oneself and the problem. Gaining insight and understanding in regards to the self defeating defenses that get in our way. This process implies an effort by the individual to seek new information and to get understanding and feedback about the behavior, problem or situation that needs to change. Interventions could include observations and confrontations and the watching of documentaries or reading of educational books/pamphlets.

For example, someone who would like to stop smoking could start reading pamphlets about the dangers of smoking, watch videos about the benefits of smoking cessation or engage in dialogues about the problem.

Counterconditioning

Countering or counter conditioning implies the process of replacing a problem behavior with an alternative, a healthier substitute. Here we seek to replace the unhealthy behavior with something healthy. This could range from exercise, to basic breathing and relaxation techniques.

One example could be, to replace negative thinking, to introduce a morning routine of self-affirmation.

When intrusive thoughts come we can confront those feelings with positive ones – but this does take practice, and therefore it is not just a band-aid for your thinking – but a process.

In the case of replacing a negative, compulsive behaviour, desensitization could be a good intervention. Looking at and understanding why a situation is a trigger and stripping it of its power can prove a helpful strategy against relapse later during the change process.

Dramatic Relief

Also called Emotional Arousal, Dramatic Relief is meant to evoke positive feelings about the change you are contemplating.

It also implies experiencing and expressing feelings surrounding both the problem and the solution.

This is achieved through roleplaying, open discussion, psychodrama and the grieving of losses as well as the celebration of success.

Environmental Re-evaluation

During this process we consider our physical and social environments and look at how the problem behavior either affects our surroundings or are encouraged/reinforced by it. For example, if a drug addict does not make certain changes to his social and physical environment the likelihood of relapse increases.

This process goes hand in hand with consciousness raising as it is about mindfulness and awareness of what is around us.

Thus interventions once again include discussion, documentaries and pamphlets, among others.

The key here is to identify situations that reinforce the problem behavior or prevent growth in a healthy way. Choosing an environment that suits your ideal behavior is important.

Once again, to use the example of a recovering drug addict, finding activities that can be enjoyed sober rather than previous ways of doing things will be imperative to maintaining change.

Helping Relationships

As the saying goes, no man is an island. We can’t do everything alone – even with an uncannily strong sense of independence and perseverance, or high self-efficacy – social support definitely does help. Especially when trying to change problem behaviors, it is helpful to have a social support network to fall back on.

Whether your social network consists of family, friends or even counselors and clergy – having someone around to help you when you stumble, an ear you can talk to, a hand you can hold – definitely makes things easier.

Self Re-evaluation

This process involves an open and honest assessment of oneself – understanding your own thought patterns, values, beliefs and emotions can be invaluable in moving forward.

Taking stock of your current situation, doing a fearless moral inventory and recognizing how the change you are contemplating will affect your life is what this process is all about.

Social Liberation

Much of our lives are often built around what others expect of us. This can be an unhealthy way of looking at life. Social liberation then is the awareness and acceptance by the individual of alternative and problem free lifestyles in society. For example, although you might have grown up in a setting where alcohol abuse was common, or grew up in a community where substances were commonplace, finding that there are individuals living an alternative lifestyle (eg. Staying sober) can lead to social liberation – freedom from a perceived social norm.

Self Liberation

Also referred to as commitment, this is the decision the individual makes to change the problem behavior. This can be a whole process in itself involving therapy and education, or as simple as a New Years resolution.

It is the finer details of this decision to make this commitment – whether overt or covert (subconscious) that makes this a process and not just an impulsive decision.

The action of choosing to change requires a stronger sense of self-efficacy, or the belief in your own ability to change.

Stimulus Control

In recovery circles we often make reference to the dangers of familiar people, places and things. Where the environmental re-evaluation looked at our physical and social environment – the people and places – here we look at the things – the situations, cues and circumstances whether tangible or intangible that could lead to relapse.

During this process we identify situations and circumstances which might trigger the problem behavior and then take certain actions to protect ourselves against relapse. This could involve restructuring your environment, changing careers, or avoiding high risk cues altogether.

It could also involve replacing or adding stimuli that encourage alternative, healthier behavior.

Reinforcement Management

As we go through the processes of change and our behavior is modified we need to reinforce the change that we have been making.

Since many addictions or problem behaviors have been reinforced over time through the brains reward system, we need to do the same with the new healthier behavior.

This could be anything from an encouraging word from a family member, a contingency contract with your counselor, or a self-reward.

For example, if I had a drinking problem and drank every night the financial reward might be significant if I were to stop drinking altogether. Therefore I could use my savings to reward myself with something I wouldn’t have been able to do otherwise. I could go have breakfast with a loved one, or take the kids to do something fun.

By rewarding positive behavior, not only do we reinforce that behavior but very quickly we find alternatives towards a happier, fuller life.

As mentioned before, the 9 processes have been added to over the years, and there is a multitude of information available on the internet, but personally I find the original nine points to be sufficient.

If you or a loved one are struggling with addiction or with issues related to mental health please consider reaching out by sending an email to andre@adlabuschagne.co.za and we will assist you with finding a solution that works for you.

The Twelve Steps: A Powerful Tool

The Twelve Steps: A Powerful Tool

by | Jun 10, 2024 | 12 Steps, Articles, Therapeuo, Treatment Modalities, Understanding Addiction

The Twelve Steps of Alcoholics Anonymous has been around for decades and has helped millions of people in their journey of recovery from addiction and compulsive behaviour towards some sort of stability and sometimes even complete remission. Studies have shown that the program of Alcoholics Anonymous is at the very least as effective as other forms of therapy (like Cognitive Behavioral Therapy and Motivational Enhancement Therapy), but for the most part seems to be more effective – leading to more alcoholics and addicts being abstinent for longer periods of time.

Widely misunderstood by the church, sometimes even completely dismissed, this program has a lot to offer as a therapeutic intervention but also as a support program for deliverance and pastoral ministries.

The program – all twelve steps – are built around a foundational belief that the only way you can kick your addiction is by submitting to a force greater than yourself.

When the program was started in the 1930’s there was no doubt that it was a Christian program. Although secularized in the name of inclusivity, the program remains true to concept and has a high success rate. Coupled with our hope in Christ, rather than an anonymous ‘higher power’, I have seen lives changed in ways I couldn’t even begin to explain.

It can be applied to any addiction – narcotics, alcohol, pornography, sex, gambling and shopping – or even compulsive behaviors and mental health issues.

It provides a simple set of guidelines that we can use as a road map on our healing journey from chaos back to order.

The Twelve Step Program is outlined in the book Alcoholics Anonymous (originally published in 1939). It is found at the beginning of the chapter “How It Works”.

The Twelve Steps are:

  1. We admitted we were powerless over alcohol — that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

The program has a strong emphasis on prayer and fellowship – and the groups are free, with the only cost being your willingness to participate. The meetings are easy to find and listed online according to country, city and even suburb.

A final question I would like to answer here is whether or not Christians should attend these meetings. I have referred many addicts to these meetings, and some have been put off by the phrase ‘Higher Power’ or ‘God of your own understanding’. I want to urge you to not let this stand in your way. God wants us to be free. 

Surely we don’t avoid taking crucial medication (like heart medication or insulin) because the prescribing doctor is a Muslim or a Jew? These meetings are a life-line for those struggling with addiction and I believe that the Divine Wisdom of God is there between the lines. For any Christian going through these kinds of issues I would suggest a two-pronged approach – throw yourself into fellowship at church, but also join one of these support groups. We need as much support as possible in this specific journey. If the secular side of these meetings really are an obstacle to you personally, please consider one of the Christian fellowships instead – but do not push it aside altogether.

As a Christian and a minister of the Gospel I believe that this is an invaluable tool for those suffering from addiction, but also for the families of those who are struggling with addiction to drugs or alcohol. 

The thing that has kept me clean for nearly a decade at time of writing is something someone said at one of the early meetings I attended. Just before praying together we stood in a circle holding hands, and a fellow addict said: “we stand this way to remind ourselves that we never need to stand alone again unless we choose to…”

You are not alone. You don’t have to go through it alone.

There are Christian alternatives to the traditional AA, CA and NA meetings (eg. Celebrate Recovery), and I would urge you to find a support group near you – it saved my life. It can do the same for you.

If you would like help in deciding where to go or how to get sober – I am always just an email away. Reach out by sending me a message to andre@adlabuschagne.co.za.

God bless you and keep you. May He shine His face upon you and grant you the peace that you need today!

IF YOU OR A LOVED ONE ARE STRUGGLING WITH ADDICTION PLEASE REACH OUT: 065 370 3806 / ANDRE@ADLABUSCHAGNE.CO.ZA. #YOUARENOTALONE