Online interventions for problem gamblers with and without co-occurring mental health symptoms: Protocol for a randomized controlled trial

Developing and testing the effectiveness of a novel online integrated treatment for problem gambling and tobacco smoking: a protocol for an open-label randomized controlled trial

BACKGROUND

Gambling and tobacco smoking are highly comorbid among North American adults. However, there is a paucity of treatment options that are integrated (i.e. targeting both gambling and tobacco smoking simultaneously), accessible, and evidence based.

METHODS

The aim of this two-arm open-label randomized controlled trial is to examine the effectiveness of an online, self-guided integrated treatment for problem gambling and tobacco smoking. A target sample of 214 participants will be recruited and be randomized into either an 8-week integrated or gambling only control condition. Both conditions will consist of seven online modules following cognitive behavioural therapy and motivational interviewing principles. Our three primary outcomes are (1) the number of days gambled, (2) money spent on gambling activities, and (3) time spent in gambling activities. Secondary outcomes include gambling disorder symptoms, cigarette use, and nicotine dependence symptoms. Assessments will be completed at baseline, at completion (i.e. 8 weeks from baseline), and at follow-up (i.e. 24 weeks from baseline). Generalized linear mixed modelling will be used to evaluate our primary and secondary outcomes. We expect that participants receiving online integrated treatment will show larger reductions in gambling relative to those receiving a control gambling only intervention. We further hypothesize that reductions in smoking will mediate these group differences.

DISCUSSION

The rates of problem gambling and tobacco smoking are high in North America; yet, the treatment options for both are limited, with no integrated treatments available. If supported, our pilot study will be a cost-effective and accessible way to improve treatments for co-occurring problem gambling and tobacco use.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03614884 . Registered on August 3, 2019.

An overview of digital and online strategies to reduce gambling harm

ISSUE ADDRESSED

Advancements in mobile- and web-based technologies proliferate everyday opportunities to gamble. The increased availability, popularity and intensity of online gambling platforms and interactive gaming activities also changes the way we construct gambling harm reduction interventions. Information and communication technologies (ICT) provide potential opportunities to reduce harm from online gambling through harm minimisation initiatives and currently available services. The aim of this review was to firstly understand the scope of peer-reviewed evidence on ICT-based strategies to reduce online gambling harm, and secondly, what evidence exists specifically in relation to ICT-based harm reduction initiatives for people who gamble online.

METHODS

Scoping review methods and a five-stage model of analysis were used to: identify the published literature on ICT-based harm minimisation activities for online gambling; distil models appropriate to address gambling harm in this setting; and synthesise all available evidence, noting gaps and patterns.

RESULTS

Sixteen gambling-specific ICT-based interventions were reviewed in depth. The majority of included studies focused on different components of computer-assisted or online therapy programs for disordered gambling, specifically the development of individual skills in managing problematic gambling behaviour.

CONCLUSIONS

The review found that despite the widespread potential ICT represent for addressing gambling harm there has been only limited published research to date.

SO WHAT

There is a clear need for further investigation into uptake, usage, focus and effectiveness of all online gambling interventions on offer. The dearth of gambling-specific empirical knowledge potentially indicates a serious resourcing and reporting issues in this area.

Online interventions for problem gamblers with and without co-occurring unhealthy alcohol use: Randomized controlled trial

BACKGROUND AND AIMS

Problem gambling and unhealthy alcohol use often co-occur. The current trial sought to establish whether adding a brief online intervention for unhealthy alcohol use to an online problem gambling intervention would lead to improvements in gambling and drinking among those with both of these concerns.

METHODS

Participants were recruited from across Canada using an advertisement targeting those concerned about their gambling who were interested in online help. No mention of unhealthy alcohol use was made in the advertisement. Participants meeting criteria for problem gambling were randomized to either receive just an online intervention for gambling (G-only) or to receive an online gambling intervention plus a brief personalized feedback intervention for unhealthy alcohol use (G + A). Participants were followed up at 3 and 6 months.

RESULTS

A total of 282 participants were recruited for the trial. Follow-up rates were good (80% and 84% at 3 and 6 months). There were significant reductions in gambling (p < .001) across time but no significant differences (p > .05) between those who received either the G-only or G + A interventions. Further, for those with unhealthy alcohol use (41% of the sample), there were no significant reductions in alcohol consumption (p > .05) across time or differences between condition.

DISCUSSION AND CONCLUSION

The addition of a brief intervention for unhealthy alcohol use to an online intervention for gambling did not appear to improve either gambling or drinking outcomes among people concerned about their gambling. Further research is merited to examine whether a combined intervention (with gambling and drinking components integrated) might result in improved outcomes and whether such an intervention might benefit the subgroup of participants who would specifically seek help for both gambling and alcohol concerns.Trial registration:ClinicalTrials.govNCT03323606; Registration date: October 24, 2017.

Pilot randomized controlled trial of an online intervention for problem gamblers

INTRODUCTION

This pilot randomized controlled trial sought to evaluate whether an online intervention for problem gambling could lead to improved gambling outcomes compared to a no intervention control. Participants were recruited through a crowdsourcing platform.

METHODS

Participants were recruited to complete an online survey about their gambling through the Mechanical Turk platform. Those who scored 5 or more on the Problem Gambling Severity Index and were thinking about quitting or reducing their gambling were invited to complete 6-week and 6-month follow-ups. Each potential participant who agreed was sent a unique password. Participants who used their password to log onto the study portal were randomized to either access an online intervention for gambling or to a no intervention control.

RESULTS

A total of 321 participants were recruited, of which 87% and 88% were followed-up at 6 weeks and 6 months, respectively. Outcome analyses revealed that, while there were reductions in gambling from baseline to follow-ups, there was no significant observable impact of the online gambling intervention, as compared to a no intervention control condition.

CONCLUSIONS

While the current trial observed no impact of the intervention, replication is merited with a larger sample size, and with participants who are not recruited through a crowdsourcing platform.Trial registration: ClinicalTrials.govNCT03124589.

Randomized controlled trial of an Internet intervention for problem gambling provided with or without access to an Internet intervention for co-occurring mental health distress

BACKGROUND AND AIMS

The current randomized controlled trial tested whether there was benefit to providing an online gambling intervention and a separate self-help mental health intervention for anxiety and depression (i.e. MoodGYM) (G + MH), compared to only a gambling intervention (G only) among people with co-occurring gambling problems and mental health distress. The primary outcome of interest was improvement in gambling outcomes. Secondary analyses also tested for the impact of the combined intervention on depression and anxiety outcomes.

METHODS

Participants who were concerned about their gambling were recruited to help evaluate an online intervention for gamblers. Those who met criteria for problem gambling were randomized to receive either the G only or the G + MH intervention. Participants were also assessed for current mental health distress at baseline, with three quarters (n = 214) reporting significant current distress and form the sample for this study. Participants were followed-up at 3- and 6-months to assess changes in gambling status, and improvements in depression and anxiety.

RESULTS

Follow-up rates were poor (47% completed at least one follow-up). While there were significant reductions in gambling outcomes, as well as on measures of current depression and anxiety, there was no significant difference in outcomes between participants receiving the G only versus the G + MH intervention.

DISCUSSION AND CONCLUSION

There does not appear to be a benefit to providing access to an additional online mental health intervention to our online gambling intervention, at least among participants who are concerned about their gambling.Trial registration: ClinicalTrials.govNCT02800096; Registration date: June 14, 2016.

Effects of a depression-focused internet intervention in slot machine gamblers: A randomized controlled trial

BACKGROUND

Problematic and pathological gambling have been linked to depression. Despite a high demand for treatment and negative financial consequences, only a small fraction of problematic and pathological gamblers seek professional help. The existing treatment gap could be narrowed by providing low-threshold, anonymous internet-based interventions. The aim of the present study was to examine the acceptance and efficacy of an online-intervention for depression ("Deprexis") in a sample of problematic and pathological slot-machine gamblers. We hypothesized that the intervention group would show a greater reduction in both depressive and gambling-related symptoms compared to a wait-list control group.

METHOD

A total of 140 individuals with self-reported gambling and mood problems were randomly allocated either to the intervention group or to a wait-list control group. After 8 weeks, all participants were invited for re-assessment. The Patient Health Questionnaire - 9 (PHQ-9) served as the primary outcome assessment. Problematic gambling was measured with the Pathological Gambling Adaptation of Yale-Brown Obsessive Compulsive Scale (PG-YBOCS) and the South Oaks Gambling Screen (SOGS). The trial is registered with the German Registry for Clinical Studies (DRKS00013888).

RESULTS

ITT analyses showed that the intervention led to a significant reduction in depressive symptoms as well as gambling-related symptoms compared to the control group, with moderate to strong effect sizes. PP analyses failed to yield significant results due to high rates of non-completion and limited statistical power. Moderator analyses indicated that Deprexis was particularly beneficial in reducing problematic gambling for those scoring high on baseline gambling-related symptoms and for those who gamble due to loneliness.

DISCUSSION

Results of the present study suggest that Deprexis might be a useful adjunct to traditional interventions for the treatment of problematic gambling. The potential of internet-based interventions that are more targeted at issues specific to gambling should be evaluated in future studies.

TRIAL REGISTRATION

German Registry for Clinical Studies DRKS00013888.

Online interventions for problem gamblers with and without co-occurring problem drinking: study protocol of a randomized controlled trial

Background

The current randomized controlled trial seeks to evaluate whether providing access to an Internet intervention for problem drinking in addition to an Internet intervention for problem gambling is beneficial for participants with gambling problems who do or do not have co-occurring problem drinking.

Methods

Potential participants will be recruited online via a comprehensive advertisement strategy, if they meet the criteria for problem gambling. As part of the baseline measures, problem drinking will also be assessed. Eligible participants (N = 280) who agree to partake in the study and to be followed up for 6 months will be randomized into one of two versions of an Internet intervention for gamblers: an intervention that targets only gambling issues (G-only) and one that combines a gambling intervention with an intervention for problem drinking (G + A). For problem gamblers who exhibit co-occurring problem drinking, it is predicted that participants who are provided access to the G + A intervention will demonstrate a significantly greater level of reduction in gambling outcomes at 6 months compared to those provided access to the G-only intervention.

Discussion

This trial will expand upon the current research on Internet interventions for addictions and inform the development of treatments for those with co-occurring problem drinking and gambling.

Trial Registration

ClinicalTrials.gov, NCT03323606. Registered on 24 October 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2672-x) contains supplementary material, which is available to authorized users.

The Blurred Future of Adolescent Gamblers: Impulsivity, Time Horizon, and Emotional Distress

The main purpose of this study was to investigate the interplay of functional and dysfunctional impulsivity, delay discounting, time perspective, and emotional negative states on gambling severity in Italian adolescents. A second aim of the study was to analyze the developmental trajectories of gambling involvement, functional and dysfunctional impulsivity, delay discounting, consideration of future consequences, and negative affectivity in a cross-sectional perspective. One thousand and ten Italian adolescents aging between 12 and 19 years were administered the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Functional and Dysfunctional Impulsivity Scale (FDIS), the Monetary Choice Questionnaire (MCQ), the Consideration of Future Consequences Scale (CFC-14), and the Depression, Anxiety and Stress Scales-21 (DASS-21). Data analyses were conducted using correlational analysis, Chi-square test, analysis of variance, and hierarchical regression analysis. Results indicated that, relative to non-gamblers and non-problem gamblers, at-risk and problem gamblers showed higher levels of impulsivity, steeper delay discounting, shorter time horizon, and reported experiencing significantly higher levels of depression, anxiety, and stress. Results of hierarchical regression analysis, with SOGS-RA scores as the dependent variable, and gender, age, FDIS, MCQ, CFC-14, and DASS-21 scores as independent variables, indicated that, along with gender and age, low scores of future orientation and high scores of dysfunctional impulsivity, depression, anxiety, present orientation, and delay discounting significantly predicted gambling severity. These findings provide further evidence that the higher the gambling involvement, the greater the tendency to devalue delayed rewards and to focus on the immediate consequences of one's behavior. Interestingly, for the first time these results reveal an association between gambling severity and both dysfunctional impulsivity and negative affective states across adolescence. Finally, results of cross-sectional analyses suggest that gambling severity contributes more than age in shaping the developmental trajectories of functional and dysfunctional impulsivity, delay discounting, time perspective, and negative affective states.

GAMBLINGLESS: FOR LIFE study protocol: a pragmatic randomised trial of an online cognitive-behavioural programme for disordered gambling

INTRODUCTION

The prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for alternative treatment delivery models that capitalise on advances in communication technology, and use self-directed activity that can complement existing services has been identified. As such, the primary aim of this study is to evaluate an online self-directed cognitive-behavioural programme for disordered gambling (GamblingLess: For Life).

METHODS AND ANALYSIS

The study will be a 2-arm, parallel group, pragmatic randomised trial. Participants will be randomly allocated to a pure self-directed (PSD) or guided self-directed (GSD) intervention. Participants in both groups will be asked to work through the 4 modules of the GamblingLess programme over 8 weeks. Participants in the GSD intervention will also receive weekly emails of guidance and support from a gambling counsellor. A total of 200 participants will be recruited. Participants will be eligible if they reside in Australia, are aged 18 years and over, have access to the internet, have adequate knowledge of the English language, are seeking help for their own gambling problems and are willing to take part in the intervention and associated assessments. Assessments will be conducted at preintervention, and at 2, 3 and 12 months from preintervention. The primary outcome is gambling severity, assessed using the Gambling Symptom Assessment Scale. Secondary outcomes include gambling frequency, gambling expenditure, psychological distress, quality of life and additional help-seeking. Qualitative interviews will also be conducted with a subsample of participants and the Guides (counsellors).

ETHICS AND DISSEMINATION

The study has been approved by the Deakin University Human Research and Eastern Health Human Research Ethics Committees. Findings will be disseminated via report, peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12615000864527; results.

Treatment modalities for patients with gambling disorder

BACKGROUND

Gambling disorder (GD) is defined as persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress. The prevalence of GD has been shown to be 1.2-7.1% in the general population. GD can severely impact on personal and vocational wellbeing as well as lead to financial problems, and has been known to be difficult to treat. This review describes the available pharmacotherapy/psychosocial treatments for GD patients, and summarizes data on the effectiveness of these GD treatments.

METHODS

This review refers to newly as well as previously published studies and guidelines.

RESULTS

The description of pharmacotherapy mainly focuses on opioid receptor antagonists, selective serotonin reuptake inhibitors, and mood stabilizers. Psychosocial treatments/strategies mainly include cognitive behavioral therapy, motivational interviewing, and Gamblers Anonymous. We also introduce relatively novel treatment modalities.

CONCLUSIONS

This review can help clinicians to decide treatment plans for their GD patients. In addition, it can be used as a reference for designing future research.