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Adding Contingency Management to Treatment as Usual for Disordered Gambling.

Primary Purpose

Gambling, Pathological

Status
Completed
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Contingency Management
Treatment as Usual
Sponsored by
University of Lethbridge
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gambling, Pathological

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • 18-75 years of age, provide written consent, receive a diagnosis of disordered gambling, are primarily seeking treatment for disordered gambling, and speak English

Exclusion Criteria:

  • Pharmacologically unmanaged psychiatric disorder that would impede counselling (e.g., psychosis), reports of neurological disorder(s), or injury resulting in a loss of consciousness greater than 10 minutes. Treatment as Usual participants will need to match CM+ participants on key measures (e.g., age, gender, education, gambling severity, substance use, psychiatric issues, comorbidities, treatment experience, ethnicity, and socio-economic status)

Sites / Locations

  • University of Lethbridge

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Contingency Management

Treatment as Usual

Arm Description

Contingency Management (CM+): This procedure is designed to reinforce treatment attendance, non-gambling behaviour, and study completion. Participants will earn points that will be recorded on vouchers that could be subsequently redeemed for gift cards at a variety of local businesses. Submission of evidence of gambling behaviour or non-attendance re-sets the point value for future vouchers to the starting level. This intervention is in addition to Treatment as Usual.

Treatment as Usual (TAU): This is typically a semi-structured approach for delivering cognitive behavioural therapy addressing the participant's experiences, thoughts, and emotions relating to their gambling.

Outcomes

Primary Outcome Measures

The total number of sessions that a participant provided evidence of gambling abstinence in the study.
Gambling Abstinence

Secondary Outcome Measures

The total number of sessions that a participant attended the study
Session Attendance
The total number of weeks that a participant attended the study.
Study Retention

Full Information

First Posted
November 19, 2015
Last Updated
August 2, 2023
Sponsor
University of Lethbridge
Collaborators
Alberta Innovates Health Solutions, Alberta Gambling Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT02613754
Brief Title
Adding Contingency Management to Treatment as Usual for Disordered Gambling.
Official Title
The Impact of Adding Contingency Management to Treatment as Usual for Disordered Gambling
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Completed
Study Start Date
March 2015 (undefined)
Primary Completion Date
August 2, 2023 (Actual)
Study Completion Date
August 2, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Lethbridge
Collaborators
Alberta Innovates Health Solutions, Alberta Gambling Research Institute

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The aim of this study is to conduct a trial to investigate the efficacy of adding Contingency Management (CM) to Treatment as Usual (TAU) for the treatment of Disordered Gambling. Results from this experiment will provide the first evidence of the additional efficacy of best-practice CM and whether it can be easily integrated into a clinical environment. Additionally, this study will correlate clinical outcomes with psychological measures and participant responses to develop new predictive treatment outcome measures.
Detailed Description
Hypothesis Behavioural approaches are direct and powerful ways of modifying problematic behaviours. The prediction is that adding best-practice CM treatments to TAU will reduce gambling behaviour and gambling urges to a greater degree than standard counselling practices. Background Problematic gambling is a significant Canadian public health concern that causes harm to the gambler, their families, and society at large (Huang & Boyer, 2007). Approximately 4% of Albertans gamble in problematic ways resulting in significant financial losses, personal distress, relationship break-downs, and in some cases suicide (Williams et al., 2011; Problem Gambling Institute of Ontario, 2014). However, recent trends appear to show a decline in those seeking treatment despite the relatively consistent problem/disordered gambling prevalence rates (Williams et al., 2011). Further, 33% - 50% of treatment seekers drop out prior to the issue resolving (Leblonde et al., 2003), where those with the most severe gambling problems have the highest drop-out rates (ibid). One possible reason for these issues is the lack of immediate benefits clients gain from treatment attendance. One treatment approach that provides immediate benefit for treatment attendance and superior treatment efficacy for substance and alcohol dependence is contingency management (Petry, 2010). Contingency management uses motivational incentives, typically vouchers that are exchangeable for retail goods and services, as rewards that participants receive for providing evidence of the target behavior and withholding them when the participant fails to perform the behaviour. This treatment has been used successfully in several countries in the treatment of various addictive substances (Garcia-Rodriguez et al., 2009; Peirce et al., 2006), and to promote healthy behaviours (Petry et al., 2011). Meta-analyses have consistently found contingency management to report improved clinical outcomes and the highest of treatment effect sizes (Dutra et al., 2010; Prendergast et al., 2006). Further, contingency management programs typically report a greater likelihood of program completion than standard care (Lott & Jencius, 2009), where the positive effects of the treatment persist many months after treatment completion (Petry & Martin, 2002). Researchers are now suggesting that contingencies can be important mechanism in the treatment of gambling (Petry et al., 2006; Christensen, 2013), as the variable but regular nature of the receipt of gambling wins have been associated with the development of problematic gambling (Blaszczynski & Nower, 2002), where contingency management uses the same approach to reverse these associations. Moreover, recent research suggests that the development of non-gambling reinforcement can successfully compete with the gambling experience resulting in reductions in gambling behaviour and increases in alternative, and pro-social, behaviours (Jackson et al., 2013). Although CM appears very successful, it has only been previously applied once to problematic gambling (West, 2008). However, there were issues with the pilot procedure (Christensen, 2013), as the program implemented was non-standard, notably the reinforcers were delayed, infrequent, of a low level, resulting in modest CM treatment outcomes (Petry, 2010). This proposal will use techniques that have been shown to improve the efficacy of a CM program. These are; 1) increasing the rate of incentives for sustained performance of the target behaviour and resetting following a lapse (Petry et al., 2006), 2) providing incentives at regular intervals (Christensen, 2013), 3) providing incentives as soon as practicable after evidence of the target behaviour is provided (Zeiler, 1977; Griffith et al., 2000), and 4) providing sufficiently meaningful incentives (Dallery et al., 2001). These additions to the standard CM procedure, which are typically used in successful treatments for substance dependence (Chopra et al., 2011), will hopefully improve the treatment efficacy of CM for disordered gamblers.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gambling, Pathological

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
45 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Contingency Management
Arm Type
Experimental
Arm Description
Contingency Management (CM+): This procedure is designed to reinforce treatment attendance, non-gambling behaviour, and study completion. Participants will earn points that will be recorded on vouchers that could be subsequently redeemed for gift cards at a variety of local businesses. Submission of evidence of gambling behaviour or non-attendance re-sets the point value for future vouchers to the starting level. This intervention is in addition to Treatment as Usual.
Arm Title
Treatment as Usual
Arm Type
Active Comparator
Arm Description
Treatment as Usual (TAU): This is typically a semi-structured approach for delivering cognitive behavioural therapy addressing the participant's experiences, thoughts, and emotions relating to their gambling.
Intervention Type
Behavioral
Intervention Name(s)
Contingency Management
Intervention Description
See arm description.
Intervention Type
Behavioral
Intervention Name(s)
Treatment as Usual
Intervention Description
See arm description
Primary Outcome Measure Information:
Title
The total number of sessions that a participant provided evidence of gambling abstinence in the study.
Description
Gambling Abstinence
Time Frame
up to 12-weeks
Secondary Outcome Measure Information:
Title
The total number of sessions that a participant attended the study
Description
Session Attendance
Time Frame
up to 12-weeks
Title
The total number of weeks that a participant attended the study.
Description
Study Retention
Time Frame
up to 12-weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: 18-75 years of age, provide written consent, receive a diagnosis of disordered gambling, are primarily seeking treatment for disordered gambling, and speak English Exclusion Criteria: Pharmacologically unmanaged psychiatric disorder that would impede counselling (e.g., psychosis), reports of neurological disorder(s), or injury resulting in a loss of consciousness greater than 10 minutes. Treatment as Usual participants will need to match CM+ participants on key measures (e.g., age, gender, education, gambling severity, substance use, psychiatric issues, comorbidities, treatment experience, ethnicity, and socio-economic status)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Darren R Christensen, PhD
Organizational Affiliation
University of Lethbridge
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Lethbridge
City
Lethbridge
State/Province
Alberta
ZIP/Postal Code
T1K3M4
Country
Canada

12. IPD Sharing Statement

Links:
URL
https://www.ulethbridge.ca/healthsciences/gambling-and-substance-use-studies
Description
Profile of Dr. Christensen

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Adding Contingency Management to Treatment as Usual for Disordered Gambling.

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