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Medical Info from Thomas Freese, PhD. UCLA Integrated Substance Abuse Programs
Provided during a Methamphetamine Treatment training in Sioux Falls, Aug. 10, 2005
Acute Meth Overdose
1) Slowing of Cardiac Conduction= need to monitor heart rate
2) Ventricular Irritability- can lead to spasms
3) Hypertensive episode= can spike to “phenomenal levels” (Dr. Freese’s words)
4) Hyperpyrexic episode= since overheating can be high enough to be life threatening,
monitor body temp and take drastic measures if needed (strip and put into an ice bath)
Also- make sure to hydrate the person ASAP.
5) CNS Seizures and anoxia- meds might be needed.
Also, whenever treating someone you suspect has been using meth, find out any other drugs
they might have used to “take the edge off.” Some common ones are alcohol, marijuana, Antivan
or Clonazepam.
Dr. Freese cautions that if a person hasn’t overdosed on meth, the actual time of “coming down”
(crashing) isn’t life threatening. Usually they just need to sleep. However, if he/she also has alcohol
abuse problems, the long time span that a meth user will often sleep can be life threatening. They
can suffer withdrawal symptoms, such as seizures, from neurochemical imbalances in their brain
caused by suddenly reducing or ceasing alcohol consumption. They can also suffer permanent
brain damage or even death due to alcohol withdrawal.
Dr. Freese told of a time he sent a meth user home to sleep after the guy reported he “didn’t
drink much.” Later, after the man was rushed to ER in crisis, Dr. Freese learned that when this
meth addict said he “didn’t drink much,” it meant he “only” drank a half quart of scotch and a 12
pack a day. Being in a "dead sleep" for several days straight was actually life threatening for him.
Acute Meth Psychosis
1) External Paranoid Ideation= Highly suspiciousness about others' motives
2) Well formed delusions
3) Hypersensitivity to environmental stimuli= shadows become “shadow people”
4) Stereotypes behavior “tweaking”= spastic, crazy, unpredictable behavior patterns
5) Panic, extreme fearfulness
6) High potential for violence
If they have multiple symptoms, they can look like a full-blown schizophrenic.
Treatment for Meth Psychosis
Typical ER Protocol
Haloperidol- 5 mg. (Anti-psychotic)
Clonazepam- 1 mg. (Anti-anxiety)
Cogentin- 1 mg. (to help relieve muscle rigidity, tremors, and difficulties
with posture and balance)
Quiet, dimly lit room
Dr. Freese noted, “Make sure to connect with a local treatment provider before releasing this
person from ER.”
Also, meth causes major problems with memory, especially related to word recall and word
recognition. So, they CAN NOT comprehend written instructions, and Dr. Freese noted, “ they lose
the ability to hang on to words. In truth, when you’re talking to them, all they might be hearing is
literally ‘blah, blah, blah.’” Consequently, he recommends that you use “visual aids” whenever
Contact info for Dr. Freese is (310) 445-0874 Ext 304,
National Institute on Drug Abuse
Behavioral Therapies Development Program - Effective Drug Abuse Treatment Approaches
The Matrix Model
Source of info\
The Matrix Model (Rawson et al., 1995) of outpatient treatment was developed during the 1980s in response to an
overwhelming demand for stimulant abuse treatment services. The intent was to create an outpatient model
responsive to the needs of stimulant-abusing patients while constructing a replicable protocol that could be evaluated.
Treatment materials draw heavily upon published literature pertaining to the areas of relapse prevention (Marlatt and
Gordon,1985), family and group therapies, drug education, self help participation and drug abuse monitoring. The
clinical materials have been selected as a result of a behavioral analysis of the type of problems encountered by
cocaine and methamphetamine users as they proceed through a period of cocaine abstinence.
Over 5000 cocaine addicts and over 1000 methamphetamine users have been treated with the method. The
experience of these patients has been the source of the data used in developing and modifying this integrated
therapeutic model. The treatment model has been extended to address the clinical needs of alcohol users and opiate
dependent individuals.
The goal of the Matrix Model has been to provide a framework within which stimulant abusers can achieve the
following: (a) cease drug use, (b) retain in treatment, (c) learn about issues critical to addiction and relapse, (d) receive
direction and support from a trained therapist, (e) receive education for family members affected by the addiction,
(f)become familiar with the self-help programs, and (g) receive monitoring by urine testing.
The Matrix model requires that the therapists use a combination of skills required to function simultaneously as teacher
and coach. The therapist fosters a positive, encouraging relationship with the patient and uses that relationship to
reinforce positive behavior change. The interaction between the therapist and the patient is realistic and direct but not
confrontational or parental. Therapists are trained to view the treatment process as an exercise that will promote selfesteem, dignity, and self-worth. A positive relationship between patient and therapist is a critical element for patient
The treatment materials contained in detailed treatment manuals include work sheets for individual sessions, family
educational groups, early recovery skills groups, relapse prevention groups, conjoint sessions, urine tests, 12 step
programs, relapse analysis, and social support groups. A pilot study comparing the Matrix outpatient model with an
inpatient hospital treatment program produced preliminary support for the clinical utility of the model for the treatment
of cocaine dependence (Rawson, 1986). A number of NIDA-funded projects have demonstrated that participants
treated with the Matrix model demonstrate statistically significant reductions in drug and alcohol use, improvements in
psychological indicators and reduced risky sexual behaviors associated with HIV transmission (Rawson et al,1995,
Shoptaw et al, 1994, Shoptaw et al 1997). These reports, along with evidence suggesting comparable treatment
response between methamphetamine users and cocaine users, (Huber, et al, 1997) and demonstrated efficacy in
enhancing naltrexone treatment of opiate addiction (Rawson et al, under review) provides a body of empirical support
for the use of the model.
The fact that the Matrix model materials have been manualized into systematic treatment protocols with instructions for
use, has tremendously facilitated the dissemination of this approach. Currently, projects are being conducted in 12
states and 4 countries employing this approach in treatment settings for stimulant, opiate and alcohol users.
Rawson, R.A., Obert, J.L. McCann, M.J. and Mann. A.J (1986) Cocaine treatment outcome: Cocaine use following inpatient,
outpatient and no treatment. CPDD NIDA Res. Monograph, 67, 271-277.
Rawson, R., Shoptaw, S., Obert, J.L., McCann, M, Hasson, A.,Marinelli-Casey, P., Brethen , P. & Ling, W. (1995). An intensive
outpatient approach for cocaine abuse: the Matrix model. Journal of Substance Abuse Treatment, 12 (2), 117-127.
Shoptaw, S. Rawson, R.A., McCann, M.J. and Obert, J.L. (1994). The Matrix model of stimulant abuse treatment: Evidence of
efficacy. Journal of Addictive Diseases, 13, 129-141.
Shoptaw, S., Frosch, D., Rawson, R., & Ling, W. (1997). Cocaine abuse counseling as HIV prevention. Journal of AIDS Education &
Prevention, 9, 511-520.
Huber, A., Ling, W., Shoptaw, S., Gulati, V. Brethen, P. and Rawson, R. (1997) Integrating treatments for methamphetamine abuse:
A psychosocial perspective. Journal of Addictive Diseases, 16, 41-50.
Rawson, R., McCann, M.J., Shoptaw, S., Miotto, K. Frosch, D., Obert, J.L. and Ling, W. (under review) Naltrexone fore opiate
addiction: Evaluation of a manualized psychosocial protocol to enhance treatment response.
37 pg. Report entitled The Matrix Model of Intensive Outpatient Treatment - A guideline developed for the Behavioral Health Recovery Management
project can be found at