Matrix Model

1. Introduction

Version followed: the public CSAT/SAMHSA Matrix Intensive Outpatient Treatment (IOP) package for stimulant use disorders (first issued 2006, reissued 2013): Counselor's Treatment Manual (SMA 13-4152, "CTM"), Client's Handbook (SMA 06-4154, "CH") and Counselor's Family Education Manual (SMA 13-4153, "FEM"). The current CLARE|MATRIX (Matrix Institute/Hazelden) commercial version, which reportedly adds motivational interviewing and contingency management more explicitly and has adult, youth and criminal-justice manuals, is not public and was not used [source: CWRU 2026 report; CEBC].

The Matrix Model is a manualised, year-long outpatient programme, not a single technique: a 16-week intensive phase of structured groups, three individual/conjoint sessions, family education and weekly drug/breath testing, followed by 36 weeks of continuing-care social support groups. It was developed in Los Angeles in the 1980s by Richard Rawson, Jeanne Obert and colleagues at the Matrix Institute during the cocaine epidemic (originally called the "neurobehavioral model"), and later used for methamphetamine and other drugs and in other countries [source: CWRU 2026, citing Rawson et al. 1995; Obert et al. 2000].

Core idea of change: early recovery fails mainly because of conditioned triggers, cravings and predictable relapse processes in a brain that is still healing. Change comes from (a) heavy external structure (a written hour-by-hour schedule, frequent attendance, testing) that keeps the client away from triggers while the brain recovers; (b) learning a small set of concrete cognitive-behavioural skills (identifying triggers, interrupting the trigger-thought-craving-use chain, spotting relapse drift and justifications); (c) staying in treatment long enough, with a supportive primary counsellor, family involvement and 12-Step/mutual-help connection, for a rewarding drug-free life to become its own motivation [source: CTM intro and ERS 1, ERS 5; CH RP 7, RP 11].

Abbreviations used in tags: CTM, CH, FEM as above; MI-slides = Matrix Institute 2006 training slides (secondary copy on SlideServe); CEBC = California Evidence-Based Clearinghouse profile; CWRU 2026 = Case Western SUD Center of Excellence Matrix Model report.

2. Framework

Overall structure [source: CTM intro; FEM intro]

Sample week [source: FEM Figure I-1]: Monday and Friday = ERS then RP (month 1), RP only afterwards; Wednesday = Family Education (later Social Support); Tuesday, Thursday and weekend = 12-Step/mutual-help meetings. CEBC describes the intensity as roughly 3 hours a day, 3 days a week, minimum IOP level of care, groups of 8-12, one full-time counsellor per about 25 clients [source: CEBC].

Phases and goals

• Intensive phase, month 1 (ERS + RP + IC 1 + family education begins): stop use, set up the schedule, learn the trigger-craving chain and thought-stopping, start meetings, understand the recovery "roadmap" [source: CTM ERS 1-8].
• Intensive phase, months 2-4 (RP twice weekly + family education + IC 2 at week 5-6): maintain abstinence through the "Wall", detect relapse drift and justification, rebuild trust, work, money, health and relationships [source: CH RP 1-19; CTM IC 2].
• Transition (month 4: IC 3, start Social Support): evaluate change across life areas and write a continuing-treatment plan [source: CTM IC 3].
• Continuing care (weeks 17-52): weekly Social Support group plus mutual-help; relearn sober socialising [source: CTM; FEM].

Recovery stages taught to clients (Roadmap for Recovery) [source: CTM ERS 5]: withdrawal; early abstinence ("Honeymoon"); protracted abstinence ("the Wall"); readjustment. Most relapses occur in withdrawal or the Wall; methamphetamine recovery can lag the usual timeline. Use the stages to predict and normalise what the client is feeling and to time extra support. The manual's exact week ranges for each stage were not read [uncertain].

Criteria for moving on [source: CTM]: progression is largely time-based (open-ended groups; a new client enters ERS and RP at whatever session is running). Clinical decision points are tied to IC sessions and test results: on-track clients complete the Recovery Checklist at IC 2; struggling or relapsing clients do a Relapse Analysis and may repeat ERS while staying in RP; repeated positive tests lead to more frequent visits/testing or a move back to ERS; continued positives may require referral to a higher level of care. Clients are not discharged for a positive test. Social Support begins in the last month of intensive treatment. RP co-leaders are recruited from clients with at least a year of abstinence who completed treatment. Formal abstinence criteria for graduating were not found [uncertain].

3. Guiding principles

Counsellor principles as taught by the Matrix Institute [source: MI-slides 2006; consistent with CTM intro]:

• Create explicit structure and expectations. Hand over a written schedule and service agreement in session 1, start and end groups on time, keep each group on its topic.
• Build a positive, collaborative relationship. The counsellor-client relationship is treated as the main treatment dynamic; be warm, respectful and on the client's side, not an enforcer [source: CTM intro].
• Teach information and cognitive-behavioural concepts. Each group reads and discusses a defined handout; explain the why (brain chemistry, conditioning) behind every request.
• Positively reinforce behaviour change; give corrective feedback when needed. Praise progress before raising problems; do not get into a struggle over one point of resistance [source: CTM IC sessions].
• Introduce and encourage self-help participation. Treat 12-Step or alternative mutual-help attendance as part of treatment, and review it each week.
• Focus on behaviour rather than feelings. Ask what the client did, will do and scheduled, rather than opening up emotional exploration; ERS is explicitly "not a therapy group" [source: FEM summary of ERS].
• Non-judgemental attitude. Lapses and positive tests are information, not moral failure; relapse "does not indicate failure" but means the plan needs changing [source: CTM IC 2].
• Base recommendations on scientific data. Justify advice (e.g. total abstinence including alcohol and cannabis) with what research shows, not personal opinion [source: CH RP 9].
• Abstinence is the bottom line. The goal is stopping all drugs and alcohol, not moderation [source: CH RP 9].

Further operating principles in the manuals:

• One primary counsellor coordinates everything. The same counsellor does the IC sessions, links group material into one coherent experience and responds to test results [source: CTM; FEM].
• Repeat key material deliberately. Early recovery impairs memory and concentration; repeat skills across sessions and keep explanations short and concrete [source: CTM intro].
• Open-ended groups; each session stands alone. Do not assume prior sessions; briefly re-teach core tools whenever new members are present [source: CTM intro].
• Manage group energy. Calm an over-excited group and lift a flat one; early recovery clients are easily over-stimulated, so keep ERS structured and low-key [source: MI-slides; FEM].
• Include the family, but do not insist. Invite significant others to IC sessions and family education; if the client refuses, respect that and revisit later [source: FEM; CTM].
• Testing is a recovery tool, not a punishment. Present it as protection and accountability; never debate lab validity [source: CTM].
• Safety first. Violence can occur in families affected by stimulants; prioritise client and family safety in conjoint work [source: FEM].
• Cultural sensitivity. Treat culture broadly and the client as an individual [source: FEM; CTM].
• Use recovering peers as co-leaders. A client co-leader models recovery by sharing first-person experience; they do not counsel [source: CTM].

4. Intervention inventory

Handout codes (IC, ERS, RP, SCH, CAL) follow the CTM/CH numbering. All example language is illustrative unless quoted. Describe or hand out the official handouts; do not recreate them from this guide.

A. Programme-level tools and individual/conjoint sessions

A1. IC Session 1: Orientation

• Purpose / when: Week 1, before the first group. Engage the client (and family member if possible), set structure and expectations, sign up for groups [source: CTM IC 1].
• Steps:
  1. Welcome client and family; ask briefly what brought them in and what they hope for.
  2. Give a short overview of the model and its components using the weekly schedule figure.
  3. Help the client choose group days/times; give a written copy.
  4. Read the service agreement (IC 1) aloud item by item, pausing after each numbered point to check understanding; explain the consequences of breaking it (including testing rules, and that observed collection may be used as a last resort).
  5. Give the Client's Treatment Companion (pocket tool for logging triggers and helpful techniques); the Client's Handbook is handed out at the first group.
  6. Invite the family member to Family Education.
• Example language (illustrative): "For the next four months your week has a shape: groups on Monday and Friday, a family session on Wednesday, meetings in between. Let's go through the agreement one point at a time so nothing surprises you later."
• Watch for: ambivalence or overwhelm at the time commitment (problem-solve schedule conflicts now rather than lecture); family conflict or safety concerns; acute intoxication or withdrawal needing medical assessment [synthesis]. Working if the client leaves with written group times and attends the first ERS.

A2. IC Session 2: Client progress / crisis intervention

• Purpose / when: Around week 5-6, and any time a relapse or crisis occurs [source: CTM IC 2].
• Steps:
  1. Deal first with anything urgent; bring family in early if the crisis involves them.
  2. If the client is on track: have them complete the Recovery Checklist (IC 2A) together with you; go through each item and reinforce successes specifically.
  3. If the client is struggling or has used: complete a Relapse Analysis Chart (IC 2B, see A3).
  4. Adjust the plan (schedule, group attendance, testing frequency, repeating ERS).
• Example language (illustrative): "You've had five clean weeks and you haven't missed a group. That's the work paying off. Which part of your schedule is helping most?"
• Watch for: clients presenting a good picture while drifting; cross-check with test results, attendance and family report [synthesis].

A3. Relapse Analysis (IC 2B)

• Purpose / when: After any lapse/relapse, positive test or near-miss; frames relapse as having antecedents and being avoidable, not a sign of failure [source: CTM IC 2].
• Steps:
  1. Set a non-blaming frame: the aim is to learn what led up to it.
  2. Work backwards from the use through the preceding days: events, people, places, emotions, thoughts, schedule gaps, stopped behaviours (mooring lines), justifications.
  3. Mark the earliest point where a different action was possible.
  4. Agree specific changes (tighter schedule, avoiding a person/place, extra meetings, more testing, repeating ERS) and write them down.
• Example language (illustrative): "Let's rewind. The use was Saturday night; what was happening Saturday morning? Thursday? Where was the first sign things were drifting?"
• Watch for: shame shutting the client down (normalise, praise honesty); repeated identical chains suggesting a higher level of care [synthesis]. Working when the client can name early warning signs and a concrete plan.

A4. IC Session 3: Continuing treatment planning

• Purpose / when: Week 16, end of intensive phase [source: CTM IC 3].
• Steps:
  1. Ask reflective questions: what helped, what changed, what still feels risky.
  2. Complete the Treatment Evaluation (IC 3A) across eight life areas: current status, goals, next steps, timelines.
  3. Draft the Continuing Treatment Plan (IC 3B): Social Support group (at least one recovery group weekly), mutual-help meetings, and whether individual or couples therapy is needed.
• Example language (illustrative): "Four months ago you couldn't get through a weekend. What's different now, and what do you need in place for the next eight months?"
• Watch for: premature confidence ("I've got this"); link to RP 13 "Be Smart, Not Strong" [synthesis].

A5. Urine/saliva and breath-alcohol testing

• Purpose / when: Weekly throughout; objective feedback and accountability; presented as a recovery tool, not a punishment [source: CTM].
• Steps:
  1. Explain the testing rules in IC 1, including the possibility of observed collection (last resort, supervisor approval).
  2. Test at least weekly, sometimes randomly, and schedule tests after high-risk periods (weekends, paydays). Test immediately after unexplained absences, odd behaviour or family reports.
  3. Positive result: review the surrounding period with the client, let them explain, do not argue about lab accuracy, proceed as if use occurred, reinforce any admission, and do a lapse analysis.
  4. Consider more frequent testing; coordinate with courts/probation where there is a release.
  5. Repeated positives: stress abstinence, increase visit frequency or return the client to ERS; continued positives may need a higher level of care. Do not discharge for a positive test.
  6. Suspected tampering: speak privately, avoid accusation, treat it as a probable sign of use.
• Example language (illustrative): "The test came back positive for methamphetamine. I'm not here to argue about the lab. Let's figure out what happened so it doesn't happen again."
• Watch for: tests becoming a battleground; counter by praising honesty and negative results [source: CTM; MI-slides]. Three consecutive negative samples during treatment predicted later abstinence in one trial, so strings of negatives are worth celebrating [source: CWRU 2026, citing Rawson et al. 2012].

A6. Scheduling (SCH 1, SCH 2)

• Purpose / when: From ERS 1 onward, every session; structure keeps the client away from triggers and fills risky empty time [source: CTM ERS 1; CH].
• Steps:
  1. Explain why: unstructured time and impulsive decisions lead to use; written plans hold better than "schedules that exist only in one's head" [source: CTM].
  2. Have the client plan every hour from now until the next session, with no gaps, including meals, sleep, work, groups, meetings, exercise.
  3. Give special attention to evenings, weekends, paydays and other high-risk times.
  4. At the next session, review how far the schedule was followed and what got in the way.
• Example language (illustrative): "Write down Saturday from wake-up to bedtime. Where's the empty two hours? That's where we need a plan."
• Watch for: vague entries ("hang out"); schedules that include triggers; repeated non-completion (see section 5). Working when actual days match the plan.

A7. Marking progress on the calendar (CAL 1, CAL 2)

• Purpose / when: Start of every ERS session (about 5 min): visible record of abstinent days [source: CTM ERS format].
• Steps: Each client checks off abstinent days since the last session and states their progress at introductions; counsellor and co-leader acknowledge milestones.
• Example language (illustrative): "Mark your days. Twelve in a row, that's the longest since you started."
• Watch for: clients hiding use days; respond without shaming and follow up individually [synthesis].

A8. Client co-leaders (peer co-leadership)

• Purpose / when: ERS and RP groups; recovering client shares first-person experience and models recovery [source: CTM].
• Steps:
  1. Select: ERS co-leaders need at least 8 weeks abstinent, regular attendance and a 3-month commitment; RP co-leaders need at least a year abstinent, completed treatment, active Social Support and 12-Step participation, and a 6-month commitment.
  2. Have them sign the co-leader agreement (CTM Appendix C).
  3. Meet briefly before group (topic, any concerns) and after (debrief).
  4. Ensure they speak in the first person, keep confidentiality, and do not counsel members one-to-one.
• Example language (illustrative, counsellor to co-leader): "Tonight's topic is boredom. Could you share what your evenings were like in your first two months and what you did about them?"
• Watch for: co-leaders lecturing or advising, or showing signs of their own drift; debrief and support them [synthesis].

B. Early Recovery Skills (ERS) group: sessions 1-8

Standard ERS format [source: CTM]: counsellor states the group's aim (basic abstinence skills); introductions with each client stating their progress; marking progress on the calendar (about 5 min); topic discussion using that session's handouts (about 35 min); scheduling (about 5 min, 15 min in session 1) and homework review (about 5 min). Keep it structured, "how to" focused, low-key, not a therapy group.

B1. ERS 1: Stop the Cycle (trigger-thought-craving-use)

• Purpose: Teach that use follows a conditioned chain, triggers set off thoughts, thoughts become cravings, cravings lead to use, and that the chain can be broken early [source: CTM ERS 1; handouts ERS 1A-1C].
• Steps:
  1. Define triggers and cravings; ask each client to name personal triggers, and those they expect to meet outside.
  2. Explain that cravings are partly physiological and won't simply yield to willpower, so behaviour must change: avoid triggers, get rid of paraphernalia, cut contact with dealers/users.
  3. Draw the chain (ERS 1B) and ask where each person's chain usually starts.
  4. Teach thought-stopping (B2); the co-leader describes how cravings eased over time.
  5. Do the longer scheduling exercise (15 min).
• Example language (illustrative): "Once the craving is in full swing, you're in a fight you'll usually lose. The trick is to catch it at the thought, before it becomes a craving."
• Watch for: clients who say they have no triggers (prompt with places, people, times, money); intense cravings during the session (see section 5).

B2. Thought-stopping techniques (ERS 1C)

• Purpose / when: Interrupt a using thought before it builds into a craving; cravings typically last "30 to 90 seconds" [source: CTM ERS 1], so the goal is to buy time and then act.
• Steps: Teach four options, have each client choose one or two and rehearse in group (the four names are from CTM; the concrete details below are my paraphrase, as the handout text itself was not read [uncertain]):
  1. Visualisation: picture a switch or lever and turn the thought off, then replace it with a planned image (e.g. a valued goal).
  2. Snapping: snap a loose band on the wrist when the thought appears, saying "no" to it.
  3. Relaxation: slow deep breaths to ride out the physical feeling.
  4. Calling someone: phone a supportive person (sponsor, family, co-leader). Then immediately do something incompatible with use (leave, go to a meeting, follow the schedule). Log what works in the Treatment Companion.
• Example language (illustrative): "The moment you notice the thought, snap the band and say 'No, not today', then call Mike or get to a meeting. Don't argue with the thought."
• Watch for: clients "entertaining" thoughts rather than stopping them; using thought-stopping on emotions (that is what ERS 3 and RP 18 address). Working when clients report shorter, weaker cravings [synthesis].

B3. ERS 2: Identifying External Triggers

• Purpose: Map people, places, things and situations linked to use, and "safe" ones [source: CTM ERS 2; ERS 2A questionnaire, 2B chart].
• Steps: Clients tick applicable triggers on the questionnaire and add their own; list safe people/situations; rate each trigger by strength of association with use on the chart (from never-used to always-used); link high-risk items to the schedule (avoid or plan around them); review thought-stopping.
• Example language (illustrative): "Look at the triggers you rated highest. Which of these is on your route home? Can we change the route?"
• Watch for: unavoidable triggers (partner who uses, job), flag for IC session or RP 4 [synthesis].

B4. ERS 3: Identifying Internal Triggers

• Purpose: Identify thoughts and emotions that lead to use (e.g. depression, shame, fear, self-doubt, also positive emotions) and plan responses; responses to internal triggers are under the client's control [source: CTM ERS 3; ERS 3A/3B].
• Steps: Normalise emotions common in early recovery; clients complete the internal trigger questionnaire and chart; discuss specific coping actions for the top two or three.
• Example language (illustrative): "You can't always choose the feeling, but you can choose what you do in the next ten minutes."
• Watch for: severe depression or suicidal thinking (go to section 5).

B5. ERS 4: Introducing 12-Step or Mutual-Help Activities

• Purpose: Explain structure and benefits of 12-Step meetings, locate local meetings, make attendance part of recovery [source: CTM ERS 4; ERS 4A/4B].
• Steps: Invite past experiences, negative and positive; explain meeting types (open/closed, speaker/discussion, step study), home group and sponsor; mention Crystal Meth Anonymous and alternative mutual-help groups; homework is at least one meeting before ERS 5.
• Example language (illustrative): "You don't have to like every meeting. Try three different ones and tell us which felt closest to home."
• Watch for: objections about religion or speaking; offer non-12-Step alternatives rather than debate [source: CTM ERS 4; CWRU].

B6. ERS 5: Body Chemistry in Recovery (Roadmap for Recovery)

• Purpose: Present recovery as physical healing with predictable stages (withdrawal, Honeymoon, Wall, readjustment), and prepare clients for the high-risk ones [source: CTM ERS 5; ERS 5 handout].
• Steps: Describe each stage and typical symptoms (fatigue, sleep and mood changes, poor concentration, low energy in the Wall); discuss self-care (nutrition, exercise, sleep, relaxation); warn that most relapses happen in withdrawal or the Wall and that methamphetamine recovery may lag behind.
• Example language (illustrative): "If you hit a stretch where everything feels flat and pointless, that's the Wall. It's chemistry, it passes, and it's the time to lean hardest on your schedule."
• Watch for: clients feeling cured during the Honeymoon and loosening structure [source: CTM ERS 5-6].

B7. ERS 6: Common Challenges in Early Recovery (including Alcohol Arguments)

• Purpose: Build substance-free coping for common early challenges and address the push to resume drinking, often around the end of the Honeymoon (about six weeks) [source: CTM ERS 6; ERS 6A/6B].
• Steps: Review five common challenges and their suggested solutions; each client names the most troublesome and a plan; list rationalisations for returning to alcohol and counter each; co-leader shares strategies.
• Example language (illustrative): "What's the argument your head makes for 'just a beer'? Let's write it down and write the answer next to it."
• Watch for: clients who see alcohol as separate from their problem (link to RP 1 and RP 9).

B8. ERS 7: Thinking, Feeling, and Doing (Addictive Behaviour)

• Purpose: Separate thoughts, emotions and behaviour; show that thoughts can be switched ("changing channels"), emotions can't be controlled but responses can, and identify addictive behaviours that signal movement toward use [source: CH ERS 7A/7B; CTM TOC].
• Steps: Explain the three elements; practise changing the channel on a using thought; clients tick their addictive behaviours (e.g. lying, stealing, unreliability, neglecting health, impulsivity, isolation, missing treatment, using other substances, stopping prescribed medication) and agree who will point these out to them.
• Example language (illustrative): "When you catch yourself lying about something small, treat it like a smoke alarm. What would you do next?"
• Watch for: defensiveness when behaviours are named; keep it self-identified. CTM counsellor notes for this session are not drawn on [uncertain].

B9. ERS 8: 12-Step Wisdom (12-Step sayings and HALT)

• Purpose: Give short, memorable recovery slogans (e.g. one day at a time, keep it simple) and the HALT check (hungry, angry, lonely, tired) as quick self-monitoring tools [source: CH ERS 8].
• Steps: Go through each saying and ask how it applies this week; explain why each HALT state raises risk and the matching fix (regular meals, constructive anger handling, contact with people, sleep); clients rate how often they are in each state and pick one change.
• Example language (illustrative): "Before you act on a craving, ask HALT: am I hungry, angry, lonely or tired? Fix that first."
• Watch for: slogans used to shut down discussion; keep them practical. CTM counsellor notes not drawn on [uncertain].

C. Relapse Prevention (RP) group

C0. RP group format (applies to all 32 sessions)

• Purpose: Twice-weekly, about 90-minute topic-based group where members share information, support each other and redirect anyone moving toward relapse. Premises: relapse is not random, follows predictable patterns, and has warning signs that staff and clients can spot [source: CTM intro; FEM]. Training goals: contact with others in recovery, specific RP content, co-leader sharing long-term sobriety experience, group cohesion [source: MI-slides].
• Steps: The CTM's segment-by-segment RP procedure is not drawn on [uncertain]. Practical rules taught by the Matrix Institute [source: MI-slides]: start and end on time; control how much time each client gets; keep the group safe so members feel the counsellor is in control; organise around the topic (it is not a process-therapy group); manage group energy; keep the focus on relapse prevention; new or unstable members may be asked to listen only; have a plan ready for an intoxicated client. A workable running order [synthesis, consistent with the ERS format]: (1) brief check-in, each member states days abstinent and any close calls since last group; (2) introduce the topic and read the handout together; (3) members complete the handout questions and discuss, co-leader shares first; (4) apply to the coming days, each member names one action; (5) close with schedules until the next group and invite anyone with active cravings to stay behind.
• Example language (illustrative): "Quick round first: days clean, and anything that got close since Monday. One or two sentences each, then we'll get into tonight's topic."
• Watch for: one member dominating, war stories that glamorise use (redirect to what was learned), members who go quiet or start missing groups (early drift signs).

For each RP topic below: purpose and content are paraphrased from the Client's Handbook handout; steps assume the C0 format. Example language is illustrative.

C1. RP 1: Alcohol

• Purpose: Show why stopping drinking is hard (alcohol is everywhere, used to manage mood, lowers inhibitions and judgement) and why it matters for stimulant recovery [source: CH RP 1].
• Steps: Clients answer the handout questions: which social situations are hard to face sober, which moods prompt a drink, what has made stopping hard, how they relied on alcohol socially or sexually, family celebrations involving alcohol, and activities they associate with drinking; plan alternatives for the top situations.
• Example language: "Which upcoming event will be your hardest sober? Let's plan it now."
• Watch for: "alcohol was never my problem"; link to RP 9.

C2. RP 2: Boredom

• Purpose: Normalise boredom (lost highs, healing brain chemistry, new routine) and reduce it as a trigger [source: CH RP 2].
• Steps: Each client lists five recreational activities to pursue; notes old pre-drug interests and new ones already started; names something to look forward to and when they last broke routine; chooses tips (scheduling, avoiding complacency, new challenges) to try.
• Example language: "Boredom isn't a character flaw here, it's a symptom. What's one thing on your list you'll put in this week's schedule?"
• Watch for: anhedonia that persists past the Wall, possibly depression (section 5).

C3. RP 3: Avoiding Relapse Drift (Mooring Lines; RP 3A/3B)

• Purpose: Teach that relapse often comes as slow, unnoticed drift, like a moored ship working loose, and give a weekly early-warning check [source: CH RP 3A/3B].
• Steps:
  1. Explain the drift image; protective behaviours are "mooring lines".
  2. Each client writes four or five specific, measurable mooring lines (e.g. exercise, appointments, scheduling, meetings, regular meals); attitudes don't count. Add people/places to avoid.
  3. Enter them on the weekly chart and tick each week.
  4. Rule of thumb: two or more unticked lines in a week means drift; act on it.
  5. Plan ahead for illness or emergencies, which often cut lines; after five weeks transfer the list to a journal or the Treatment Companion.
• Example language: "Which of your mooring lines snapped this week? Two? Then we treat this as drift and tighten up now."
• Watch for: vague lines ("stay positive"); make them countable. Review the chart at later sessions and IC 2 [synthesis].

C4. RP 4: Work and Recovery

• Purpose: Balance work and recovery so neither undermines the other [source: CH RP 4].
• Steps: Identify the client's situation and matching advice: demanding job (adjust the schedule with counsellor and employer/EAP, ask about flexible hours, recovery first); unsatisfying job (postpone big changes for roughly 6-12 months); high-risk job (near users or unaccounted cash: plan a change); unemployed (balance job-seeking with treatment and keep the counsellor informed).
• Example language: "If work and group clash, which one is easier to move this month?"
• Watch for: overwork as a substitute high, or work used to justify missing groups.

C5. RP 5: Guilt and Shame

• Purpose: Distinguish guilt (about actions; can prompt amends) from shame (about who one is), and counter the idea that recovery depends on being good or strong [source: CH RP 5].
• Steps: Clients list actions they feel guilty about, whether they still do and what they could do about each; answer the handout's shame questions; discuss that smart choices and work, not willpower, produce recovery.
• Example language: "Guilt says 'I did something bad.' Shame says 'I am bad.' Which one is talking right now?"
• Watch for: trauma disclosures or overwhelming shame (contain, follow up individually; section 5).

C6. RP 6: Staying Busy

• Purpose: Idle time and isolation can start craving; replace them with planned activity and people [source: CH RP 6].
• Steps: Clients answer how free time has triggered them, how they will respond to using thoughts in free time, how isolation fed their use and how being alone feels now, recent fun, old activities and friends re-contacted and new ones added, or plans if none.
• Example language: "When are you alone with nothing planned this week? That's the slot we need to fill."
• Watch for: frantic busyness that leads to exhaustion (HALT).

C7. RP 7: Motivation for Recovery

• Purpose: Show that reasons for entering treatment (crisis, pressure) differ from reasons to stay abstinent, and that staying abstinent long enough for life to improve sustains recovery [source: CH RP 7].
• Steps: Clients list why they entered treatment and why they continue today, and whether those reasons have changed.
• Example language: "You came because of the court. What's keeping you here now that's yours?"
• Watch for: motivation resting only on external pressure; reinforce emerging internal reasons [synthesis].

C8. RP 8: Truthfulness

• Purpose: Address dishonesty as part of addiction and practise honesty in recovery [source: CH RP 8].
• Steps: Clients describe ways they were untruthful while using and where honesty has been hard since; work through the checklist of partial truths, telling people what they want to hear and omissions.
• Example language: "Leaving out the part that matters is still not the truth. Where are you doing that now?"
• Watch for: links to positive tests and concealed lapses; reinforce disclosure.

C9. RP 9: Total Abstinence

• Purpose: Make the case for stopping all substances, including alcohol and cannabis, citing follow-up data linking their use to stimulant relapse [source: CH RP 9].
• Steps: Review common drinking rationalisations and the counter to each; discuss how numbing discomfort with another substance blocks dealing with the stimulant problem and risks new dependence; note that difficulty stopping alcohol suggests greater dependence.
• Example language: "If giving up alcohol feels impossible, that's useful information about how much it has a hold on you."
• Watch for: clients on prescribed medication worrying this applies to them; clarify that prescribed medication taken as directed is not the target and should not be stopped without the prescriber [synthesis, consistent with ERS 7B listing stopping prescribed medication as an addictive behaviour].

C10. RP 10: Sex and Recovery

• Purpose: Separate intimate sex within a committed relationship from impulsive sex used as a high, which can start relapse (especially for stimulant users) [source: CH RP 10].
• Steps: Clients reflect on impulsive sexual experiences and links with drug use, and describe a healthy intimate relationship they have had or want.
• Example language: "For many people stimulants and sex got wired together. Noticing that link is part of protecting your recovery."
• Watch for: discomfort in mixed groups; allow private reflection rather than disclosure; sexual health and safety needs [synthesis].

C11. RP 11: Anticipating and Preventing Relapse

• Purpose: Define relapse as a process (behaviours and thinking return before the drug does) and identify three warning-sign clusters: addictive behaviour, addictive thinking and emotional build-up [source: CH RP 11].
• Steps: Clients identify their own addictive behaviours, excuses they have made to use, and any emotional build-up (boredom, anxiety, frustration, depression); choose actions from the checklist (call counsellor or friend, take time off, talk with family, attend a meeting, exercise, reschedule more tightly) or write their own.
• Example language: "Relapse started before the pipe was in your hand. Which of the three signs shows up first for you?"
• Watch for: clients naming signs but no action; insist on one concrete step.

C12. RP 12: Trust

• Purpose: Accept that trust rebuilds slowly through consistent behaviour; manage resentment at being doubted [source: CH RP 12].
• Steps: Clients describe how use damaged trust, whether being doubted makes them want to use, how they cope with suspicion, and what they can do to rebuild trust.
• Example language: "Being doubted when you're clean is hard. What will you do with that feeling instead of using it as a reason?"
• Watch for: suspicion as a relapse justification (link to RP 16).

C13. RP 13: Be Smart, Not Strong (Recovery IQ)

• Purpose: Recovery depends on smart choices (avoiding triggers, risky people/places) rather than strength [source: CH RP 13].
• Steps: Clients rate themselves on the handout's eleven recovery behaviours (e.g. thought-stopping, scheduling, keeping appointments, avoiding triggers, abstaining from all substances, avoiding users and using places, exercise, truthfulness, meetings) on a four-point scale, total a "Recovery IQ" and pick the lowest items to improve.
• Example language: "Testing yourself by walking past the old corner isn't strength, it's a bad bet. What's the smart version?"
• Watch for: pride in "being able to handle" triggers.

C14. RP 14: Defining Spirituality

• Purpose: Explore spirituality broadly (values, meaning, sense of self) as a source of inner peace that reduces the need for substances; 12-Step and mutual-help are one route [source: CH RP 14].
• Steps: Clients reflect on what they want from life and whether they are getting it, what gives them a sense of security, what qualities they need to approve of themselves, and what success means.
• Example language: "This isn't about religion unless you want it to be. What gives your life meaning when you're not using?"
• Watch for: religious trauma or strong secular objections; keep it values-based.

C15. RP 15: Managing Life; Managing Money

• Purpose: Tackle neglected life tasks and money-related triggers [source: CH RP 15].
• Steps: Clients tick neglected life tasks (fines, taxes, bills, repairs, insurance, banking, chores) and take on one per week, writing how they'll start; tick money issues (cash as a trigger, hiding money, debt, gambling, compulsive spending, arguments, theft) and set goals such as temporarily handing control of money to a trusted person, small debt instalments, a budget, spending agreements, using a bank account, saving.
• Example language: "Payday has been a trigger for you. Who could hold your card for the next month?"
• Watch for: overwhelm at the size of the pile; one item per week.

C16. RP 16: Relapse Justification I

• Purpose: Show how the addicted brain manufactures excuses; prepare responses in advance [source: CH RP 16].
• Steps: Review the four justification categories (someone else's fault; catastrophe; using for a specific purpose; depression, anger, loneliness or fear) with examples; each client names their most likely justifications and a planned response for each.
• Example language: "When you hear yourself say 'after what she did, I deserve it', that's the justification talking. What will you do in that moment?"
• Watch for: justifications appearing in the group itself; name them gently.

C17. RP 17: Taking Care of Yourself

• Purpose: Rebuild self-esteem through self-care [source: CH RP 17].
• Steps: Clients tick neglected areas (medical and dental care, appearance, diet, clothes linked to using days, eyesight and hearing, exercise, caffeine and nicotine) and choose one or two per week, naming the first step.
• Example language: "Which one could you book this week? A dentist appointment counts as recovery work."
• Watch for: untreated medical problems; refer [synthesis].

C18. RP 18: Emotional Triggers

• Purpose: Flag loneliness, anger and feeling deprived as fast routes to relapse; build daily emotional awareness [source: CH RP 18].
• Steps: Clients identify which of these have triggered them and other dangerous emotions; start daily free-writing about feelings (breathe, write without worrying about spelling, ask what they are feeling right now).
• Example language: "Ten minutes a day: what am I feeling, and what do I need? No one marks it."
• Watch for: literacy limits; allow voice notes or drawings [synthesis].

C19. RP 19: Illness

• Purpose: Illness weakens defences and can become a justification; it disrupts routine (missed groups and meetings, no exercise, time alone in bed, unstructured days) [source: CH RP 19, partly read].
• Steps: Clients identify how past illnesses affected use and plan protective habits (light exercise when able, regular meals, sleep, stress reduction), plus how to stay connected to treatment while unwell. Rest of the handout not read [uncertain].
• Example language: "If you get flu next week, how will you stay connected, phone check-ins, meetings online?"
• Watch for: prescribed pain or sleep medication risks; coordinate with the prescriber [synthesis].

C20. RP 20-32 and electives

The titles below are from the CTM table of contents; their handout content is not drawn on, so only the topic is named and the C0 format applies. Do not treat any added detail as Matrix content [uncertain].

Use: obtain the CTM and Client's Handbook pages for these sessions before running them. Elective B is useful before major holidays and Elective A when the group needs a progress review [synthesis].

D. Family Education group

D1. Family Education sessions (12)

• Purpose / when: Weekly, about 90 min, for clients and family members together; clients may join any time in the first 3 months. Teaches addiction and recovery, supports families, and builds a shared vocabulary [source: FEM].
• Session topics and formats [source: FEM]: 1 Triggers and Cravings (presentation); 2 Alcohol and Recovery (presentation); 3 Recovery (panel of people in recovery); 4 Methamphetamine and Cocaine (presentation); 5 Roadmap for Recovery (presentation); 6 Coping With the Possibility of a Relapse (multifamily discussion); 7 Opioids and Club Drugs (presentation); 8 Families in Recovery (presentation); 9 Rebuilding Trust (multifamily discussion); 10 Marijuana (presentation); 11 Living With an Addiction (multifamily discussion); 12 Communication Traps (multifamily discussion).
• Steps by format [source: FEM]:
  • Presentation sessions: about 40-45 min slide presentation, about 30 min focused discussion on the topic, 15-20 min open discussion.
  • Multifamily discussion sessions: start with reading the handout or posing its questions, then facilitated discussion with everyone seated in a circle.
  • Panel session: about 45 min of presentations by people in recovery (and possibly family members), about 30 min questions, about 15 min open discussion.
  • Invite anyone who is triggered or craving during the session to stay afterwards until they feel focused on recovery again; clients without family present can phone home to create accountability.
• Example language (illustrative): "Family members often ask 'How will I know if they're using again?' Tonight we'll look at the warning signs and what you can do that actually helps."
• Watch for: very small (2) or very large (30+) groups hamper discussion; family blame or confrontation in group (redirect to education); signs of domestic violence (safety first, see section 5); client refusing family involvement (don't insist) [source: FEM].

D2. Family helping checklists (older Matrix Institute variant)

• Purpose: In the 2006 Matrix Institute training version, individual sessions used family-oriented tools such as a Beginning Helping Checklist on which family members mark what they are willing to do (e.g. allow talk about cravings, remind the client of reasons for stopping, help avoid triggers, encourage continued treatment, walk away if abused), plus Middle Helping, Wall and Drug and Alcohol Dreams checklists [source: MI-slides]. These do not appear in the public CTM table of contents; use only if you have the Matrix Institute materials [uncertain].
• Steps (if used): go through the checklist with client and family in an IC session; agree which helping behaviours both accept; revisit at IC 2 [synthesis].
• Example language (illustrative): "Which of these would feel like help to you, and which would feel like being watched?"
• Watch for: family members taking on a policing role.

E. Continuing care

E1. Social Support group (36 sessions)

• Purpose / when: Weekly from the last month of intensive treatment to the end of the year; helps clients relearn socialising without substances and keeps them connected [source: CTM; FEM; CWRU].
• Steps: Run a less structured, discussion-based group on a one-word theme each week; example themes include patience, intimacy, isolation, rejection, work [source: CTM intro], anger, commitment, cravings, fear, friendships, honesty, trust [source: MI-slides]. The CTM Social Support guidance is not drawn on, so session procedure is [uncertain]; a workable approach [synthesis]: brief check-in, introduce the theme with one question, members discuss experiences and strategies, close with a plan for the week.
• Example language (illustrative): "Tonight's word is 'rejection'. When did you last feel rejected since getting clean, and what did you do with it?"
• Watch for: members drifting away after the intensive phase; follow up missed sessions promptly [synthesis].

E2. Ongoing 12-Step / mutual-help facilitation

• Purpose / when: Throughout the year; attendance at 12-Step or alternative mutual-help meetings is an expected part of treatment and the main long-term support [source: CTM ERS 4, RP 30 title; CWRU].
• Steps: Introduce in ERS 4; schedule specific meetings on non-group days; ask about meetings at each check-in; encourage a home group and sponsor; accept any accessible mutual-help programme that fits the client [source: CTM; CWRU].
• Example language (illustrative): "Which meeting is on your schedule for Thursday, and who might you talk to afterwards?"
• Watch for: attending but not connecting; suggest arriving early or staying for coffee [synthesis].

5. Handling problems

Lapse, relapse and positive tests [source: CTM]

• Do not discharge for a positive test. Review the period, let the client explain, don't debate lab validity, proceed as if use occurred, praise any admission, and complete a Relapse Analysis (A3).
• Add an IC session (IC 2 is explicitly for relapse/crisis), increase testing and visit frequency, and have the client repeat ERS while continuing in RP.
• Continued positives despite these steps: discuss a higher level of care (more intensive outpatient, residential, or medical/withdrawal management).
• Example (illustrative): "Using again doesn't cancel the weeks you've done. It tells us where the plan has a hole. Let's find it."

Suspected tampering or denial [source: CTM]: speak privately, don't accuse, treat tampering as a likely sign of use, and consider observed collection only as a last resort with supervisor approval and only if explained at orientation.

Missed sessions and non-adherence

• Group sessions cannot be made up; individual sessions can be rescheduled. Clients should notify the counsellor ahead of absences; phone notice is acceptable when last-minute [source: CTM].
• An unexplained absence warrants prompt contact and, on return, a drug test [source: CTM]. Call the same day, ask what happened without blame, and check the schedule and mooring lines for drift [synthesis].
• Schedules not completed: shrink the task (plan only the next 24 hours, or only evenings), fill it in together at the end of group, ask a family member to help, and praise partial completion [synthesis].
• Practical barriers (work hours, childcare, transport): solve them concretely using RP 4's work guidance; consider changing group times [source: CH RP 4; synthesis].

Cravings or being triggered in session [source: FEM]: invite the client to stay after group until they feel focused on recovery again; clients without family present can phone home. Also use thought-stopping, a phone call to a support and a concrete plan for the next few hours [synthesis].

Intoxicated client arrives [source: MI-slides says have a plan; details are synthesis]: speak privately, don't let them stay in group, assess for medical risk (chest pain, overheating, severe agitation, overdose signs; call emergency services if present), arrange safe transport (not driving), and schedule an individual session within a day or two.

Disruptive, dominating or glamorising members [source: MI-slides]: start and end on time, control each member's airtime, keep to the topic, bring a high-energy group down and lift a flat one. New or unstable members can be asked to listen only. Redirect war stories to "what did that teach you?"; address persistent disruption individually [synthesis].

Resistance and ambivalence

• Praise progress before addressing problems; don't struggle over one point of resistance [source: CTM]. Return to the client's own reasons (RP 7) and use the scientific rationale rather than authority [source: MI-slides; CH RP 7].
• Mandated clients (court, employer, child welfare): be transparent about what is reported and to whom; look for internal reasons over time (RP 7) [synthesis; CWRU notes drug-court combinations].
• "I can still drink / smoke cannabis": use RP 9 and ERS 6; keep abstinence as the goal while staying in a working relationship [source: CH RP 9; MI-slides].
• Refusing 12-Step: discuss past experiences, offer alternative mutual-help groups; any accessible group that fits counts [source: CTM ERS 4; CWRU].

Overwhelm in early recovery [source: CTM intro; ERS 5]: memory and concentration are poor early on, so repeat key points, use short handouts, write things down and keep sessions structured and low-stimulation. Normalise Wall symptoms as temporary brain recovery.

Ruptures in the counsellor relationship [synthesis]: because the relationship is the primary dynamic (CTM), repair quickly: name the strain ("Last week felt like I was policing you"), acknowledge your part, and restate that testing and structure serve the client's goals. Keep the same primary counsellor where possible.

Family problems

• Client refuses family involvement: respect it, don't insist, revisit later [source: FEM; CTM].
• Possible domestic violence: client and family safety first [source: FEM]. Screen privately and separately before any conjoint work, do not hold conjoint sessions while there is a risk of violence, safety-plan and follow local adult/child protection duties [synthesis].
• Families demanding instant trust or policing the client: use RP 12 and Family Education session 9 (Rebuilding Trust) [source: CH; FEM].

Co-leader relapse or boundary problems [synthesis]: step the co-leader down privately and supportively, offer them extra treatment contact, and brief the group only as much as the co-leader agrees.

Modality-specific clinical issues (problems the sources reviewed don't address; all [synthesis])

• Severe depression, anhedonia or suicidal thinking, common in stimulant withdrawal and the Wall: ask directly about suicidal thoughts at intake and whenever mood drops; use a structured risk assessment and your service's protocol; build a written safety plan; do lethal-means counselling (secure or remove medications and other means, involve family in safe storage); refer for psychiatric assessment. RP 29 (Coping With Feelings and Depression) is not a substitute.
• Paranoia, hallucinations or agitation (especially with methamphetamine): don't challenge beliefs in group; see individually, assess safety and refer for medical/psychiatric assessment; keep groups calm.
• Opioid or other co-use: after a period of abstinence tolerance falls and overdose risk rises; provide overdose education and naloxone in line with local practice, and coordinate medication for opioid use disorder where indicated (buprenorphine has been combined with the model in research [source: CWRU, citing Salehi et al. 2015]).
• Cognitive impairment or low literacy: read handouts aloud, use visual schedules, allow verbal answers.
• Adolescents, criminal justice settings: separate CLARE|MATRIX youth and criminal-justice manuals exist but were not reviewed [source: CWRU; uncertain]; do not simply run the adult groups with teenagers.
• Telehealth delivery: not addressed in the sources; if used, plan for testing logistics and group privacy [uncertain].

Sources

Sources:

• Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders: Counselor's Treatment Manual (SAMHSA SMA 13-4152) (text available through ERS 6; RP section not drawn on)
• Matrix IOP: Counselor's Family Education Manual (SAMHSA SMA 13-4153)
• Matrix IOP: Client's Handbook (Massachusetts copy) (text available through RP 19)
• Client's Handbook, 2006 edition, SMA 06-4154 (govinfo)
• Matrix Model: The Format (Matrix Institute 2006 slides, SlideServe copy) (secondary copy)
• Matrix Model Full Report, Case Western Reserve SUD Center of Excellence (2026)
• Matrix Model Intensive Outpatient Program, CEBC

Further reading (not drawn on):

• Center for Substance Abuse Treatment (2006). Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders (Counselor's Treatment Manual; Client's Handbook; Counselor's Family Education Manual; Client's Treatment Companion). Rockville, MD: SAMHSA.
• Rawson, R. A., Shoptaw, S. J., Obert, J. L., et al. (1995). An intensive outpatient approach for cocaine abuse treatment: The Matrix model. Journal of Substance Abuse Treatment, 12(2), 117-127.
• Obert, J. L., McCann, M. J., Marinelli-Casey, P., et al. (2000). The Matrix Model of outpatient stimulant abuse treatment: History and description. Journal of Psychoactive Drugs, 32(2), 157-164.
• Rawson, R. A., et al. (2004). A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction, 99(6), 708-717.