title: Patient reactance moderates the effect of directive telephone counseling for methamphetamine users.
abstract: OBJECTIVE
  This study examined the impact of the interaction between patient reactance and treatment directiveness on the effectiveness of telephone aftercare for methamphetamine dependence.
  
  
  METHODS
  Reactance was assessed at baseline, and participants were randomly assigned to directive or nondirective treatment conditions. Logistic regression tested for the significance of the interaction as a predictor of 3-month and 12-month use of methamphetamine and stimulants.
  
  
  RESULTS
  A significant interaction was observed at the 3-month follow-up, in which the directive condition was less effective for patients higher in reactance and was more effective for patients lower in reactance. Among patients at a high level of reactance, the nondirective condition increased the likelihood of abstinence.
  
  
  CONCLUSIONS
  This study suggests that, in the context of telephone-based care, directive interventions offer short-term clinical benefit for methamphetamine users who readily accept influence from authority figures, whereas nondirective interventions offer benefit for patients who do not readily accept influence. The short-term nature of these effects indicates that there is a need for brief but ongoing telephone support to maintain treatment gains.
authors: Integrated Substance Abuse Programs, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90025, USA. karno@ucla.edu
authors: Mitchell
authors: M
authors: Karno
authors: David
authors: D
authors: Farabee
authors: Mary-Lynn
authors: ML
authors: Brecht
authors: Richard
authors: R
authors: Rawson
mesh_terms: D000328:Adult; D000359:Aftercare / Q000379:methods* / Q000523:psychology*; D019969:Amphetamine-Related Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008694:Methamphetamine; D013689:Telephone; D016896:Treatment Outcome
chemical_list: D008694:Methamphetamine