Intervention Summary

Matrix Model

The Matrix Model is an intensive outpatient treatment approach for stimulant abuse and dependence that was developed through 20 years of experience in real-world treatment settings. The intervention consists of relapse-prevention groups, education groups, social-support groups, individual counseling, and urine and breath testing delivered over a 16-week period. Patients learn about issues critical to addiction and relapse, receive direction and support from a trained therapist, become familiar with self-help programs, and are monitored for drug use by urine testing. The program includes education for family members affected by the addiction. The therapist functions simultaneously 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. Therapists are trained to conduct treatment sessions in a way that promotes the patient's self-esteem, dignity, and self-worth.

Descriptive Information

Areas of Interest	Substance use disorder treatment
Outcomes	1: Treatment retention 2: Treatment completion 3: Drug use during treatment
Outcome Categories	Drugs Treatment/recovery
Ages	18-25 (Young adult) 26-55 (Adult)
Genders	Male Female
Races/Ethnicities	Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	Outpatient
Geographic Locations	Urban Suburban
Implementation History	Dozens of States and numerous community agencies in the United States have received training and have begun implementing the Matrix Model. At the Southern California Matrix Institute clinics, approximately 20,000 individuals have been treated using this approach. Internationally, the Matrix Model has been implemented in Beirut and Lebanon and throughout Thailand in substance abuse treatment facilities.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	The Matrix Model has been adapted for use with gay and bisexual men who use methamphetamine. It has also been adapted for use with Spanish-speaking, Thai, Native American, and Slovakian populations.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Rawson, R. A., Shoptaw, S. J., Obert, J. L., McCann, M. J., Hasson, A. L., Marinelli-Casey, P. J., et al. An intensive outpatient approach for cocaine abuse treatment: The Matrix model. Journal of Substance Abuse Treatment, 12, 117-127.

Study 2

Rawson, R. A., Marinelli-Casey, P., Anglin, M. D., Dickow, A., Frazier, Y., Gallagher, C., et al.. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction, 99, 708-717.

Supplementary Materials

Huber, A., Ling, W., Shoptaw, S., Gulati, V., Brethen, P., & Rawson, R. Integrating treatments for methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases, 16, 41-50.

Matrix Model Fidelity Instrument

Rawson, R. A., Obert, J. L., McCann, M. J., & Ling, W. Psychological approaches to the treatment of cocaine dependence: A neurobehavioral approach. Journal of Addictive Diseases, 11, 97-119.

Rawson, R. A., Obert, J. L., McCann, M. J., & Mann, A. J. Cocaine treatment outcome: Cocaine use following inpatient, outpatient, and no treatment. In L. S. Harris (Ed.), Problems of Drug Dependence: Proceedings of the 47th Annual Scientific Meeting. NIDA Research Monograph Series, #67, 271-277.

Outcomes

Outcome 1: Treatment retention
Description of Measures	Based on the total number of weeks participants spent in treatment and the number of sessions attended, treatment retention was operationalized as an ordinal variable with five categories in an approximate normal distribution. A score of 5 indicated the longest retention, and a score of 1 indicated the shortest retention.
Key Findings	Matrix participants were 38% more likely to stay in treatment compared with participants receiving treatment as usual.
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental
Quality of Research Rating	1.9 (0.0-4.0 scale)

Outcome 2: Treatment completion
Description of Measures	Treatment completion was defined as the number of clients completing treatment. Treatment completion was operationalized as a binary variable with 1 indicating the client completed treatment and 0 indicating the client did not complete treatment.
Key Findings	Across eight comparison sites, Matrix participants were 27% more likely to complete treatment than participants receiving treatment as usual.
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental
Quality of Research Rating	2.0 (0.0-4.0 scale)

Outcome 3: Drug use during treatment
Description of Measures	This outcome was measured through a combination of client self-reports of stimulant use (past 30-day use from the Addiction Severity Index) and verification through urinalysis.
Key Findings	Stimulant drug-use indicators were significantly reduced during treatment for both Matrix participants and the treatment-as-usual participants. The frequency of methamphetamine use, as measured by the mean number of days used in the past 30 days, declined from 11 days at the beginning of treatment to 4 days at treatment discharge. Compared with a subgroup of participants receiving 12 weeks of total treatment at comparison sites, Matrix participants on average produced more drug-free urine samples (4.3 versus 3.3).
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental
Quality of Research Rating	2.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	18-25 (Young adult) 26-55 (Adult)	Data not reported/available	50% White 27% Black or African American 23% Hispanic or Latino
Study 2	18-25 (Young adult) 26-55 (Adult)	55% Female 45% Male	60% White 18% Hispanic or Latino 17% Asian 5% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Treatment retention	2.3	2.3	2.0	1.5	2.0	1.5	1.9
2: Treatment completion	2.0	2.0	2.5	1.5	2.5	1.5	2.0
3: Drug use during treatment	2.8	3.1	2.5	2.0	2.3	2.0	2.4

Study Strengths

Reliability of outcomes was not described [in reviewed articles] but can be assumed given the nature of the self-reports. The Addiction Severity Index (confirmed with urinalysis) is as reliable and valid a measure as any self-report instrument used in the field. Follow-up rates were very good but were stated for the sample as a whole; therefore, reviewers could not determine whether attrition may have been differential across conditions. The authors gave careful consideration to the best ways to analyze data where nonequivalence of study conditions was a significant issue.

Study Weaknesses

Individuals in the control group were required to seek their own treatment, and the authors acknowledged this confound. The therapy condition by treatment dose analyses are based on different definitions of dose/participation for the two conditions. Control condition was arguably not a true control condition in which fidelity of treatment components was measured systematically. Although the authors were quite open about study limitations and the heterogeneity of the comparison sites, there were significant differences in treatment dose between conditions and sites. Participants assigned to Matrix received more hours of treatment, making conclusive statements about the efficacy of the Matrix components difficult.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Intensive Outpatient Alcohol and Drug Treatment (Slovakian version)

Intensive Outpatient Alcohol and Drug Treatment (Spanish version)

Intensive Outpatient Alcohol and Drug Treatment (Thai version)

Matrix Institute. The Matrix Model: Families in recovery [DVD]. Center City, MN: Matrix Institute.

Matrix Institute. The Matrix Model: La unidad familiar--Documentos y hojas de trabajo [The family unit--Handouts and worksheets] [DVD]. Center City, MN: Matrix Institute.

Matrix Institute. The Matrix Model: Road map for recovery [DVD]. Center City, MN: Matrix Institute.

Matrix Institute. The Matrix Model: Tratamiento intensive de alcohol y drogas para paciente externos--Documentos y hojas de trabajo [Intensive outpatient alcohol and drug treatment--Handouts and worksheets] [DVD]. Center City, MN: Matrix Institute.

Matrix Institute. The Matrix Model: Triggers and cravings [DVD]. Center City, MN: Matrix Institute.

Matrix Institute. The Matrix Model: Culturally designed client handouts for American Indians/Alaskan Natives. Los Angeles: Matrix Institute.

Matrix Institute. Training descriptions and presentation [Handout].

Rawson, R., Obert, J., McCann, M., & Ling, W. The Matrix Model intensive outpatient alcohol and drug treatment: A 16-week individualized program. Center City, MN: Matrix Institute.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.5	3.5	3.5	3.5

Dissemination Strengths

The therapist manuals, patient binder, DVDs, and other materials provide useful information to both therapists and administrators relevant to implementation. Implementation materials also include a family component, which is at a skill level consistent with substance abuse staff who may not have had formal family therapy training. Implementation materials have also been translated into several languages. A variety of trainings across the country are provided almost weekly, in addition to available coaching and supervisor training. Training includes a discussion that supports systems adoption and successful technology transfer. Quality assurance is supported by process and performance fidelity assessment, including routine chart reviews and patient outcome assessment.

Dissemination Weaknesses

No guidelines are provided for selecting therapists. No detailed information is provided on how and by whom fidelity instruments are used.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
The Matrix Adult Model with DVDs	$599	Yes
2-day, on-site training	$5,000 for up to 20 participants	No
2-day, off-site training	$500 per participant	No
2.5-day advanced Key Supervisor training (includes Matrix fidelity Instruments)	$1,000 per participant	No

Additional Information

Publicly funded treatment costs for Matrix Model services are approximately $1,900 per client. Average reimbursement from private insurance/managed care is approximately $3,500.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Huber, A., Ling, W., Shoptaw, S., Gulati, V., Brethen, P., & Rawson, R. Integrating treatments for methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases, 16, 41-50.

* Rawson, R. A., Marinelli-Casey, P., Anglin, M. D., Dickow, A., Frazier, Y., Gallagher, C., et al.. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction, 99, 708-717.

Rawson, R. A., Obert, J. L., McCann, M. J., & Ling, W. Psychological approaches to the treatment of cocaine dependence: A neurobehavioral approach. Journal of Addictive Diseases, 11, 97-119.

* Rawson, R. A., Shoptaw, S. J., Obert, J. L., McCann, M. J., Hasson, A. L., Marinelli-Casey, P. J., et al. An intensive outpatient approach for cocaine abuse treatment: The Matrix Model. Journal of Substance Abuse Treatment, 12, 117-127.