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Internet-based interventions for problem gamblers: self-directed recovery
ISRCTN ISRCTN06220098
DOI 10.1186/ISRCTN06220098
ClinicalTrials.gov identifier
EudraCT number
Public title Internet-based interventions for problem gamblers: self-directed recovery
Scientific title Internet-based interventions for problem gamblers: Randomized clinical trial of online self-directed cognitive-behavioural motivational therapy
Acronym N/A
Serial number at source N/A
Study hypothesis The proposed research will evaluate a full Internet-based self-directed intervention for problem gamblers using a randomized controlled trial comparing participants who are provided access to the Self Change Tools (SCTs) as compared to those who are only provided to the CYG (www.CheckYourGambling.net) personalized feedback screener (the control condition). There is one primary hypothesis and four secondary hypotheses:

Hypothesis 1: Respondents will display significant reductions in their gambling behaviour in the twelve months after being provided access to the online SCTs.

In addition, two potential moderators and two potential mediators of the impact of the full intervention, program involvement and perceived self-efficacy, will be tested as secondary hypotheses:

Hypothesis 2: Respondents with greater baseline self-efficacy will display significantly greater reductions in their gambling behaviour in the twelve months after being provided access to the online SCTs or the CYG compared to participants with lower baseline self-efficacy.

Hypothesis 3: Respondents who have never assessed gambling or mental health treatment will display significantly greater reductions in their gambling behaviour in the twelve months after being provided access to the online SCTs or the CYG compared to participants with previous treatment involvement.

Hypothesis 4: Respondents in the SCTs intervention condition who have more involvement with the SCTs intervention between baseline and three-month follow-up will demonstrate more improvement in gambling outcomes at six- and twelve-month follow-up, compared to respondents who have less involvement with the SCTs intervention.

Hypothesis 5: Respondents in the SCTs intervention condition will display significantly greater increases in their perceived self-efficacy to deal with their gambling concerns in the three months after being provided access to the online SCTs as compared to participants in the control condition. Participants with greater improvement in self-efficacy will show greater improvement in gambling behaviour.
Lay summary Background and study aims
Gambling disorders affect about one in ten Canadian adults. Effective treatments are available but only a small proportion of affected individuals will choose to attend formal treatment. As a result self-directed treatments have also been developed and found effective. Self-directed treatments provide individuals with information and support to initiate a recovery program without attending formal treatment. In previous research we developed an intervention package that helps people to be motivated to tackle their gambling problem and to use basic behavioral and cognitive change strategies. This intervention is offered in a combined telephone and self-help workbook package. In two separate evaluations, participants with gambling disorders were followed for one year (N = 314) and two years (N = 101) and showed a reduction in gambling. The present study will investigate how well this self-directed intervention offered as a free online resource (Self Change Tools SCTs) works. The Internet is an excellent way of offering self-directed treatment for gambling problems. It is increasingly accessible to members of the public and is increasingly used to access health-related information. Online gambling sites are also becoming more popular gambling platforms.

Who can participate?
This study aims to recruit 180 men and women over the age of 18 from across Canada. Participants must have a gambling problem and not be interested in attending formal treatment.

What does the study involve?
Individuals are randomly allocated to either have access to an online self-directed intervention (SCTs) or to a comparison condition (www.CheckYourGambling.net CYG). The SCTs will provide strategies for reducing or quitting gambling. The comparison condition will be an alternative website that offers a self-assessment of gambling involvement and gambling-related problems. The participant's use of the resources and their gambling involvement (days of gambling, dollars loss) and their gambling problems will be tracked for a twelve month follow-up period, at three, six and twelve months.

What are the possible benefits and risks of participating?
Possible benefits for participants include help to reduce their involvement in gambling either through these interventions or by receiving information about other sources. There are no identified risks to the safety of participants. At all phases of the participantsí involvement they will be free to access other forms of treatment for gambling problems. Information about other resources will be included in the online resources and will be available from any study personnel upon request. The results of this research will be important for informing policy-makers who are developing treatment systems.

Where is the study run from?
The study and is run from the University of Calgary in collaboration with the Centre for Addiction and Mental Health (Toronto).

When is the study starting and how long is it expected to run for?
It is anticipated that recruitment will start May 2012. Participants will be enrolled in the study for one year, however the anticipated completion date of research activity is May 2015.

Who is funding the study?
The study is funded by the Canadian Institutes of Health Research (CIHR).

Who is the main contact?
Dr. David Hodgins
dhodgins@ucalgary.ca
Ethics approval The University of Calgary Conjoint Faculties Research Ethics Board approval April 27, 2012 File No. 7279
Study design Randomized clinical trial
Countries of recruitment Canada
Disease/condition/study domain Problem Gambling
Participants - inclusion criteria 1. 18 years of age or older
2. Perception of a gambling problem and scoring a 3 or greater on the Problem Gambling Severity Index of the Canadian Problem Gambling Index (PGSI- CPGI; (Ferris & Wynne, 2001))
3. Gambled at least once in the past month; not involved in treatment at present (includes Gamblers Anonymous and any medical or psychological treatment where gambling problems are addressed)
4. Willingness and ability to access a website in English (to ensure reading ability)
5. Willingness to have telephone contacts recorded
6. Willing to provide follow-up data on gambling
7. Willingness to provide the name of a collateral (family or friend) to help locate them for follow-up interviews and the name of the same or a different collateral for data validation. Use of psychiatric medications for other mental health disorders will not be an exclusion criterion, although use will be assessed and monitored as a potential treatment moderator.
Participants - exclusion criteria 1. Are presently involved in treatment (includes Gamblers Anonymous and any medical or psychological treatment where gambling problems are addressed)
Anticipated start date 01/04/2012
Anticipated end date 31/03/2015
Status of trial Ongoing
Patient information material Not available in web format, please use the contact details below to request a patient information sheet
Target number of participants 180
Interventions Check your gambling (CYG; www.CheckYourGambling.net).
CYG will be used as the control intervention. In the CYG, the participant completes a brief assessment and then receives a personalized feedback report which includes a list of techniques that the person could adopt to lower the risk associated with their gambling.

Self-change Tools (SCTs).
SCTs will integrate the self-directed written materials (Hodgins & Makarchuk, 2002) that were evaluated in the three brief treatment trials (Hodgins et al., 2001; Hodgins et al., 2009; Diskin & Hodgins, 2009) and a trial of a self-directed relapse prevention for gambling problems (Hodgins, Currie, el-Guebaly, & Diskin, 2007). A major focus is to provide individuals with clear and concise behavioural and cognitive strategies for meeting the goal of reducing or quitting gambling. The various workbook sections are readily adaptable into online interactive formats. The materials will be presented as a series of options from which participants will choose what strategies seem most relevant to them. Participants will have ongoing access to the site over the follow-up period to make it as similar as possible to other web resources in terms of accessibility.
Primary outcome measure(s) 1. Gambling behavior, measured using self-report questionnaires including questions on engagement in types of gambling measured both at initial assessment and follow-up (3, 6, 12 months).
2. Frequency and money spent on gambling
3. Problem gambling severity, measured using the past year Problem Gambling Severity Index (PGSI) and the lifetime and past three month versons of the NORC DSM-IV Screen for Gambling Problems (NODS)
4. Self-rated improvement
Secondary outcome measure(s) 1. Self-efficacy to reduce gambling using the Gambling Abstinence Self-efficacy Scale (GASS) and self-identified goals and how successful participants think they will be
2. Psychiatric distress measured using the Kessler 10 (K10) questionnaire
3. Quality of life using the WHOQoL-8

Measured both at initial assessment and follow-up (3, 6, 12 months).
Sources of funding Canadian Institutes of Health Research (CIHR) (Canada) ref: Application No. 258944
Trial website
Publications 1. 2013 protocol in http://www.ncbi.nlm.nih.gov/pubmed/23294668
Contact name Dr  David  Hodgins
  Address Department of Psychology
University of Calgary
2500 University Dr. N.W.
  City/town Calgary
  Zip/Postcode T2N 1N4
  Country Canada
  Email dhodgins@ucalgary.ca
Sponsor Canadian Institutes of Health Research (UK)
  Address c/o Liliane Chénard
Room 97, 160 Elgin Steet
Address locator: 4809A
  City/town Ottawa
  Zip/Postcode K1A 0W9
  Country Canada
Date applied 22/05/2012
Last edited 25/02/2013
Date ISRCTN assigned 07/06/2012
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