A Pilot SMART Design for Pathological Gamblers (SMART)

Pathological gambling is serious problem, with significant psychological, financial, and public health consequences. Nevertheless, controlled trials examining the efficacy of therapeutic interventions for pathological gamblers are sparse, and many pathological gamblers recover on their own, or with only minimal interventions. In this initial study of a SMART design for pathological gamblers, we will offer a brief intervention to all (n = 100), and subsequently randomize individuals based upon their initial treatment response to varying intensities of additional care from none to 8 sessions of individual cognitive behavioral therapy (CBT) plus 14 weeks of Aftercare. Gambling outcomes will be assessed pre-treatment and at about weeks 10, 24, 36 and 52.

Following 2 sessions of MET intervention received by all patients, patients in Condition 1 receive no further intervention.

Patients in Condition 2 will receive 8 sessions of the CBT (Cognitive Behavioral Therapy) intervention.

MET is a client-centered, directive form of therapy designed to enhance clients' intrinsic motivation to change.

In CBT, clients learn to modify their thoughts as well as their behaviors by increasing awareness of the relationship between thoughts, emotions, and actions.

Inclusion Criteria: age > 18 years old, DSM-IV criteria for pathological gambling >2 gambling episodes in past 60 days spent >$100 wagering in the past 60 days willingness to accept random assignment after the brief intervention. Exclusion Criteria: Reading level below 5th grade uncontrolled psychiatric conditions (e.g., active suicidal intention, psychosis, bipolar disorder)