Matrix Model and Medication Assisted Treatment

Introduction
Concurrent with the development of the Matrix Model
Intensive Outpatient Treatment Program, the Matrix
Institute was doing other work that involved medication-
assisted treatment. Matrix Institute was contracted
by SAMHSA to write the Technical Assistance Publication
(TAP) 7, “Treatment of Opiate Addiction with
Methadone: a Counselor Manual,” (McCann et al., 1994).
Ten years later Matrix was contracted by SAMHSA and
the Danya Learning Center to author “Buprenorphine
Treatment of Opioid Addiction: a Counselor’s Guide,”
(McCann et al., 2004). Matrix Institute sites have conducted
research with naltrexone for opioids and alcohol,
acamprosate for alcohol, and a variety of medications
for cocaine and methamphetamine dependence.
While the Matrix Institute is most widely known for the
Matrix Model, there is also extensive experience with
addiction medicines and with counseling as a component
of medication assisted treatment (MAT).
This article will discuss some of the counseling issues
that are relevant when working with patients taking
addiction medications.

The Matrix Model
The Matrix Model is a multi-element package of therapeutic
strategies that complement each other and
combine to produce an integrated outpatient treatment
experience. It is a set of evidence-based practices
delivered in a clinically coordinated manner as a
“program.” Treatment is delivered in a 16-week intensive
outpatient program primarily in structured group
sessions targeting the skills needed in early recovery
and for relapse prevention. The Matrix Model is listed
on the SAMHSA’s National Registry of Evidence-based
Programs and Practices.
The Matrix Model has a number of central therapeutic
constructs. These include: structure and expectations;
psychoeducation; cognitive/behavioral skills; family

education; self help groups; and urine and breath alcohol
testing.

Medication Assisted Treatment
The revision to the Matrix Model Treatment Manual
that was released by Hazelden Publishing in September,
2014, includes a track of individual sessions to inform
patients about medication-assisted treatment and
deals with the issues in recovery that arise for patients
taking medication.
There is no intention to either encourage or dissuade
the use of medications, rather to make patients aware
of these medication options. Medications may be
helpful or even necessary for some patients working to
overcome a substance use disorder. An important message
to patients is that medication use does not in any
way preclude, diminish, or taint recovery. Medication,
in some cases, may be necessary to open the way to
recovery just as self-help groups do for some patients.
Therapists should not provide medical advice, but
instead should direct patients to physicians or other
medical providers regarding medications and medical
care. However, in order to provide the best possible
treatment, therapists should be knowledgeable about
addiction medicines and understand this component
of treatment. It is important for counselors to have
accurate information as part of their general knowledge
base regarding the commonly used addiction
medicines.

Counseling Issues with MAT
In addition to the specific knowledge regarding medications,
it is critical that the counselor understand the
impact of MAT on recovery in a general sense. It is not
uncommon for patients to encounter negative feelings
regarding medications in the recovery community.
Providers, significant others, and the patients themselves
often have ambivalence regarding medication
and sometimes feel “real” recovery can be achieved
only when medications are discontinued. Counselors
can help dispel myths and misinformation, and provide
essential guidance and support for patients in MAT and
their families.

Overview of Counseling Topics
Initial Session for Patients taking Addiction Medication.
Medications for substance dependencies have physical
effects that the patient will discuss with his or her
physician. There are other matters of a more general
nature related to MAT in the context of treatment and
recovery. Sometimes patients are ambivalent or guilty
about using medication. Sometimes patients feel that
they don’t need to make behavioral changes because
of the medication. They may feel the medication effects
are sufficient to prevent relapse. This session is to
reinforce the difference between “medication-taking,”
and “drug-taking.” Doing whatever helps in recovery is
a good thing; and this includes taking medication. Also
in this session, the counselor should ensure that the patient
is not overly focused on medication to the exclusion
of emotional, cognitive, spiritual, and behavioral
change. Sometimes medications can be so effective
that patients do not see the need to do more.

Reactions from others in recovery.
Other patients in Matrix treatment or in 12-step meetings
may express negative opinions about medication-
assisted treatment. This often puts the patient in
conflict (“do I keep the medication a secret,” or “do I tell
the truth and have to contend with the negative opinions?”).
One of the most important elements of a solid
foundation in recovery is honesty. On the other hand,
hearing that “you are not really in recovery,” or “a drug
is a drug,” can be at best confusing, and beyond that
deflating and damaging to the degree a patient may
discontinue medication. This session is to anticipate
some of these possible reactions and discuss constructive
ways to deal with them. The counselor should be
clear and unwavering in support of the patient and
reinforce following the physician’s direction.

Medication plan.
The counselor should stress the importance of having a
plan for medication following treatment and to discuss
this with the physician. Non-compliance with the physician’s
direction, unplanned discontinuation of medication,
reductions or increases in the amount of medication
taken can be signs of possible relapse. There is
a common misconception that the goal for all patients
should be to stop taking medication. This is not the case;

everyone is different and the goal for each person
should be determined by the patient in conjunction
with his/her physician.

Finally, the counselor should discuss plans for dealing
with future situations requiring pain medication,
sedatives, or other abuseable medications, particularly
those related to the patient’s drug of choice. Prescribed
medications have the potential to kindle cravings and
can lead to relapse. The main message with regard to
these situations is communication with the treating
physician, the addiction medicine physician, and the
counselor or sponsor.
In the 21st century we have more and more options for
treatment. As medication use becomes more prevalent
the counselor will play and important role in bridging
the medical aspects of treatment to the broader aspects
of recovery.