The Matrix Model and Contingency Management: A Resource Review for Behavioral Health Providers

Drug Overdose Deaths in the United States, 1999-2018

Stimulant use is on the rise. According to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, in 2018, there were 67,367 drug overdose deaths in the United States (Figure 1), 4.1% fewer deaths than in 2017 (70,237). While that is encouraging news, during that same time period, the age-adjusted rate of drug overdose deaths involving cocaine increased from 1.4 per 100,000 standard population in 1999 to 2.5 in 2006, then decreased to 1.3 in 2010 and 1.5 in 2011. From 2012 through 2018, the rate increased on average by 27% per year to a rate of 4.5 in 2018 (Figure 4) and The age-adjusted rate of drug overdose deaths involving psychostimulants with abuse potential, which include drugs such as methamphetamine, amphetamine, and methylphenidate, increased from 0.2 in 1999 to 0.8 in 2012. From 2012 through 2018, the rate increased on average by 30% per year to a rate of 3.9 in 2018.

Treatment for Stimulant Use Disorders is Effective

According to TIP 47: Substance Abuse: Clinical Issues in Intensive Outpatient Treatment (IOT), the six most commonly used and effective treatments for substance use disorders (SUDs) are:

• 12-Step facilitation
• Cognitive-behavioral – for articles that address this modality and highlight resources and training opportunities, check out the following Catalyst blog posts:
  • What the Research Says About Addressing Stimulant Use Disorders: A Resource Review for Behavioral Health Providers
  • Anger: Helping Behavioral Health Clients to Choose Their Responses to This Very Normal Emotion
  • TIP 34 and Cognitive Behavioral Therapy: Tools for Working with Psychosis…and So Much More!
• Motivational – for articles that address this modality and highlight resources and training opportunities, check out the following Catalyst blog posts:
  • Providing Male-Specific Substance Use Disorder Treatment: An Introductory Guide for Behavioral Health Providers
  • Motivational Interviewing: The One Tool Every Behavioral Health Provider Needs
  • How Can a Professional Become a MINT Trainer?
• Therapeutic community – for articles that address this modality and highlight resources and training opportunities, check out the following Catalyst blog posts:
  • What the Research Says About Addressing Stimulant Use Disorders: A Resource Review for Behavioral Health Providers
• Matrix model
• Community reinforcement and contingency management.

Each of these treatment modalities has strengths and challenges, and summary descriptions of these approaches and lists of the strengths and challenges of each are outlined in Chapter 8 of Intensive Outpatient Treatment Approaches in Treatment Improvement Protocol (TIP) Series, No. 47,  Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Two of the approaches named, the Matrix Model and Contingency Management, have a solid empirical base showing effectiveness. When combined, statistically improved treatment outcomes such as higher rates and lengths of drug abstinence, have been documented (Roll, et al., 2006).

What is Contingency Management?

“Contingency management refers to a type of behavioural therapy in which individuals are ‘reinforced’, or rewarded, for evidence of positive behavioural change. These interventions have been widely tested and evaluated in the context of substance misuse treatment, and they most often involve provision of monetary-based reinforcers for submission of drug-negative urine specimens. The reinforcers typically consist of vouchers exchangeable for retail goods and services or the opportunity to win prizes. Although contingency management has a great deal of evidence supporting its efficacy,¹ and the UK National Institute for Health and Clinical Excellence guidelines recommend its use, few psychiatrists and other mental health professionals are familiar with these interventions, and even fewer implement contingency management in their practice” (Petry, 2011).

The National Institutes of Health (NIH), in its Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), states that “Research has demonstrated the effectiveness of treatment approaches using contingency management (CM) principles, which involve giving patients tangible rewards to reinforce positive behaviors such as abstinence. Studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs” (NIH, 2012).

What is the Matrix Model?

“The Matrix model was developed during the 1980s as an effective way to treat the increasing number of people dependent on stimulant drugs, particularly cocaine. Developers designed the Matrix model as a more intensive intervention than the then-standard weekly outpatient counseling or 28-day inpatient treatment” (SAMHSA, 2006). Foundations of the Matrix Model consist of:

• Establishing a strong therapeutic relationship between the client and counselor
• Teaching clients how to structure time and initiate an orderly and healthy lifestyle
• Imparting accurate, comprehensible information about acute and subacute withdrawal effects and cravings for substances
• Providing opportunities to learn and practice relapse prevention and coping techniques
• Involving family and significant others in the therapeutic and educational processes to gain their support for—and prevent their sabotaging of—treatment
• Encouraging clients to participate in community-based mutual-help groups
• Conducting random urinalyses or breath tests to assess treatment effectiveness

The Matrix Model was developed as a protocol for a 16-week program and contains components for early recovery groups, family education sessions, relapse prevention groups, and social support groups (SAMHSA, 2006).

Resources for Behavioral Health Providers

Stimulant Use Disorder Webinar Series – This webinar series was sponsored by the Great Lakes Addiction Technology Transfer Center and the Northwest ATTC in 2019. While the descriptions and PowerPoints only are available on the previous link on the ATTC Website, the YouTube videos are available as follows:

• Stimulant Use Disorder Webinar Series Part 1 – Strategies to Address Cocaine and Methamphetamine
  • Stimulant Use Disorder Webinar Series Part 1: PowerPoint Slides
• Stimulant Use Disorder Webinar Series Part 2 – A panel of providers presenting their experiences with effective treatment strategies and evidence-based practices for working with individuals with stimulant use disorders.
  • Stimulant Use Disorder Webinar Series Part 2: PowerPoint Slides
• Stimulant Use Disorder Webinar Series Part 3 – Change management strategies for successfully implementing these evidence-based practices.
  • Stimulant Use Disorder Webinar Series Part 3: PowerPoint Slides

Motivational Incentives – A Proven Approach to Treatment – This collection of products includes tools needed to learn about and use Motivational Incentives, also referred to as Contingency Management.

Additional resources can be found on the ATTC Network website in their searchable Products & Resources Catalog.

Visit CASAT Training for both online and/or upcoming trainings about stimulant use disorder, the Matrix Model, and Motivational Incentives (Contingency Management).

Additional materials and links can be found in the CASAT OnDemand Resources & Downloads section of our website.

References

Center for Substance Abuse Treatment. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series 47. DHHS Publication No. (SMA) 06-4182. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.

Center for Substance Abuse Treatment. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series 47. DHHS Publication No. (SMA) 06-4182. Editor’s Note. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017.

Eghbali, H., Zare, M., Bakhtiari, A., Monirpoor, N., & Ganjali, A. (2013). The effectiveness of matrix interventions in improving methadone treatment. International Journal of High Risk Behaviors & Addiction, 1(4), Published online 2013 Mar 2. doi: 10.5812/ijhrba.8906

National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide. ( No. 12-4180.;no. 12-4180.;). Rockville, Md.: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services.

Petry, N. M. (2011). Contingency management: What it is and why psychiatrists should want to use it. The Psychiatrist, 35(5), 161-163. doi:10.1192/pb.bp.110.031831

Roll, J. M., Petry, N. M., Stitzer, M. L., Brecht, M. L., Peirce, J. M., McCann, M. J., . . . Kellogg, S. (2006). Contingency management for the treatment of methamphetamine use disorders. American Journal of Psychiatry, 163(11), 1993-1999. doi:10.1176/ajp.2006.163.11.1993

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