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

John A Cunningham, David C Hodgins, Kylie Bennett, Anthony Bennett, Marina Talevski, Corey S Mackenzie, Christian S Hendershot, John A Cunningham, David C Hodgins, Kylie Bennett, Anthony Bennett, Marina Talevski, Corey S Mackenzie, Christian S Hendershot

Abstract

Background: Comorbidity between problem gambling and depression or anxiety is common. Further, the treatment needs of people with co-occurring gambling and mental health symptoms may be different from those of problem gamblers who do not have a co-occurring mental health concern. The current randomized controlled trial (RCT) will evaluate whether there is a benefit to providing access to mental health Internet interventions (G + MH intervention) in addition to an Internet intervention for problem gambling (G-only intervention) in participants with gambling problems who do or do not have co-occurring mental health symptoms.

Methods: Potential participants will be screened using an online survey to identify participants meeting criteria for problem gambling. As part of the baseline screening process, measures of current depression and anxiety will be assessed. Eligible participants agreeing (N = 280) to take part in the study will be randomized to one of two versions of an online intervention for gamblers - an intervention that just targets gambling issues (G-only) versus a website that contains interventions for depression and anxiety in addition to an intervention for gamblers (G + MH). It is predicted that problem gamblers who do not have co-occurring mental health symptoms will display no significant difference between intervention conditions at a six-month follow-up. However, for those with co-occurring mental health symptoms, it is predicted that participants receiving access to the G + MH website will display significantly reduced gambling outcomes at six-month follow-up as compared to those provided with G-only website.

Discussion: The trial will produce information on the best means of providing online help to gamblers with and without co-occurring mental health symptoms.

Trial registration: ClinicalTrials.gov NCT02800096 ; Registration date: June 14, 2016.

Keywords: Anxiety; Brief intervention; Clinical trial; Comorbidity; Depression; Gambling disorders; Internet intervention; Online intervention; Randomized controlled trial; Trial protocol.

Figures

Fig. 1
Fig. 1
Overview of the proposed intervention trial

References

    1. Bischof A, Meyer C, Bischof G, Kastirke N, John U, Rumpf HJ. Comorbid Axis I-disorders among subjects with pathological, problem, or at-risk gambling recruited from the general population in Germany: results of the PAGE study. Psychiatry Res. 2013;210(3):1065–1070. doi: 10.1016/j.psychres.2013.07.026.
    1. Desai RA, Potenza MN. Gender differences in the associations between past-year gambling problems and psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol. 2008;43(3):173–183. doi: 10.1007/s00127-007-0283-z.
    1. Kessler RC, Hwang I, LaBrie R, Petukhova M, Sampson NA, Winters KC, Shaffer HJ. DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychol Med. 2008;38(9):1351–1360. doi: 10.1017/S0033291708002900.
    1. Petry NM, Stinson FS, Grant BF. Comorbidity of DSM-IV pathological gambling and psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychology. 2005;66(5):564–574.
    1. Lorains FK, Cowlishaw S, Thomas SA. Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys. Addiction. 2011;106(3):490–498. doi: 10.1111/j.1360-0443.2010.03300.x.
    1. Martin RJ, Usdan S, Cremeens J, Vail-Smith K. Disordered gambling and co-morbidity of psychiatric disorders among college students: An examination of problem drinking, anxiety and depression. J Gambl Stud. 2014;30(2):321–333. doi: 10.1007/s10899-013-9367-8.
    1. Wynn J, Hudyma A, Hauptman E, Houston TN, Faragher JM. Treatment of problem gambling: development, status, and future. Drugs and Alcohol Today. 2014;14(1):42–50. doi: 10.1108/DAT-10-2013-0044.
    1. Toneatto T, Ladouceur R. Treatment of pathological gambling: A critical review of the literature. Psychol Addict Behav. 2003;17(4):284–292. doi: 10.1037/0893-164X.17.4.284.
    1. Stea JN, Hodgins DC. A Critical Review of Treatment Approaches for Gambling Disorders. Curr Drug Abuse Rev. 2011;4(2):67–80. doi: 10.2174/1874473711104020067.
    1. Geisner IM, Bowen S, Lostutter TW, Cronce JM, Granato H, Larimer ME. Gambling-Related Problems as a Mediator Between Treatment and Mental Health with At-Risk College Student Gamblers. J Gambl Stud. 2014;31:1005–13. doi: 10.1007/s10899-014-9456-3.
    1. Dowling NA, Merkouris SS, Lorains FK. Interventions for comorbid problem gambling and psychiatric disorders: Advancing a developing field of research. Addict Behav. 2016;58:21–30. doi: 10.1016/j.addbeh.2016.02.012.
    1. Hodgins DC, el-Guebaly N. The influence of substance dependence and mood disorders on outcome from pathological gambling: five-year follow-up. J Gambl Stud. 2010;26(1):117–127. doi: 10.1007/s10899-009-9137-9.
    1. Blaszczynski A, Nower L. A pathways model of problem and pathological gambling. Addiction. 2002;97(5):487–499. doi: 10.1046/j.1360-0443.2002.00015.x.
    1. Kim SW, Grant JE, Eckert ED, Faris PL, Hartman BK. Pathological gambling and mood disorders: clinical associations and treatment implications. J Affect Disorders. 2006;92(1):109–116. doi: 10.1016/j.jad.2005.12.040.
    1. Quilty LC, Watson C, Robinson JJ, Toneatto T, Bagby RM. The prevalence and course of pathological gambling in the mood disorders. J Gambl Stud. 2011;27(2):191–201. doi: 10.1007/s10899-010-9199-8.
    1. Afifi TO, Cox BJ, Martens PJ, Sareen J, Enns MW. Demographic and social variables associated with problem gambling among men and women in Canada. Psychiat Res. 2010;178(2):395–400. doi: 10.1016/j.psychres.2009.10.003.
    1. Parhami I, Mojtabai R, Rosenthal RJ, Afifi TO, Fong TW. Gambling and the onset of comorbid mental disorders: a longitudinal study evaluating severity and specific symptoms. J Psychiatr Pract. 2014;20(3):207–219. doi: 10.1097/01.pra.0000450320.98988.7c.
    1. Cunningham JA. Little use of treatment among problem gamblers. Psychiat Serv. 2005;56(8):1024–1025. doi: 10.1176/appi.ps.56.8.1024-a.
    1. Suurvali H, Hodgins DC, Toneatto T, Cunningham JA. Treatment-seeking among Ontario problem gamblers: results of a population survey. Psychiatr Serv. 2008;59:1343–1346. doi: 10.1176/ps.2008.59.11.1343.
    1. Slutske WS. Natural recovery and treatment-seeking in pathological gambling: results of two U.S. national surveys. Am J Psychiatry. 2006;163(2):297–302. doi: 10.1176/appi.ajp.163.2.297.
    1. Suurvali H, Hodgins DC, Toneatto T, Cunningham JA. Hesitation to seek gambling-related treatment among Ontario problem gamblers. J Addict Med. 2012;6(1):39–49. doi: 10.1097/ADM.0b013e3182307dbb.
    1. Portnoy DB, Scott-Sheldon LA, Johnson BT, Carey MP. Computer-delivered interventions for health promotion and behavioral risk reduction: A meta-analysis of 75 randomized controlled trials, 1988-2007. Prev Med. 2008;47(1):3–16. doi: 10.1016/j.ypmed.2008.02.014.
    1. Cunningham JA, Hodgins DC, Toneatto T. Problem gamblers’ interest in self-help services. Psychiatr Serv. 2008;59(6):695–696. doi: 10.1176/ps.2008.59.6.695a.
    1. Hodgins DC, Holub A. Treatment of problem gambling. In: Smith DCH G, Williams R, editors. Research and measurement issues in gambling studies. New York: Elsevier; 2007. pp. 372–391.
    1. Raylu N, Oei TPS, Loo J. The current status and future direction of self-help treatments for problem gamblers. Clin Psychol Rev. 2008;28(8):1372–1385. doi: 10.1016/j.cpr.2008.07.005.
    1. Hodgins DC, Fick GH, Murray R, Cunningham JA. Internet-based interventions for disordered gamblers: study protocol for a randomized controlled trial of online self-directed cognitive-behavioural motivational therapy. BMC Public Health. 2013;13:10. doi: 10.1186/1471-2458-13-10.
    1. Luquiens A, Tanguy ML, Lagadec M, Benyamina A, Aubin HJ, Reynaud M. The efficacy of three modalities of internet-based psychotherapy for non-treatment-seeking online problem gamblers: a randomized controlled trial. J Med Internet Res. 2016;18(2):e36. doi: 10.2196/jmir.4752.
    1. Ferris J, Wynne H. Canadian Centre on Substance Abuse. 2001. The Canadian problem gambling index: final report.
    1. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SLT, Walters EE, Zaslavsky AM. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–976. doi: 10.1017/S0033291702006074.
    1. Brooks RT, Beard J, Steel Z. Factor structure and interpretation of the K10. Psychol Assessment. 2006;18(1):62–70. doi: 10.1037/1040-3590.18.1.62.
    1. ICH Harmonised Tripartite Guideline. Statistical principles for clinical trials. International Conference on Harmonisation E9 Expert Working Group. Stat Med. 1999;18(15):1905–1942.
    1. Hodgins DC, Makarchuk K. Becoming a winner. Defeating problem gambling. Edmonton: AADAC; 2002.
    1. Hodgins DC, Currie SR, el-Guebaly N. Motivational enhancement and self-help treatments for problem gambling. J Consult Clin Psychol. 2001;69(1):50–57. doi: 10.1037/0022-006X.69.1.50.
    1. Hodgins DC, Currie SR, Currie G, Fick GH. Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better. J Consult Clin Psychol. 2009;77(5):950–960. doi: 10.1037/a0016318.
    1. Diskin KM, Hodgins DC. A randomized controlled trial of a single session motivational intervention for concerned gamblers. Behav Res Ther. 2009;47(5):382–388. doi: 10.1016/j.brat.2009.01.018.
    1. Christensen H, Griffiths KM, Jorm AF. Delivering interventions for depression by using the internet: randomised controlled trial. Brit Med J. 2004;328(7434):265–268A. doi: 10.1136/.
    1. Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression - Randomised controlled trial. Brit J Psychiat. 2004;185:342–349. doi: 10.1192/bjp.185.4.342.
    1. Powell J, Hamborg T, Stallard N, Burls A, McSorley J, Bennett K, Griffiths KM, Christensen H. Effectiveness of a Web-based cognitive-behavioral tool to improve mental well-being in the general population: randomized controlled trial. J Med Internet Res. 2013;15(1):2–18. doi: 10.2196/jmir.2240.
    1. Toce-Gerstein M, Volberg RA: The NODS-CLiP: A new brief screen for pathological gambling. Paper presented at the International Symposium on Problem Gambling and Co-Occurring Disorders. Mystic, CT; 2004.
    1. Wulfert E, Hartley J, Lee M, Wang N, Franco C, Sodano R. Gambling screens: Does shortening the time frame affect their psychometric properties? J Gambl Stud. 2005;21(4):521–536. doi: 10.1007/s10899-005-5561-7.
    1. Hodgins DC. Using the NORC DSM Screen for Gambling Problems as an outcome measure for pathological gambling: psychometric evaluation. Addict Behav. 2004;29(8):1685–1690. doi: 10.1016/j.addbeh.2004.03.017.
    1. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9 - Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder - The GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Dawson DA, Grant BF, Stinson FS, Zhou Y. Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcohol Clin Exp Res. 2005;29(5):844–854. doi: 10.1097/01.ALC.0000164374.32229.A2.
    1. Ialomiteanu A, Adlaf EM. CAMH Monitor 2009: Technical Guide. Toronto: Centre for Addiction and Mental Health; 2010.
    1. Schmidt S, Muhlan H, Power M. The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study. Eur J Public Health. 2006;16(4):420–428. doi: 10.1093/eurpub/cki155.
    1. Wiebe J, Mun P, Kaufman N. Gambling and Problem Gambling in Ontario, 2005. Responsible Gambling Council: Canada; 2006.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する