Abstract
Several therapy modalities have been developed for gambling disorder (GD), and the cognitive behavioral therapy (CBT) is one of the most promising approaches. The objective of this study was to explore the impact of patients’ adherence to guidelines concerning money control on the effectiveness and outcomes of a CBT program. Sample included n = 998 gambling disorder (GD) patients aged between 18 and 80 years old, who were consecutively attended in a Spanish reference-university-based hospital specialized in gambling treatment. The CBT program consisted of 16 weekly group sessions (each lasting about 90 min) aimed to achieve definitive abstinence from all types of gambling. Money control was integrated during the complete treatment. Different assessments were made: at baseline, during the CBT program, and at the end of the intervention. The risk of dropout during therapy was lower in patients who reported money control (19.1% versus 76.4%, p = 0.001), and differences were also found in the Kaplan-Meier cumulative survival functions of dropout (χ2 = 118.9, p < 0.001). No differences were found for the risk of relapse (defined in this study as the occurrence of gambling episodes during the intervention) (26.4% versus 28.0%, p = 0.775) or in the cumulative survival function of relapse (χ2 = 0.16, p = 0.689). At the end of the intervention, patients with money control had lower levels of gambling severity and comorbid psychopathology. The benefits of money control as a stimulus control during the CBT highlight the need to design intervention programs with reliable adherence strategies addressed to achieve complete abstinence from the gambling activities. Personalized interventions for GD should identify patients with higher needs of stimulus control training.
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References
Aalen, O. O., Borgan, O., & Gjessing, H. K. (2008). Survival and event history analysis: a process point of view. New York: Springer.
Abbott, M., Hodgins, D. C., Bellringer, M., Vandal, A. C., Palmer Du Preez, K., Landon, J., et al. (2018). Brief telephone interventions for problem gambling: a randomized controlled trial. Addiction, 113(5), 883–895. https://doi.org/10.1111/add.14149.
American Psychiatric Association. (2010). Diagnostic and statistical manual of mental disorders (Fourth Edition-Rev) (4th Rev). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (fifth edition) (5th ed.). Washington D.C: Author.
Auer, M., & Griffiths, M. D. (2013). Voluntary limit setting and player choice in most intense online gamblers: an empirical study of gambling behaviour. Journal of Gambling Studies, 29(4), 647–660. https://doi.org/10.1007/s10899-012-9332-y.
Auer, M., & Griffiths, M. D. (2016). Personalized behavioral feedback for online gamblers: a real world empirical study. Frontiers in Psychology, 7, 1875. https://doi.org/10.3389/fpsyg.2016.01875.
Auer, M., Hopfgartner, N., & Griffiths, M. D. (2018). The effect of loss-limit reminders on gambling behavior: a real-world study of Norwegian gamblers. Journal of Behavioral Addictions, 7(4), 1056–1067. https://doi.org/10.1556/2006.7.2018.106.
Buth, S., Wurst, F. M., Thon, N., Lahusen, H., & Kalke, J. (2017). Comparative analysis of potential risk factors for at-risk gambling, problem gambling and gambling disorder among current gamblers-results of the Austrian representative survey 2015. Frontiers in Psychology, 8, 2188. https://doi.org/10.3389/fpsyg.2017.02188.
Caillon, J., Grall-Bronnec, M., Perrot, B., Leboucher, J., Donnio, Y., Romo, L., & Challet-Bouju, G. (2019). Effectiveness of at-risk gamblers’ temporary self-exclusion from internet gambling sites. Journal of Gambling Studies, 35(2), 601–615. https://doi.org/10.1007/s10899-018-9782-y.
Calado, F., & Griffiths, M. D. (2016). Problem gambling worldwide: an update and systematic review of empirical research (2000–2015). Journal of Behavioral Addictions, 5(4), 592–613. https://doi.org/10.1556/2006.5.2016.073.
Calado, F., Alexandre, J., & Griffiths, M. D. (2017). Prevalence of adolescent problem gambling: a systematic review of recent research. Journal of Gambling Studies, 33(2), 397–424. https://doi.org/10.1007/s10899-016-9627-5.
Carlbring, P., & Smit, F. (2008). Randomized trial of internet-delivered self-help with telephone support for pathological gamblers. Journal of Consulting and Clinical Psychology, 76(6), 1090–1094. https://doi.org/10.1037/a0013603.
Chebli, J.-L., Blaszczynski, A., & Gainsbury, S. M. (2016). Internet-based interventions for addictive behaviours: a systematic review. Journal of Gambling Studies, 32(4), 1279–1304. https://doi.org/10.1007/s10899-016-9599-5.
Cloninger, C. R., Przybeck, T. R., Syrakic, D. M., & Wetzel, R. D. (1994). The temperament and character inventory (TCI). A guide to its development and use. Washington University: Center for Psychobiology of Personality.
Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database of Systematic Reviews, 11, CD008937. https://doi.org/10.1002/14651858.CD008937.pub2.
Cunningham, J. A., Hodgins, D. C., Toneatto, T., & Murphy, M. (2012). A randomized controlled trial of a personalized feedback intervention for problem gamblers. PLoS One, 7(2), e31586. https://doi.org/10.1371/journal.pone.0031586.
Cunningham, J. A. (2014). Intervention adherence is related to participant retention: implications for research. Journal of Medical Internet Research, 16(5):e133. https://doi.org/10.2196/jmir.2948
Dar, R., Stronguin, F., Marouani, R., Krupsky, M., & Frenk, H. (2005). Craving to smoke in orthodox Jewish smokers who abstain on the Sabbath: a comparison to a baseline and a forced abstinence workday. Psychopharmacology, 183(3), 294–299. https://doi.org/10.1007/s00213-005-0192-3.
Dar, R., Rosen-Korakin, N., Shapira, O., Gottlieb, Y., & Frenk, H. (2010). The craving to smoke in flight attendants: relations with smoking deprivation, anticipation of smoking, and actual smoking. Journal of Abnormal Psychology, 119(1), 248–253. https://doi.org/10.1037/a0017778.
Derogatis, L. R. (1994). SCL-90-R: Symptom Checklist-90-R. administration, scoring and procedures manual—II for the revised version. Towson: Clinical Psychometric Research.
Diskin, K. M., & Hodgins, D. C. (2009). A randomized controlled trial of a single session motivational intervention for concerned gamblers. Behaviour Research and Therapy, 47(5), 382–388. https://doi.org/10.1016/j.brat.2009.01.018.
Dupont, W. D. (2009). Statistical modeling for biomedical researchers: a simple introduction to the analysis of complex data, second edition. In Statistical modeling for biomedical researchers: a simple introduction to the analysis of complex data. https://doi.org/10.1017/CBO9780511575884.
Echeburúa, E., Báez, C., Fernández, J., & Páez, D. (1994). Cuestionario de juego patológico de south oaks (SOGS): Validación española (south oaks gambling screen (SOGS): Spanish validation). Análisis de Modificación de Conducta, 20, 769–791.
Finner, H. (1993). On a monotonicity problem in step-down multiple test procedures. Journal of the American Statistical Association, 88, 920–923. https://doi.org/10.1080/01621459.1993.10476358.
Gainsbury, S. M., Abarbanel, B. L. L., Philander, K. S., & Butler, J. V. (2018). Strategies to customize responsible gambling messages: a review and focus group study. BMC Public Health, 18(1), 1381. https://doi.org/10.1186/s12889-018-6281-0.
Ginley, M. K., Rash, C. J., & Petry, N. M. (2019). Psychological interventions in gambling disorders. In A. Heinz, N. Romanczuk-Sieferth, & M. N. Potenza (Eds.), Gambling disorder (pp. 181–194). Switzerland: Springer.
Giroux, I., Goulet, A., Mercier, J., Jacques, C., & Bouchard, S. (2017). Online and mobile interventions for problem gambling, alcohol, and drugs: a systematic review. Frontiers in Psychology, 8, 954. https://doi.org/10.3389/fpsyg.2017.00954.
Gonzalez De Rivera, J. L., Derogatis, L. R., De las Cuevas, C., Gracia Marco, R., Rodríguez-Pulido, F., Henry-Benitez, M., & Monterrey, A. (1989). The Spanish version of the SCL-90-R. Normative data in the general population. Towson: Clinical Psychometric Research.
Grant, J. E., & Kim, S. W. (2006). Medication management of pathological gambling. Minnesota Medicine, 89(9), 44–48 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17024925.
Gupta, S. (2011). Intention-to-treat concept: A review. Perspectives in Clinical Research, 2(3), 109–112. https://doi.org/10.4103/2229-3485.83221.
Gutiérrez-Zotes, J. A., Bayón, C., Montserrat, C., Valero, J., Labad, A., Cloninger, C. R., & Fernández-Aranda, F. (2004). Temperament and character inventory revised (TCI-R). Standardization and normative data in a general population sample. Actas Españolas de Psiquiatría, 32(1), 8–15 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14963776.
Hing, N., Sproston, K., Tran, K., & Russell, A. M. T. (2017). Gambling responsibly: who does it and to what end? Journal of Gambling Studies, 33(1), 149–165. https://doi.org/10.1007/s10899-016-9615-9.
Hodgins, D., & Holub, A. (2007). Treatment of pathological gambling. In G. Smith, D. Hodgins, & R. Williams (Eds.), Research and measurement issues in gambling studies (pp. 372–399). Toronto: Elsevier.
Hollingshead, A. B. (2011). Four factor index of social status. Yale Journal of Sociology, 8, 21–51.
Horvitz-Lennon, M., O’Malley, A. J., Frank, R. G., & Normand, S.-L. T. (2005). Improving traditional intention-to-treat analyses: a new approach. Psychological Medicine, 35(7), 961–970 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16045063.
Jiménez-Murcia, S., Stinchfield, R., Alvarez-Moya, E., Jaurrieta, N., Bueno, B., Granero, R., Aymamí, M. N., Gómez-Peña, M., Martínez-Giménez, R., Fernández-Aranda, F., & Vallejo, J. (2009). Reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for pathological gambling. Journal of Gambling Studies, 25(1), 93–104. https://doi.org/10.1007/s10899-008-9104-x.
Keen, B., Blaszczynski, A., & Anjoul, F. (2017). Systematic review of empirically evaluated school-based gambling education programs. Journal of Gambling Studies, 33(1), 301–325. https://doi.org/10.1007/s10899-016-9641-7.
Kelley, K., & Preacher, K. J. (2012). On effect size. Psychological Methods, 17(2), 137–152. https://doi.org/10.1037/a0028086.
Lesieur, H. R., & Blume, S. B. (1987). The South Oaks Gambling Screen (SOGS): a new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144(9), 1184–1188. https://doi.org/10.1176/ajp.144.9.1184.
Marlatt, G. A. (1996). Taxonomy of high-risk situations for alcohol relapse: evolution and development of a cognitive-behavioral model. Addiction, 91 Suppl, S37–S49 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8997780.
Merkouris, S. S., Thomas, S. A., Browning, C. J., & Dowling, N. A. (2016). Predictors of outcomes of psychological treatments for disordered gambling: a systematic review. Clinical Psychology Review, 48, 7–31. https://doi.org/10.1016/j.cpr.2016.06.004.
Mostazir, M., Taylor, R. S., Henley, W., & Watkins, E. (2019). An overview of statistical methods for handling nonadherence to intervention protocol in randomized control trials: a methodological review. Journal of Clinical Epidemiology, 108, 121–131. https://doi.org/10.1016/j.jclinepi.2018.12.002.
Nowak, D. E. (2018). A meta-analytical synthesis and examination of pathological and problem gambling rates and associated moderators among college students, 1987-2016. Journal of Gambling Studies, 34(2), 465–498. https://doi.org/10.1007/s10899-017-9726-y.
Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B.-H., & Molde, H. (2005). Outcome of psychological treatments of pathological gambling: a review and meta-analysis. Addiction, 100(10), 1412–1422. https://doi.org/10.1111/j.1360-0443.2005.01204.x.
Pallesen, S., Molde, H., Arnestad, H. M., Laberg, J. C., Skutle, A., Iversen, E., Støylen, I. J., Kvale, G., & Holsten, F. (2007). Outcome of pharmacological treatments of pathological gambling: a review and meta-analysis. Journal of Clinical Psychopharmacology, 27(4), 357–364. https://doi.org/10.1097/jcp.013e3180dcc304d.
Parke, A., Griffiths, M., Pattinson, J., & Keatley, D. (2018). Age-related physical and psychological vulnerability as pathways to problem gambling in older adults. Journal of Behavioral Addictions, 7(1), 137–145. https://doi.org/10.1556/2006.7.2018.18.
Peter, S. C., Brett, E. I., Suda, M. T., Leavens, E. L. S., Miller, M. B., Leffingwell, T. R., Whelan, J. P., & Meyers, A. W. (2019). A meta-analysis of brief personalized feedback interventions for problematic gambling. Journal of Gambling Studies, 35(2), 447–464. https://doi.org/10.1007/s10899-018-09818-9.
Petry, N. M. (2005). Pathological gambling: etiology, comorbidity and treatment. Washington D.C.: American Psychological Association.
Petry, N. M., Ginley, M. K., & Rash, C. J. (2017). A systematic review of treatments for problem gambling. Psychology of Addictive Behaviors, 31(8), 951–961. https://doi.org/10.1037/adb0000290.
Pickering, D., Keen, B., Entwistle, G., & Blaszczynski, A. (2018). Measuring treatment outcomes in gambling disorders: a systematic review. Addiction, 113(3), 411–426. https://doi.org/10.1111/add.13968.
Rizeanu, S. (2015). Pathological gambling treatment - review. Procedia - Social and Behavioral Sciences, 13, 613–618. https://doi.org/10.1016/j.sbspro.2015.03.114.
Robinson, T. E., & Berridge, K. C. (1993). The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Research Reviews, 18(3), 247–291. https://doi.org/10.1016/01650173(93)90013-P.
Robinson, T. E., & Berridge, K. C. (2008). Review. The incentive sensitization theory of addiction: some current issues. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 363(1507), 3137–3146. https://doi.org/10.1098/rstb.2008.0093.
Rodda, S. N., Bagot, K. L., Cheetham, A., Hodgins, D. C., Hing, N., & Lubman, D. I. (2018). Types of change strategies for limiting or reducing gambling behaviors and their perceived helpfulness: a factor analysis. Psychology of Addictive Behaviors, 32(6), 679–688. https://doi.org/10.1037/adb0000393.
Rodda, S. N., Bagot, K. L., Manning, V., & Lubman, D. I. (2019). “It was terrible. I didn’t set a limit”: proximal and distal prevention strategies for reducing the risk of a bust in gambling venues. Journal of Gambling Studies, in press, 35, 1407–1421. https://doi.org/10.1007/s10899-019-09829-0.
Saunders, J. B., Hao, W., Long, J., King, D. L., Mann, K., Fauth-Bühler, M., Rumpf, H. J., Bowden-Jones, H., Rahimi-Movaghar, A., Chung, T., Chan, E., Bahar, N., Achab, S., Lee, H. K., Potenza, M., Petry, N., Spritzer, D., Ambekar, A., Derevensky, J., Griffiths, M. D., Pontes, H. M., Kuss, D., Higuchi, S., Mihara, S., Assangangkornchai, S., Sharma, M., Kashef, A. E., Ip, P., Farrell, M., Scafato, E., Carragher, N., & Poznyak, V. (2017). Gaming disorder: its delineation as an important condition for diagnosis, management, and prevention. Journal of Behavioral Addictions, 6(3), 271–279. https://doi.org/10.1556/2006.6.2017.039.
Stata-Corp. (2019). Stata statistical software: Release 16. College Station: StataCorp LLC.
Steyerberg, E. W., Harrell, F. E., Borsboom, G. J., Eijkemans, M. J., Vergouwe, Y., & Habbema, J. D. (2001). Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. Journal of Clinical Epidemiology, 54(8), 774–781. https://doi.org/10.1016/S0895-4356(01)00341-9.
Stinchfield, R. (2003). Reliability, validity, and classification accuracy of a measure of DSM-IV diagnostic criteria for pathological gambling. American Journal of Psychiatry, 160(1), 180–182. https://doi.org/10.1176/appi.ajp.160.1.180.
Subramaniam, M., Wang, P., Soh, P., Vaingankar, J. A., Chong, S. A., Browning, C. J., & Thomas, S. A. (2015). Prevalence and determinants of gambling disorder among older adults: a systematic review. Addictive Behaviors, 41, 199–209. https://doi.org/10.1016/j.addbeh.2014.10.007.
Ten Have, T. R., Normand, S.-L. T., Marcus, S. M., Brown, C. H., Lavori, P., & Duan, N. (2008). Intent-to-treat vs. non-intent-to-treat analyses under treatment non-adherence in mental health randomized trials. Psychiatric Annals, 38(12), 772–783. https://doi.org/10.3928/00485713-20081201-10.
van der Maas, M., Shi, J., Elton-Marshall, T., Hodgins, D. C., Sanchez, S., Lobo, D. S., Hagopian, S., & Turner, N. E. (2019). Internet-based interventions for problem gambling: scoping review. JMIR Mental Health, 6(1), e65. https://doi.org/10.2196/mental.9419.
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We thank the CERCA Programme/Generalitat de Catalunya for institutional support.
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This manuscript and research were supported by grants from the Ministerio de Economía y Competitividad (PSI2015–68701-R), Instituto de Salud Carlos III (ISCIII) (FIS PI14/00290 and PI17/01167) and cofunded by FEDER funds /European Regional Development Fund (ERDF), a way to build Europe. CIBERobn and CIBERSAM are both initiatives of ISCIII. This research was partially funded by the Delegación del Gobierno para el Plan Nacional sobre Drogas (2017I067) and received the support of the Secretariat for Universities and Research of the Ministry of Business and Knowledge of the Government of Catalonia. TMM, CVA and MLM are supported by a predoctoral Grant of the Ministerio de Educación, Cultura y Deporte (FPU16/02087; FPU16/01453; FPU15/02911). HLG is supported by the Beatriu de Pinos program of the Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia (grant number 2017 BP00035).
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Granero, R., Blaszczynski, A., Fernández-Aranda, F. et al. Does Money Control Enhance the Effectiveness of CBT for Gambling Disorder?. Int J Ment Health Addiction 19, 1045–1064 (2021). https://doi.org/10.1007/s11469-019-00212-z
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DOI: https://doi.org/10.1007/s11469-019-00212-z