Contingency Management as an Adjunct Treatment for Rural and Remote Disordered Gamblers

Piloting the Addition of Contingency Management to Best Practice Counselling as an Adjunct Treatment for Rural and Remote Disordered Gamblers

The purpose of this project is to pilot contingency management as an adjunct treatment to counselling as usual using internet delivered video-conferencing applications for remote disordered gamblers. This project further investigates the impact of adding contingency management to counselling to improve counselling attendance and retention and uses internet-delivered approaches to assist rural and remote disordered gamblers gain access to counselling treatments.

The chosen methodology is a randomised clinical trial where participants are allocated into one of two conditions; Contingency Management and Cognitive Behavioural Therapy (CM+), or Cognitive Behavioural Therapy alone (CBT) for the treatment of disordered gambling. Participants will experience a battery of tests pre- and post-treatment examining clinical, psychological, and behavioural issues, including co-morbid substance use. Alberta Rural Development Network (ARDN) affiliates will be provided with information regarding how participants can access the Qualtrics study site (e.g., an on-line survey hosting company) and will be individually directed to the study site by the principal investigator to complete the consent form and the base-line assessments. Counselling will be provided free of charge using Skype or Facetime video-conferencing internet applications. Participation in each condition will last 14 weeks: 12 weeks for treatment, and 2 weeks of assessments (one week prior to treatment and one week post treatment). Pre-treatment assessments (including demographic information) will take approximately 30-45 minutes, as will the post-treatment assessments. The progress check-ups by the Principal Investigator will take 5 to 10 minutes. A subset of treatment seekers, counsellors, and community/project stakeholders (e.g., ARDN affiliates) will also be chosen to participate in qualitative interviews to explore their experiences as well as their perceptions regarding the utility of the program for residents of rural and remote areas. The qualitative interviews will take approximately 30-60 minutes.

This is a treatment where participants earn points for treatment attendance and for providing evidence of gambling abstinence. These points are added to study accounts that can be redeemed for goods and services available at a variety of on-line businesses (e.g., Amazon, Walmart, etc.). Submission of evidence of gambling behaviour or non-attendance at an on-line counselling session re-sets subsequent points to the starting level. The CM procedure is implemented as part of the CBT counselling session.

CBT is currently considered "best practice" for the treatment of problem gambling, as noted in the National Health and Medical Research Council (Australia) endorsed Clinical Guidelines for problem and pathological gambling treatment (Problem Gambling Research and Treatment Centre, 2011). CBT is typically a semi-structured approach for delivering cognitive behavioural therapy addressing the participant's experiences, thoughts, and emotions relating to their gambling and substance use. Techniques include psychoeducation, behavioural interventions, and cognitive strategies. Participants are expected to attend on-line counselling sessions three times a week for approximately 12 weeks. All participants will receive individual counselling from an experienced counsellor/therapist.

In addition to Cognitive Behavioural Therapy, this intervention uses small incentives to reinforce study attendance and gambling abstinence.

This intervention uses psychoeducation, behavioural strategies, and cognitive restructuring to assist the participant in their efforts to become abstinent from gambling.

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

Inclusion Criteria: capable of providing written consent, received a diagnosis of gambling disorder (American Psychiatric Association, 2013), gambled within the last month, live in a rural or remote location, and speak English Exclusion Criteria: Medically unmanaged psychiatric or neurological disorder(s) except for disordered gambling

Christensen DR, Witcher CSG, Leighton T, Hudson-Breen R, Ofori-Dei S. Piloting the addition of contingency management to best practice counselling as an adjunct treatment for rural and remote disordered gamblers: study protocol. BMJ Open. 2018 Apr 3;8(4):e018804. doi: 10.1136/bmjopen-2017-018804.