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

Introduction - Problematic gambling is a significant Canadian public health concern that causes harm to the gambler, their families, and society at large. However, a significant minority of gambling treatment seekers drop-out prior to the issue being resolved, where those with higher impulsivity scores have the highest drop-out rates. The aim of this study is to investigate the effects of internet-delivered Cognitive Behavioural Therapy (CBT) and internet-delivered CBT and CM (CM+) to rural and remote Albertan gamblers. Contingency Management (CM) is a successful treatment approach for substance dependence that uses small incentives to reinforce abstinence. This approach may be suitable for the treatment of gambling disorder. Further, internet delivered CM may hold particular promise in rural contexts, as these communities typically struggle to access traditional clinic based counselling opportunities.

Methods and analysis - 54 adults with gambling disorder will be randomised into one of two conditions; Contingency Management and Cognitive Behavioural Therapy (CM+), or Cognitive Behavioural Therapy alone (CBT). Gambling will be assessed at intake, every treatment session, post-treatment, and follow-up. The primary outcome measures are treatment attendance, gambling abstinence, gambling, gambling symptomology, and gambling urge. In addition, qualitative interviews assessing study experiences will be conducted with the supervising counsellor, graduate student counsellors, and a sub-set of treatment-seekers. This is the first study to use contingency management as a treatment for gambling disorder in a rural and remote population.

Ethics and dissemination - This study is approved by the University of Lethbridge Human Subject Research committee (#2016-080). The investigators plan to publish the results from this study in academic peer-reviewed journals. Summary information will be provided to the funder.
Trial registration number - NCT02953899; Pre-results.