Contingency Management + Cognitive Behavioural Therapy for Gambling Addiction

Overseen By Chad Witcher, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Lethbridge

Disqualifiers: Unmanaged psychiatric, neurological disorders

Stay on Your Current Meds You can continue your current medications while participating

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 39

Duration: 12 weeks

54 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you have a medically unmanaged psychiatric or neurological disorder, you may not be eligible to participate.

What data supports the effectiveness of the treatment Contingency Management + Cognitive Behavioural Therapy for Gambling Addiction?

Research shows that Cognitive Behavioral Therapy (CBT) is effective in reducing gambling behaviors and improving psychological states like depression and anxiety in problem gamblers. Additionally, Contingency Management, which uses incentives to encourage positive behaviors, has a strong evidence base in treating substance misuse and could be beneficial for gambling addiction as well. ^{1 2 3 4 5}

Is Contingency Management combined with Cognitive Behavioral Therapy safe for treating gambling addiction?

Cognitive Behavioral Therapy (CBT) and Contingency Management (CM) have been used safely in treating various conditions, including gambling addiction and substance misuse. These treatments involve structured therapy sessions and incentives to encourage positive behavior, and there is no evidence suggesting they are unsafe for humans. ^{5 6 7 8 9}

How is the treatment of Contingency Management combined with Cognitive Behavioural Therapy unique for gambling addiction?

This treatment is unique because it combines Cognitive Behavioural Therapy (CBT), which helps change negative thought patterns, with Contingency Management (CM), which uses incentives to encourage positive behaviors like abstinence and attendance. This combination aims to improve motivation and engagement in treatment, which is particularly beneficial for those who struggle with retention in gambling addiction programs. ^{2 5 9 10 11}

What is the purpose of this trial?

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.

Research Team

Darren R Christensen, PhD

Principal Investigator

University of Lethbridge

Eligibility Criteria

This trial is for English-speaking individuals living in rural or remote areas who have been diagnosed with a gambling disorder and have gambled within the last month. They must be able to give written consent. People with unmanaged psychiatric or neurological conditions, other than gambling disorder, cannot participate.

Inclusion Criteria

Capable of providing written consent

Live in a rural or remote location

Gambled within the last month

Exclusion Criteria

Medically unmanaged psychiatric or neurological disorder(s) except for disordered gambling

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (virtual)

Pre-treatment Assessment

Participants complete baseline assessments including demographic information

1 week

1 visit (virtual)

Treatment

Participants receive Cognitive Behavioural Therapy (CBT) or CBT with Contingency Management (CM) for 12 weeks

12 weeks

36 visits (virtual, 3 times a week)

Post-treatment Assessment

Participants complete post-treatment assessments to evaluate clinical, psychological, and behavioural outcomes

1 week

1 visit (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Cognitive Behavioural Therapy
• Contingency Management

Trial Overview The study tests if adding Contingency Management to regular Cognitive Behavioural Therapy (CBT) helps improve attendance and retention in counselling sessions for disordered gamblers using video-conferencing tools designed for those living far from treatment centers.

Participant Groups

Group I: Contingency Management Experimental Treatment 1 Intervention

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.

Group II: Cognitive Behavioural Therapy Active Control 1 Intervention

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.

Cognitive Behavioural Therapy is already approved in United States, Canada, European Union for the following indications:

Approved in United States as Cognitive Behavioral Therapy for:

• Anxiety disorders
• Substance use disorders
• Depression
• Post-traumatic stress disorder (PTSD)
• Eating disorders

Approved in Canada as Cognitive Behavioural Therapy for:

• Anxiety disorders
• Substance use disorders
• Depression
• Post-traumatic stress disorder (PTSD)
• Eating disorders

Approved in European Union as Cognitive Behavioural Therapy for:

• Anxiety disorders
• Substance use disorders
• Depression
• Post-traumatic stress disorder (PTSD)
• Eating disorders

Who Is Running the Clinical Trial?

University of Lethbridge

Lead Sponsor

Trials

10

Recruited

760+

Rural Development Network

Collaborator

Trials

1

Recruited

50+

Alberta Rural Development Network

Collaborator

Trials

1

Recruited

50+

Findings from Research

A systematic review of 12 randomized controlled trials involving 1654 adults found that adding cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET) to contingency management (CM) did not improve rates of abstinence from substance use at the end of treatment or during follow-up.

The analysis showed no significant benefits in secondary outcomes, such as self-reported days of substance use, indicating that CM alone is as effective as when combined with these psychotherapeutic interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. Sheridan Rains, L., Steare, T., Mason, O., et al.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

How does routinely delivered cognitive-behavioural therapy for gambling disorder compare to "gold standard" clinical trial? [2018]

2. England pubmed.ncbi.nlm.nih.gov

Cognitive-behavior therapy for problem gambling: a critique of current treatments and proposed new unified approach. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of a Self Help Cognitive Behavioural Treatment Program for Problem Gamblers: A Randomised Controlled Trial. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for pathological gamblers. [2018]

5. England pubmed.ncbi.nlm.nih.gov

Gambling treatment service providers' views about contingency management: a thematic analysis. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Two-group randomised, parallel trial of cognitive and exposure therapies for problem gambling: a research protocol. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

A systematic review of treatments for problem gambling. [2019]

9. England pubmed.ncbi.nlm.nih.gov

Piloting the addition of contingency management to best practice counselling as an adjunct treatment for rural and remote disordered gamblers: study protocol. [2019]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Client Views of Contingency Management in Gambling Treatment: A Thematic Analysis. [2023]

11. England pubmed.ncbi.nlm.nih.gov

Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. [2021]