Counselor's Treatment Manual - Substance Abuse and Mental Health ...

Counselor's Treatment Manual

Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders

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Counselor's Treatment

Manual

Matrix Intensive Outpatient Treatment for

People With Stimulant Use Disorders

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857

Acknowledgments

Numerous people contributed to this document, which is part of the Methamphetamine Treatment Project (MTP). The document was written by Jeanne L. Obert, M.F.T., M.S.M.; Richard A. Rawson, Ph.D.; Michael J. McCann, M.A.; and Walter Ling, M.D. The MTP Corporate Authors provided valuable guidance and support on this document.

This publication was developed with support from the University of California at Los Angeles (UCLA) Coordinating Center through Grant No. TI11440. MTP was funded by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The research was conducted from 1998 to 2002 in cooperation with the following institutions: County of San Mateo, San Mateo, CA (TI11411); East Bay Recovery Project, Hayward, CA (TI11484); Friends Research Institute, Inc., Concord, CA (TI11425); Friends Research Institute, Inc., Costa Mesa, CA (TI11443); Saint Francis Medical Center of Hawaii, Honolulu, HI (TI11441); San Diego Association of Governments, San Diego, CA (TI11410); South Central Montana Regional Mental Health Center, Billings, MT (TI11427); and UCLA Coordinating Center, Los Angeles, CA (TI11440). The publication was produced by JBS International, Inc. (JBS), under Knowledge Application Program (KAP) contract numbers 270-99-7072 and 270-04-7049 with SAMHSA, HHS. Christina Currier served as the CSAT Government Project Officer. Andrea Kopstein, Ph.D., M.P.H., served as the Deputy Government Project Officer. Cheryl Gallagher, M.A., served as CSAT content advisor.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.

Public Domain Notice

All materials appearing in this publication except those taken from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Printed Copies

This publication may be ordered or downloaded from SAMHSA's Publications Ordering Web page at . Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Espa?ol).

Recommended Citation

Center for Substance Abuse Treatment. Counselor's Treatment Manual: Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders. HHS Publication No. (SMA) 13-4152. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.

Originating Office

Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857.

HHS Publication No. (SMA) 13-4152 First Printed 2006 Reprinted 2007, 2008, 2009, 2010, 2011, 2013, and 2014

Contents

I. Introduction to the Matrix Intensive Outpatient Treatment for People

With Stimulant Use Disorders Approach and Package . . . . . . . . . . . . . . . . . . . 1

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Matrix IOP Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

The Role of the Counselor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Working With Client Co-Leaders and Client?Facilitators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

The Matrix IOP Package . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Introduction to the Counselor's Treatment Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

II. The Role of Drug and Breath-Alcohol Testing in Matrix IOP. . . . . . . . . . . . . . 11

Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Addressing a Positive Urine Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

III. Individual/Conjoint Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Session 1: Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Session 2: Client Progress/Crisis Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Session 3: Continuing Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Handouts for Individual/Conjoint Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

IV. Early Recovery Skills Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Session 1: Stop the Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Session 2: Identifying External Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Session 3: Identifying Internal Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Session 4: Introducing 12-Step or Mutual-Help Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Session 5: Body Chemistry in Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Session 6: Common Challenges in Early Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Session 7: Thinking, Feeling, and Doing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Session 8: 12-Step Wisdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

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Counselor's Treatment Manual: Matrix Intensive Outpatient Treatment

Handouts for Early Recovery Skills Group Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

V. Relapse Prevention Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Session 1: Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Session 2: Boredom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Session 3: Avoiding Relapse Drift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Session 4: Work and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Session 5: Guilt and Shame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Session 6: Staying Busy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Session 7: Motivation for Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Session 8: Truthfulness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Session 9: Total Abstinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Session 10: Sex and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Session 11: Anticipating and Preventing Relapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Session 12: Trust. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Session 13: Be Smart, Not Strong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Session 14: Defining Spirituality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Session 15: Managing Life; Managing Money . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Session 16: Relapse Justification I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Session 17: Taking Care of Yourself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Session 18: Emotional Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Session 19: Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Session 20: Recognizing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Session 21: Relapse Justification II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Session 22: Reducing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Session 23: Managing Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Session 24: Acceptance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

Session 25: Making New Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

Session 26: Repairing Relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144

Session 27: Serenity Prayer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Session 28: Compulsive Behaviors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

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Contents Session 29: Coping With Feelings and Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

Session 30: 12-Step and Mutual-Help Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Session 31: Looking Forward; Managing Downtime. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Session 32: One Day at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Elective Session A: Client Status Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Elective Session B: Holidays and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162

Elective Session C: Recreational Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Handouts for Relapse Prevention Group Sessions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

VI. Social Support Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Social Support Group Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

Appendices

Appendix A. The Methamphetamine Treatment Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

Appendix B. Notes on Group Facilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Appendix C. Sample Agreement for Co-Leaders and Client?Facilitators . . . . . . . . . . . . . . . 247

Appendix D. Acronyms and Abbreviations List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249

Appendix E. Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Appendix F. Field Reviewers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Appendix G. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Appendix H. Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

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