Online Self-Directed Interventions for Gambling Disorder: Randomized Controlled Trial

Hodgins, David C.; Cunningham, John A.; Murray, Robert; Hagopian, Sylvia

doi:10.1007/s10899-019-09830-7

Original Paper
Published: 30 January 2019

Online Self-Directed Interventions for Gambling Disorder: Randomized Controlled Trial

David C. Hodgins ORCID: orcid.org/0000-0003-2737-5200¹,
John A. Cunningham²,
Robert Murray² &
Sylvia Hagopian²

Journal of Gambling Studies volume 35, pages 635–651 (2019)Cite this article

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Abstract

Self-directed treatments for gambling disorder have been developed to attract individuals who are reluctant to seek formal treatment. Self-directed treatments provide individuals with information and support to initiate a recovery program without attending formal treatment. In this study, an online version of a previously evaluated telephone-based intervention package is compared to a brief online normative feedback intervention called Check Your Gambling. In a randomized controlled trial design, participants with gambling problems who were not interested in formal treatment (N = 181) were recruited through media announcements. After a baseline telephone assessment, participants were assigned to have access to either the brief Check Your Gambling, or the extended self-management tools intervention. Follow-up assessments were conducted at 3, 6, and 12 months post baseline by blinded interviewers. Participant nominated collaterals were contacted to validate self-reported gambling involvement. The follow-up rate at 12 months was 78%. Participants in both conditions showed significant reductions in days of gambling and problem severity but no differences between conditions were found, contrary to the primary hypothesis. Lack of previous treatment for gambling and higher baseline self-efficacy predicted fewer days of gambling in both conditions. Self-efficacy increased over time but did not appear to mediate changes in gambling. Participants who were most engaged in the extended online program showed better outcomes. Those with low engagement showed a slower trajectory of change but equivalent improvements by 12 months. The extended online intervention was not associated with better outcomes than the brief Check Your Gambling intervention. Future research needs to explore the attractiveness, uptake, and effectiveness of online interventions with and without therapist support to understand their potential role in gambling disorder treatment systems.

Trial Registration ISRCTN06220098.

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References

Abbott, M., Hodgins, D. C., Bellringer, M., Vandal, A. C., Palmer Du Preez, K., Landon, J., et al. (2018). Brief telephone interventions for problem gambling: A randomized controlled trial. Addiction, 113(5), 883–895. https://doi.org/10.1111/add.14149.
Article PubMed Google Scholar
Aiken, M. (1982). A program for balancing the allocation of subjects to treatment in a clinical trial. Computers in Biomedical Research, 15(5), 519–524.
Google Scholar
Andersson, G., & Carlbring, P. (2017). Internet-assisted cognitive behavioral therapy. Psychiatric Clinics of North America, 40(4), 689–700. https://doi.org/10.1016/j.psc.2017.08.004.
Article PubMed Google Scholar
Boudreault, C., Giroux, I., Jacques, C., Goulet, A., Simoneau, H., & Ladouceur, R. (2018). Efficacy of a self-help treatment for at-risk and pathological gamblers. Journal of Gambling Studies, 34(2), 561–580. https://doi.org/10.1007/s10899-017-9717-z.
Article PubMed Google Scholar
Campos, M. D., Rosenthal, R. J., Chen, Q., Moghaddam, J., & Fong, T. W. (2015). A self-help manual for problem gamblers: The impact of minimal therapist guidance on outcome. International Journal of Mental Health and Addiction, 14(4), 579–596. https://doi.org/10.1007/s11469-015-9579-5.
Article Google Scholar
Carlbring, P., Degerman, N., Jonsson, J., & Andersson, G. (2012). Internet-based treatment of pathological gambling with a three-year follow-up. Cognitive Behaviour Therapy, 41(4), 321–334. https://doi.org/10.1080/16506073.2012.689323.
Article PubMed PubMed Central Google Scholar
Carlbring, P., & Smit, F. (2008). Randomized trial of internet-delivered self-help with telephone support for pathological gamblers. Journal of Consulting and Clinical Psychology, 76(6), 1090–1094. https://doi.org/10.1037/a0013603.
Article PubMed Google Scholar
Casey, L. M., Oei, T. P. S., Raylu, N., Horrigan, K., Day, J., Ireland, M., et al. (2017). Internet-based delivery of cognitive behaviour therapy compared to monitoring, feedback and support for problem gambling: A randomised controlled trial. Journal of Gambling Studies, 33(3), 993–1010. https://doi.org/10.1007/s10899-016-9666-y.
Article PubMed Google Scholar
Castren, S., Pankakoski, M., Tamminen, M., Lipsanen, J., Ladouceur, R., & Lahti, T. (2013). Internet-based CBT intervention for gamblers in Finland: Experiences from the field. Scandinavian Journal of Psychology, 54(3), 230–235.
Article PubMed Google Scholar
Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290. https://doi.org/10.1037/1040-3590.6.4.284.
Article Google Scholar
Cunningham, J. A. (2005). Little use of treatment among problem gamblers. Psychiatric Services, 56(8), 1024–1025. https://doi.org/10.1176/appi.ps.56.8.1024.
Article PubMed Google Scholar
Cunningham, J. A., Hodgins, D. C., Toneatto, T., & Murphy, M. (2012). A randomized controlled trial of a personalized feedback intervention for problem gamblers. PLoS ONE, 7(2), e31586. https://doi.org/10.1371/journal.pone.0031586.
Article CAS PubMed PubMed Central Google Scholar
Cunningham, J. A., Hodgins, D. C., Toneatto, T., Rai, A., & Cordingley, J. (2009). Pilot study of a personalized feedback intervention for problem gamblers. Behavior Therapy, 40(3), 219–224. https://doi.org/10.1016/j.beth.2008.06.005.
Article PubMed Google Scholar
Currie, S. R., Hodgins, D. C., & Casey, D. M. (2013). Validity of the Problem Gambling Severity Index interpretive categories. Journal of Gambling Studies, 29(2), 311–327. https://doi.org/10.1007/s10899-012-9300-6.
Article PubMed Google Scholar
Diskin, K. M., & Hodgins, D. C. (2009). A randomized controlled trial of a single session motivational intervention for concerned gamblers. Behaviour Research and Therapy, 47(5), 382–388. https://doi.org/10.1016/j.brat.2009.01.018.
Article PubMed Google Scholar
Ferris, J., & Wynne, H. (2001). The Canadian Problem Gambling Index: Final report. Ottawa: Canadian Centre on Substance Abuse.
Google Scholar
Gerstein, D. R. M. S., Toce, M., Hoffman, J., Palmer, A., & Johnston, R. (1999). Gambling impact and behavior study. Report of the National Gambling Impact Study Commission. Chicago: National Opinion Research Center.
Google Scholar
Goslar, M., Leibetseder, M., Muench, H. M., Hofmann, S. G., & Laireiter, A. R. (2017). Efficacy of face-to-face versus self-guided treatments for disordered gambling: A meta-analysis. Journal of Behavioral Addictions, 6(2), 142–162. https://doi.org/10.1556/2006.6.2017.034.
Article PubMed PubMed Central Google Scholar
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford.
Google Scholar
Hodgins, D. C. (2004). Using the NORC DSM Screen for Gambling Problems as an outcome measure for pathological gambling: psychometric evaluation. Addictive Behaviors, 29(8), 1685–1690. https://doi.org/10.1016/j.addbeh.2004.03.017.
Article PubMed Google Scholar
Hodgins, D. C., Currie, S. R., Currie, G., & Fick, G. H. (2009). Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better. Journal of Consulting and Clinical Psychology, 77(5), 950–960. https://doi.org/10.1037/a0016318.
Article PubMed Google Scholar
Hodgins, D. C., Currie, S. R., & el-Guebaly, N. (2001). Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69(1), 50–57.
Article CAS PubMed Google Scholar
Hodgins, D. C., Currie, S. R., el-Guebaly, N., & Diskin, K. M. (2007). Does providing extended relapse prevention bibliotherapy to problem gamblers improve outcome? Journal of Gambling Studies, 23(1), 41–54. https://doi.org/10.1007/s10899-006-9045-1.
Article PubMed Google Scholar
Hodgins, D. C., Currie, S. R., el-Guebaly, N., & Peden, N. (2004a). Brief motivational treatment for problem gambling: a 24-month follow-up. Psychology of Addictive Behaviors, 18(3), 293–296. https://doi.org/10.1037/0893-164x.18.3.293.
Article PubMed Google Scholar
Hodgins, D. C., Fick, G. H., Murray, R., & Cunningham, J. A. (2013). Internet-based interventions for disordered gamblers: Study protocol for a randomized controlled trial of online self-directed cognitive-behavioural motivational therapy. BMC Public Health, 13, 10. https://doi.org/10.1186/1471-2458-13-10.
Article PubMed PubMed Central Google Scholar
Hodgins, D. C., & Makarchuk, K. (2002). Becoming a winner: Defeating problem gambling. Calgary: University of Calgary.
Google Scholar
Hodgins, D. C., & Makarchuk, K. (2003). Trusting problem gamblers: Reliability and validity of self-reported gambling behavior. Psychology of Addictive Behaviors, 17(3), 244–248. https://doi.org/10.1037/0893-164x.17.3.244.
Article PubMed Google Scholar
Hodgins, D. C., Peden, N., & Makarchuk, K. (2004b). Self-efficacy in pathological gambling treatment outcome: Development of a gambling abstinence self-efficacy scale (GASS). International Gambling Studies, 4(2), 99–108. https://doi.org/10.1080/14459790412331296947.
Article Google Scholar
Hodgins, D. C., & Schluter, M. (2018). The role of treatment in reducing gambling-related harm. In H. Bowden-Jones, C. Dickson, C. Dunand, & O. Simon (Eds.), Problem gambling: Harm-reduction as a public health approach. London: Taylor and Francis.
Google Scholar
Labrie, R. A., Peller, A. J., Laplante, D. A., Bernhard, B., Harper, A., Schrier, T., et al. (2012). A brief self-help toolkit intervention for gambling problems: A randomized multisite trial. American Journal of Orthopsychiatry, 82(2), 278–289. https://doi.org/10.1111/j.1939-0025.2012.01157.x.
Article PubMed Google Scholar
Luquiens, A., Tanguy, M. L., Lagadec, M., Benyamina, A., Aubin, H. J., & Reynaud, M. (2016). The efficacy of three modalities of Internet-based psychotherapy for non-treatment-seeking online problem gamblers: A randomized controlled trial. Journal of Medical Internet Research, 18(2), e36. https://doi.org/10.2196/jmir.4752.
Article PubMed PubMed Central Google Scholar
Marchica, L., & Derevensky, J. L. (2016). Examining personalized feedback interventions for gambling disorders: A systematic review. Journal of Behavioral Addictions, 5(1), 1–10. https://doi.org/10.1556/2006.5.2016.006.
Article PubMed PubMed Central Google Scholar
Oei, T. P. S., Raylu, N., & Lai, W. W. (2018). Effectiveness of a self help cognitive behavioural treatment program for problem gamblers: A randomised controlled trial. Journal of Gambling Studies, 34(2), 581–595. https://doi.org/10.1007/s10899-017-9723-1.
Article CAS PubMed Google Scholar
Petry, N. M., Ginley, M. K., & Rash, C. J. (2017). A systematic review of treatments for problem gambling. Psychology of Addictive Behaviors, 31(8), 951–961. https://doi.org/10.1037/adb0000290.
Article PubMed PubMed Central Google Scholar
Petry, N. M., Weinstock, J., Ledgerwood, D. M., & Morasco, B. (2008). A randomized trial of brief interventions for problem and pathological gamblers. Journal of Consulting and Clinical Psychology, 76(2), 318–328. https://doi.org/10.1037/0022-006x.76.2.318.
Article PubMed PubMed Central Google Scholar
Riper, H., Blankers, M., Hadiwijaya, H., Cunningham, J., Clarke, S., Wiers, R., et al. (2014). Effectiveness of guided and unguided low-intensity internet interventions for adult alcohol misuse: A meta-analysis. PLoS ONE, 9(6), e99912. https://doi.org/10.1371/journal.pone.0099912.
Article CAS PubMed PubMed Central Google Scholar
Rodda, S., Merkouris, S., Abraham, C., Hodgins, D. C., Cowlishaw, S., & Dowling, N. (2018). Therapist-delivered and self-help interventions for gambling problems: A review of contents. Journal of Behavioural Addictions, 7(2), 1–16. https://doi.org/10.1556/2006.7.2018.44.
Article Google Scholar
Swan, J. L., & Hodgins, D. C. (2015). Brief interventions for disordered gambling. Canadian Journal of Addiction, 6(2), 29–36.
Google Scholar
Yakovenko, I., & Hodgins, D. C. (2016). Latest developments in treatment for disordered gambling: Review and critical evaluation of outcome studies. Current Addiction Reports, 3(3), 299–306.
Article Google Scholar
Yakovenko, I., Quigley, L., Hemmelgarn, B. R., Hodgins, D. C., & Ronksley, P. (2015). The efficacy of motivational interviewing for disordered gambling: systematic review and meta-analysis. Addictive Behaviors, 43, 72–82. https://doi.org/10.1016/j.addbeh.2014.12.011.
Article PubMed Google Scholar

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Funding

This study was funded by Canadian Institute of Health Research (project grant).

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University of Calgary, Calgary, Canada
David C. Hodgins
Centre for Addiction and Mental Health, Toronto, Canada
John A. Cunningham, Robert Murray & Sylvia Hagopian

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David C. Hodgins
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John A. Cunningham
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Robert Murray
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Sylvia Hagopian
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Correspondence to David C. Hodgins.

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Hodgins, D.C., Cunningham, J.A., Murray, R. et al. Online Self-Directed Interventions for Gambling Disorder: Randomized Controlled Trial. J Gambl Stud 35, 635–651 (2019). https://doi.org/10.1007/s10899-019-09830-7

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Published: 30 January 2019
Issue Date: 15 June 2019
DOI: https://doi.org/10.1007/s10899-019-09830-7

Keywords

Clinical trial
Brief intervention
Gambling disorder
Online intervention
Normative feedback