The Matrix Model – Stages of Recovery

July 11, 2014

By Terence T.Gorski, Author
www.relapse.org

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The Matrix Model for Cocaine Addiction was originally developed by Richard Rawson. http://www.sciencedirect.com/science/article/pii/074054729400080B

I believe the recovery chart depicted her is modified from the framework of the Matrix Recovery Model.

The model is developmental in nature (i.e. their are a series of developmental steps and stages of recovery). The idea of Post Acute Withdrawal is built into the model by intruding the the concept of “hitting the wall” which is a severe episode of PAW. PAW however, was not specifically mentioned in early versions of the model.

The Matrix Model was popular during the years of “The Cocaine Epidemic” in the 1980”s and 1990’s. It was an empirical model growing out of treatment experience and I clinical practice.

As with many other models it was expanded to include all addictive substances without any real evidence it was valid. It implies progressive recovery, with relapse as a treatment recovery failure.

There is no specific relapse prevention plan or emergency plan to stop relapse quickly should it occur. As a result the model, toy knowledge, has not adapted to integrate the chronic life-style related disease model and the need for relapse prevention and management of the course of the entire lifespan.

The model has been used in many programs and helped many people to recover.

The Matrix Model has been recognized as an evidence-based program and practice by NREPP – http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=87

I cannot locate the specific diagram and it is not referenced. The idea that neurological symptoms of recovery (PAW) can be predicted by days abstinent is controversial. Stage of addiction, type and amount of drug(s) used, age and health status of the patient, type of treatment, nutrition and stress management effect the progression of recovery.

GORSKI BOOKS


Relapse Prevention: The Difference Between Counseling and Therapy

May 13, 2014

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The GORSKI-CENAPS® Model is designed to be used on two levels: the counseling level and the psychotherapy level. Let’s look at the distinction between those two levels.

1. The Counseling Level: Patients need to learn new ways of thinking and acting that will allow them to manage high-risk situations and other problems that occur in their lives without using alcohol or drugs. The primary focus is to teach the client how to do something different when they encounter these situations. Patients are taught to identify and more effectively manage the thoughts and feelings that get in the way of learning new and more effective ways of dealing with problem situations. This level is described in The Relapse Prevention Counseling (RPC) Workbook.

2. The Psychotherapy Level: These situations are created by repetitive self-defeating behaviors that are motivated by core personality and lifestyle problems. These basic mistaken beliefs about self, others, and the world motivate clients to become involved in and mismanage high-risk situations in spite of their conscious intent not to. This level is described in The Relapse Prevention a Therapy Workbook (RPT).

Core personality problems are self-defeating habits of thinking, feeling, acting, and relating to others.

Core lifestyle problems are the habitual ways of living and the agreements and relationships that we establish with other people at work, in the community, with friends, family, and lovers. These core lifestyle problems are a social structure that both supports and justifies the personality problems.

There are two different types of treatment designed to address these two different levels of client problems.

1. Counseling: Counseling is the process of teaching clients how to identify and manage high-risk situations and to identify and change the patterns of thinking, feeling, and acting that prevent them from effectively managing the situation. This is called Relapse Prevention Counseling.

2. Psychotherapy: Psychotherapy is the process of teaching clients how to identify and manage the core personality and lifestyle problems that cause them to keep putting themselves in high risk situations. It then teaches them how to identify and change the core belief systems and unconscious life rules that create and maintain their personality and lifestyle. This is called Relapse Prevention Therapy.

The GORSKI-CENAPS® Model has components that can address both levels of problems, but it is recommended that clinicians working at the psychotherapy level have a background in both addiction counseling and advanced clinical training in psychotherapy.

The following general decision rules are applied for determining when to work at the counseling or psychotherapy level. Before moving to the psychotherapy level:

1. Clients must be able to stay abstinent from alcohol and drugs before they can successfully work on psychotherapy issues.

2. Clients should be able to identify and manage high-risk situations at a counseling level without using alcohol or drugs before moving into Psychotherapy.

3. Clients need to have some skills at managing stress in a sober and responsible way. Focusing treatment upon core personality and lifestyle issues can defocus clients from identifying and managing high-risk situations that can cause alcohol and drug use. As a result, a premature focus upon psychotherapy can increase the risk of relapse.

4. Working on the psychotherapy issues can also increase pain and stress. This makes it even more difficult for the client to manage the high-risk situation.

5. Every high-risk situation is like the tip of an iceberg. It sits on top of a cluster of underlying personality and lifestyle problems. These underlying problems are often surfaced when the client starts learning how to identify and manage the high-risk situation.

6. It is often difficult to keep the client focused upon learning how to manage the high-risk situation when these deeper issues get activated. The client wants to focus upon the deeper issue because it is easier to look at psychotherapy issues than to focus upon learning basic abstinence skills. Since these issues are real and cause the client pain and discomfort, the counselor often feels obligated to work on these issues

7. It is inappropriate to ignore core personality and lifestyle issues or communicate to the client that these issues are not important. The client will have to resolve these issues if they are to learn how to maintain long-term abstinence. The issue is, there are other immediate situations that represent an immediate risk to abstinence. These issues must be dealt with first. Later we will review a technique called Bookmarking that will allow us to honor core personality and lifestyle issues as they come while keeping the primary focus upon identifying and managing the high-risk situations that can cause alcohol and drug use.

GORSKI BOOKS: www.relapse.org

LIVE SOBER – BE RESPONSIBLE – LIVE FREE


Understanding The Twelve Steps

May 12, 2014

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by Terence T. Gorski
Author

Millions of people have transformed their lives by working the Twelve Steps of Alcoholics Anonymous. Their success has come from their ability to truly understand these principles and to apply them in their daily lives. Yet for many embarking on the road to recovery, the Steps can seem vague, even confusing.

This practical, no-nonsense guide takes the mystery out of the Twelve Steps, presenting a straightforward explanation of what each step means, as well as examples of how it translates to real life. Written by a certified alcoholism and drug abuse counselor with more than twenty years of experience, it offers a wealth of wisdom, knowledge, and genuine support for anyone in recovery.
Understanding the Twelve Steps features:

Clear, easy-to-understand interpretation of the Twelve Steps — the vital building blocks of recovery.
This book provides checklists that summarize the tasks and objectives of each step.

This book explains:

– The Twelve Promises are the positive changes you can expect in your life if you follow the Twelve Steps

– What happens at Twelve Step meetings

– Why it is important to have a sponsor

– How the 12-step Program allows recovering people to share their experience, strength, and hope

From Library Journal

This highly accessible guide to the Twelve Steps of Alcoholics Anonymous (AA) that comes at a time when the popularity of such programs are at an all-time high. Drawing on his experience as an alcohol/substance abuse counselor, Gorski (author of Passages Through Recovery , HarperCollins, 1989) interprets each of the steps, and explains their importance in the recovery process.

This book provides valuable insight into how the steps can be “worked” or used by those trying to abstain from alcohol is also provided. While Melody Beattie’s Codependents’ Guide to the Twelve Steps (Prentice Hall Pr., 1990) focuses on the steps as they apply to people dealing with codependent issues, Gorski’s primary audience is the alcoholic. However, those newly involved in other 12-step programs (i.e., Al-Anon, Gamblers Anonymous, etc.) will gain better understanding from this. Recommended for popular psychology and self-help collections.

– Linda S. Greene, Chicago

Back to Understanding the Twelve Steps: An Interpretation and Guide for Recovering (Paperback)
About this item
Product Description
Millions of people have transformed their lives by working the Twelve Steps of Alcoholics Anonymous. Their success has come from their ability to truly understand these principles and to apply them in their daily lives. Yet for many embarking on the road to recovery, the Steps can seem vague, even confusing.
This practical, no-nonsense guide takes the mystery out of the Twelve Steps, presenting a straightforward explanation of what each step means, as well as examples of how it translates to real life. Written by a certified alcoholism and drug abuse counselor with more than twenty years of experience, it offers a wealth of wisdom, knowledge, and genuine support for anyone in recovery.
Understanding the Twelve Steps features:
Clear, easy-to-understand interpretation of the Twelve Steps — the vital building blocks of recovery
Checklists that summarize the tasks and objectives of each step
The Twelve Promises — the positive changes you can expect in your life if you follow the Twelve Steps
What happens at Twelve Step meetings and why it is important to have a sponsor
The experiences, strength, and hope of other recovering people

From Library Journal
This highly accessible guide to the Twelve Steps of Alcoholics Anonymous comes at a time when the popularity of such programs are at an all-time high. Drawing on his experience as an alcohol/substance abuse counselor, Gorski ( Passages Through Recovery , HarperCollins, 1989) interprets each of the steps, and explains their importance in the recovery process. Valuable insight into how the steps should be “worked” or used by those trying to abstain from alcohol is also provided. While Melody Beattie’s Codependents’ Guide to the Twelve Steps (Prentice Hall Pr., 1990) focuses on the steps as they apply to people dealing with codependent issues, Gorski’s primary audience is the alcoholic. However, those newly involved in other 12-step programs (i.e., Al-Anon, Gamblers Anonymous, etc.) will gain better understanding from this. Recommended for popular psychology and self-help collections.
– Linda S. Greene, Chicago
Copyright 1991 Reed Business Information, Inc.

About the Author
Terence T. Gorski is the president of The CENAPS Corporation, a training and consultation firm specializing in recovery from addictive disease and relapse prevention therapy. He is a popular speaker and conducts training and workshops in more than twenty different cities each year.

Mr. Gorski is the author of numerous books, audio, and video tapes, including Passages Through Recovery — An Action Plan for Preventing Relapse, Staying Sober — A Guide for Relapse Prevention, The Staying Sober Work-book, and How to Start Relapse Prevention Support Groups.

He is the clinical director of the National Relapse Prevention Certification School, which trains counselors and therapists in relapse prevention therapy methods.

Here is an excerpt from the book. © Reprinted by permission. All rights reserved.

Chapter 1: WHAT IS A TWELVE STEP PROGRAM?

This book describes the single, most effective program for the treatment of alcoholism. That program, of course, is Alcoholics Anonymous, best known as A.A. Alcoholics Anonymous is a worldwide fellowship of men and women who share their experience, strength, and hope with each other in an effort to recover from alcoholism. It is a voluntary fellowship. No one is forced to belong, but millions of voluntary members benefit greatly from their involvement. If you want to make Twelve Step programs work for you, you need to understand the fellowship of A.A. and how to work with it. This book is intended to help you do just that.

Many people find the miracle of sobriety by working the Twelve Steps. Since nothing else has worked for them, many believe that the Steps are mystical and magical, and, as a result, these same persons fail to search for and identify the underlying principles that make them work. Working the Steps can create the miracle of sobriety, but the miracle isn’t magic. The miracle occurs because working the Twelve Steps allows people to use powerful principles of recovery. Those who are willing to dig beneath the surface and truly understand the principles upon which the Steps are based are better able to use the principles in their lives.

The primary purpose of A.A. is to help alcoholics stop drinking. It was never intended to be all things to all people; however, A.A. recognizes that the Twelve Steps can help people with other problems. Thus, it allows organizations such as Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous, Overeaters Anonymous, and others to use its Steps and principles. These related fellowships are developing as separate organizations so that A.A. can keep its primary focus on helping alcoholics to stop drinking.

A.A. is based upon a program of Twelve Steps to recovery that act as a personal guide to sobriety, and Twelve Traditions that act as guiding principles or bylaws for A.A. as a whole. Knowledge of the Twelve Steps is of critical importance to all recovering people for two reasons: (1) The Steps work if you work them, and (2) Twelve Step programs are inexpensive and readily available in most communities. As a result, they are the most widely used lifeline for people recovering from chemical dependence, codependence, and other compulsive or addictive disorders.

A.A. AS A NONPROFESSIONAL GROUP

As a result of the Traditions, A.A. is and shall forever remain nonprofessional. There are no medical professionals, as such, involved in designing or running A.A. or other Twelve Step programs. Although medical professionals do join as members, they have no more or no less influence on the organization than other members. Twelve Step programs do not provide medical or psychiatric treatment or psychotherapy. If you are involved in any Twelve Step program that has a psychotherapist in charge who runs it like a therapy group, be cautious. You are probably not at a Twelve Step meeting. This situation rarely, if ever, occurs in A.A.; however, it does happen in some of the newer Twelve Step programs.

If you are attending a Twelve Step meeting that is run by a psychotherapist who individually counsels the members, it is not a Twelve Step meeting; it is a therapy group. It is important to learn the difference, because Twelve Step meetings are based on the Twelve Steps of A.A. and the leaders act in a nonprofessional role.

A.A. members help themselves and others to stay sober. Members can be assured that they are not going to be solicited for donations or asked to get involved in anything else. Individual members of A.A. do have the right to participate in any religion, political forum, or cause that they wish. There are no restrictions. But they are not allowed to present themselves as A.A. members or to bring the name of A.A. into any controversy.

LEVELS OF TWELVE STEP INVOLVEMENT

Nobody is forced to do anything in A.A. It is one of the few organizations I know that supports the inherent constitutional right to do what we want. There is no coercion to participate on any level. If you want to belong, that’s fine. You are welcome to attend meetings and work the Steps. If you don’t want to belong, that’s also fine.

For most members, however, their involvement progresses through a number of levels. At the first level, they attend meetings. At the second, they read Twelve Step literature and discuss it with other members of the program. At the third level, they get a sponsor who can show them how the program works. At the fourth level, they start working the Twelve Steps. As members start to grow and change — a result of attending meetings and working the Steps — they are ready to move to a fifth level of involvement and begin sponsoring others. After they gain experience as sponsors, they are then ready for the sixth level of involvement, general service work, guided by A.A.’s Twelve Traditions, the set of principles that act as bylaws. General service work is designed to benefit A.A. as a whole. Notice the progression: Individuals help themselves first, then they help other people in the program, then they help the program as a whole. In summary, the levels of involvement are as follows:

1. Attending meetings

2. Reading and discussing A.A. literature

3. Getting a sponsor

4. Working the Twelve Steps

5. Sponsoring others

6. Service guided by the Traditions

Attending Meetings

You start working a Twelve Step program by regularly attending meetings. In A.A. it is said, “If you bring the body, the mind will follow,” because the Twelve Step program rubs off on people if they hang around long enough. Attending meetings isn’t a passive process. Working a program means you need to get actively involved, participating at the meetings you attend. The easiest way to take part is to say, “I pass” — a perfectly acceptable remark. No one in a Twelve Step program is obligated to say more. Most people, however, want to say more because they find it both enjoyable and beneficial. The more open and honest your comments, the faster you get well.

There is a joke that asks, “What is the difference between a drunk and an alcoholic?” Answer: “A drunk doesn’t have to go to meetings; an alcoholic does!” A.A. stresses the importance of attending meetings, especially during the first three months of sobriety. Many members suggest attending ninety meetings in ninety days. By doing “ninety in ninety,” beginners receive an intense exposure to the Twelve Step program and the people who use it. The principle that underlies doing “ninety in ninety” is a simple one — the more meetings you attend early on, the greater your chances of long-term recovery. There is no rule, of course, that you have to attend exactly ninety meetings in the first ninety days; go as often as your lifestyle allows. But keep in mind that the more meetings you attend, the faster you will get well.

Many members complain about having to attend meetings, but those who recover keep going even when they don’t feel like it. You don’t have to like going to meetings, you just have to keep going. Meetings are the lifeline to sobriety. When you attend meetings, you take a needed time-out from an alcohol- and drug-centered world and remind yourself that you are an alcoholic, cannot safely use alcohol and other drugs, and that you need the fellowship of other sober alcoholics to stay sober.

Reading Twelve Step Literature

The second level of involvement is to read Twelve Step literature and discuss your reactions, both positive and negative, with other members. The early members of A.A. identified the basic principles needed to get sober and stay that way. They compiled that information in two books — Alcoholics Anonymous (often called the Big Book) and Twelve Steps and Twelve Traditions. Both books are available from the central office of Alcoholics Anonymous in New York City. These books provide the basic principles needed to begin living the sober life.

Getting a Sponsor

After you feel comfortable going to meetings, making comments, and reading the basic literature, the third level of involvement is to get a sponsor. A sponsor is another member of the Twelve Step program who has more experience at recovery than you do. In order to get a sponsor, you must have participated in the program long enough to get to know people. Listen to the comments of others. Try to find someone you respect and admire, someone who knows more than you do about the program and can show you the ropes. In the business world, a sponsor is called a mentor.

When you find such a person and ask him or her to be your sponsor, you are in essence asking, “Would you be willing to spend time with me and teach me how you work the program?” There’s a slogan in the Twelve Step program: “If you want what we have, you do what we did.” And it’s primarily in the sponsorship relationship that this principle comes alive. You find a sponsor who has the type of recovery you would like to have, ask him to teach you what steps he took, and then try to do those things in your recovery.

A therapist does not take the place of a sponsor. You need a Twelve Step sponsor even if you have the best therapist in the world. A good therapist will encourage recovering people to become involved in Twelve Step programs and to get a sponsor. As a therapist, I don’t mandate Twelve Step attendance, but I do strongly encourage it. If someone refuses to attend even one meeting to see what the organization is all about, I may say, “If you’re not willing to go to Twelve Step meetings, I’m not willing to treat you. Why? Because if you’re not willing to go and find out what Twelve Step programs involve, I don’t think you really want to do what’s necessary to recover.” I base this attitude on an A.A. slogan: “We must be willing to go to any lengths to get sober.” If you are not willing to clear a few evenings and attend some meetings, I question your willingness …p

About the Author
Terence T. Gorski is the president of The CENAPS Corporation, a training and consultation firm specializing in recovery from addictive disease and relapse prevention therapy. He is a popular speaker and conducts training and workshops in more than twenty different cities each year.

Mr. Gorski is the author of numerous books, audio, and video tapes, including Passages Through Recovery — An Action Plan for Preventing Relapse, Staying Sober — A Guide for Relapse Prevention, The Staying Sober Work-book, and How to Start Relapse Prevention Support Groups.

http://www.amazon.com/gp/aw/d/0671765582?pc_redir=1399803668&robot_redir=1


introduction to The GORSKI-CENAPS Model of Addiction, Recovery, and Relapse

August 6, 2010

This blog will give a brief and easy to understand description of addiction, recovery, and relapse prevention for addiction and related problems.

Addiction is a biopsychosocial disease with profound spiritual consequences.

  • BIO means “biological” or pertaining to the physical actions of the body.
  • PSYCHO means psychological and pertains to the actions of both the brain (the hardware of thinking, feeling, and acting) and the mind (the nonphysical software that programs the actions of the brain).
  • SOCIAL pertains to the complex interactions that we have with other people, things, and systems. The social dimension also includes culture which is the basis for deep feelings of either belonging or alienation – feelings of being a part of or apart from.

Added to this mix is the complex interaction between addiction and spirituality. For the purpose of this blog, SPIRITUALITY pertains to our search for a meaning and purpose in life that is larger than ourselves. It is, in Twelve Step language, the search for a power greater than ourselves that will give us the courage, strength, and hope to go on in spite of hardship and adversity. Spirituality is the power that gives us the ability to go on even in the face of our inevitable death.

As you can see we will be covering a lot of territory – so keep coming back.

You can review my published materials and inorfmation on training and consultation at http://www.cenaps.com.


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