Patricia Marinelli-Casey

An intensive outpatient approach for cocaine abuse treatment: The matrix model

The Matrix model of outpatient treatment was developed during the 1980s in response to an overwhelming demand for cocaine abuse treatment services. The model was constructed using components based upon empirically supported findings from the substance abuse research field. Over the course of development, data were collected on the treatment model and the model was modified based upon empirical evaluation. A pilot study comparing the Matrix outpatient model with an inpatient hospital treatment program produced preliminary support for the clinical utility of the model. An open trial comparing publicly and privately funded patients demonstrated that patients with fewer resources were more difficult to engage and retain in this model of outpatient treatment. In a controlled trial, a clear positive relationship was documented between duration and amount of treatment involvement in the Matrix model and positive outcome at 1 year. Due to a variety of methodological issues, the study was not able to answer definitively the question of clinical efficacy. In all of these studies, patients treated with the Matrix model demonstrated statistically significant reductions in drug and alcohol use and improvements in psychological indicators. This body of work, along with the public acceptance the model has received in the treatment community, support the usefulness of this intensive outpatient approach for cocaine abuse. Further research is underway to provide additional controlled information on the value of this treatment approach.

Research reportAn intensive outpatient approach for cocaine abuse treatment: The matrix model

The Matrix model of outpatient treatment was developed during the 1980s in response to an overwhelming demand for cocaine abuse treatment services. The model was constructed using components based upon empirically supported findings from the substance abuse research field. Over the course of development, data were collected on the treatment model and the model was modified based upon empirical evaluation. A pilot study comparing the Matrix outpatient model with an inpatient hospital treatment program produced preliminary support for the clinical utility of the model. An open trial comparing publicly and privately funded patients demonstrated that patients with fewer resources were more difficult to engage and retain in this model of outpatient treatment. In a controlled trial, a clear positive relationship was documented between duration and amount of treatment involvement in the Matrix model and positive outcome at 1 year. Due to a variety of methodological issues, the study was not able to answer definitively the question of clinical efficacy. In all of these studies, patients treated with the Matrix model demonstrated statistically significant reductions in drug and alcohol use and improvements in psychological indicators. This body of work, along with the public acceptance the model has received in the treatment community, support the usefulness of this intensive outpatient approach for cocaine abuse. Further research is underway to provide additional controlled information on the value of this treatment approach.

The Matrix Model of Outpatient Stimulant Abuse Treatment: History and Description

Abstract The Matrix model was originally developed in response to the cocaine epidemic of the 1980s. The program consists of relapse prevention groups, education groups, social support groups, individual counseling, and urine and breath testing delivered in a structured manner over a 16-week period. The treatment is a directive, nonconfrontational approach which focuses on current issues and behavior change. Several evaluations of the model have supported its usefulness and efficacy with methamphetamine (MA) users. Methamphetamine users appear to respond to treatment similarly to cocaine users and many continue to show improvements at follow-up.

Depression among methamphetamine users: association with outcomes from the Methamphetamine Treatment Project at 3-year follow-up.

Although depression is highly comorbid with substance use disorders, little is known about the clinical course and outcomes of methamphetamine (MA) users with depressive symptoms and syndromes. In this study of MA-dependent individuals entering psychosocial treatment, we predicted that (1) depressive symptoms would decline during treatment, an effect that would vary as a function of MA use and (2) depression diagnoses post-treatment would be associated with poorer outcomes. Participants (N = 526) were assessed for depression, substance use, and psychosocial outcomes at baseline, treatment discharge, and 3-year follow-up. Depressive symptoms declined significantly during treatment, an effect that was greatest among those who abstained from MA. Major depression at follow-up was associated with poorer MA use outcomes and impairment across multiple domains of functioning. The findings highlight the relationship of depressive symptoms and diagnoses to treatment outcomes, and suggest a need for further studies of depression in populations using MA.

Psychopathology in methamphetamine-dependent adults 3 years after treatment.

INTRODUCTION AND AIMS Although psychiatric symptoms are frequently observed in methamphetamine (MA) users, little is known about the prevalence of psychiatric disorders in MA-dependent individuals. This is the first study to examine the association of psychiatric disorders with substance use and psychosocial functioning in a large sample of MA users 3 years after treatment. We predicted that psychiatric diagnoses and severity would be associated with substance use and poorer overall functioning over the 3 year post-treatment course. DESIGN AND METHODS Participants (N = 526) received psychosocial treatment for MA dependence as part of the Methamphetamine Treatment Project and were reassessed for psychosocial functioning and substance use at a mean of 3 years after treatment initiation. DSM-IV psychiatric diagnoses were assessed at follow-up using the Mini-International Neuropsychiatric Interview. Psychosocial functioning was assessed using the Addiction Severity Index. RESULTS Overall, 48.1% of the sample met criteria for a current or past psychiatric disorder other than a substance use disorder. Consistent with prior reports from clinical samples of cocaine users, this rate was largely accounted for by mood disorders, anxiety disorders and antisocial personality. Those with an Axis I psychiatric disorder evidenced increased MA use and greater functional impairment over time relative to those without a psychiatric disorder. DISCUSSION AND CONCLUSIONS This initial investigation of psychiatric diagnoses in MA users after treatment indicates elevated rates of Axis I and II disorders in this population and underscores the need for integrated psychiatric assessment and intervention in drug abuse treatment settings.

Clinical course and outcomes of methamphetamine-dependent adults with psychosis

Little is known about the association between psychosis and treatment outcomes in methamphetamine (MA) users. Using data from 526 adults in the largest psychosocial clinical trial of MA users conducted to date, this study examined psychiatric, substance use, and functional outcomes of MA users with concomitant psychotic illness 3 years after treatment. The presence of a psychotic disorder was associated with increased health service utilization and higher levels of psychiatric symptomatology across multiple domains over time. MA users with co-occurring psychotic illness may therefore benefit from early psychosocial and/or pharmacologic interventions to address psychiatric symptoms.

Methamphetamine dependence and human immunodeficiency virus risk behavior

We examined human immunodeficiency virus (HIV)-related risk behaviors among methamphetamine (MA)-dependent users. Secondary data analysis was performed on data from a large clinical trial: The Methamphetamine Treatment Project (N = 784). All MA-dependent participants were enrolled in an outpatient treatment program, receiving either a standardized psychosocial protocol (Matrix model) or treatment-as-usual. HIV-related risk behavior, including injection and unsafe sexual practices, was assessed using the AIDS Risk Assessment at baseline, treatment discharge, and 6, 12, and 36 months following treatment participation. Results indicated that HIV risk behaviors substantially decreased over time. Treatment factors (retention and completion) and frequency of MA use were both positively associated with increased reduction of HIV risk behaviors. The findings suggested that treatment of MA dependence is promising for reducing behaviors that have been shown to transmit HIV.

Risk Factors for Suicide Attempts in Methamphetamine-Dependent Patients

The purpose of this study was to identify risk factors for suicide attempts (SA) in methamphetamine (MA)-dependent patients. MA-dependent adults (N = 526) who participated in the Methamphetamine Treatment Project were interviewed before and three years after treatment. Baseline psychiatric, medical, demographic, and substance use characteristics were assessed using the Addiction Severity Index and the Beck Depression Inventory (BDI). Lifetime history of SA was assessed at follow-up. Risk factors for SA included gender, intravenous MA use, BDI > 20 at baseline, and clinically significant psychiatric history. Psychiatric characteristics of MA users are strongly associated with SA, warranting careful assessment of psychiatric history.

Health-related Quality of Life Trajectories of Methamphetamine-Dependent Individuals as a Function of Treatment Completion and Continued Care Over a 1-Year Period

This study applies a chronic illness framework to evaluate treatment outcomes among individuals dependent on methamphetamine (MA). Using growth curve modeling, health-related quality of life (HRQOL) trajectories of MA-dependent individuals (N = 723) were examined over a 1-year period. Results show greater improvements in mental HRQOL trajectories as a function of treatment completion and continued care, although fairly static trajectories in physical health status. Other factors affecting HRQOL trajectories included gender, psychosocial functioning, drug use severity, and health impairment. Results extend research on treatment evaluations for MA dependence, highlighting the importance of continued service utilization for improved quality of life outcomes.

Anxiety Disorders among Methamphetamine Dependent Adults: Association with Post‐Treatment Functioning

Although anxiety is one of the most prominent psychiatric complaints of methamphetamine (MA) users, little is known about the association between anxiety disorders and treatment outcomes in this population. Using data from 526 adults in the largest psychosocial clinical trial of MA users conducted to date, this study examined psychiatric, substance use, and functional outcomes of MA users with concomitant anxiety disorders 3 years after treatment. Anxiety disorders were associated with poorer alcohol and drug use outcomes, increased health service utilization, and higher levels of psychiatric symptomatology, including suicidality. Addressing anxiety symptoms and syndromes in MA users may be helpful as a means of optimizing treatment outcomes.