Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT02613754 |
| Other study ID # |
HSRC 2015-020 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
March 2015 |
| Est. completion date |
August 2, 2023 |
Study information
| Verified date |
August 2023 |
| Source |
University of Lethbridge |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial 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.
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.
