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.

Method: 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.

Figure 1

Simple slopes plot of the Directiveness × Patient Reactance interaction as a predictor of the conditional probability of any methamphetamine or cocaine use at the 3-month follow-up. High and low reactance levels are plotted at the mean ±1 SD, respectively.