Does this work in the real world? Real clients, group vs.
individual, therapists competence? How does it work? Can we make it
more efficient or more effective? What place does it have in the
overall range of treatment options?
Family models Psychodynamic models Gamblers Anonymous Cognitive
Behavioural Cognitive-behavioural models Motivational Interviewing
Multimodal Treatment Various medications
Slide 6
Family models Psychodynamic models Gamblers Anonymous Cognitive
Behavioural Cognitive-behavioural models Motivational Interviewing
Multimodal Treatment Various medications
Slide 7
Family models Psychodynamic models Gamblers Anonymous Cognitive
Behavioural Cognitive-behavioural models Motivational Interviewing
Multimodal Treatment Various medications
Slide 8
Pallesen et al. (2005) 22 uncontrolled and controlled studies,
1434 clients Large effect of treatment post-treatment and at
follow-up (17 months), compared with no treatment
Slide 9
Response for drug Response for placebo Naltrexone [2
studies]62%34% Nalmefene [2 studies]52%46% Fluvoxamine [2
studies]72%48% Paroxetine [2 studies]63%40% Sertraline [1
study]68%66% Bupropion [1 study]36%47% Olanzapine [2 studies]67%71%
Medication RCTs Hodgins, Stea & Grant, The Lancet, in
press
Slide 10
Gooding & Tarrier (2009) 25 CBT trials - very diverse Mode:
Individuals, group, self-directed Therapy: CBT, Imaginal
desensitization, CBT-MI combos Type of gambling: Length: 4 to 112
sessions (Median = 14.5) Large effects at 3, 6, 12, and 24 months
Better quality studies, smaller effects File drawer effect 585
studies required.
Nancy Petrys 8 session CBT (Petry, 2005) Each session has a
worksheet Overall goal is to improve coping skills Petry et al.
(2007) coping skills improvement does lead to better outcomes (i.
e., effective ingredient)
Slide 13
Session 4Session 8 Social Support 26%67% GA/therapy support
4%43% Cognitive skills 21%31% Distraction45%26% Avoid triggers
40%20%
Slide 14
Specific day of the week 33% Mood- stressed, bored, lonely 30%
Unstructured time27% Access to money22% Gambling cue19% A specific
time of the day 17%
Slide 15
Action% of people New activities/Change in focus68% Stimulus
Control/Avoidance48% Treatment/GA support37% Cognitive skills34%
Budgeting31% Willpower/Decision-making/self-control23% Social
support10% Others confession, no money, non- gambling external
factors, self-reward, spiritual, addressing other addictions
MI (4 sessions) Group CBT (8 sessions) Waitlist MI, GCBT >
waitlist Attendance Mi: M = 2.9 of 4 sessions (72%) GCBT: 5.6 of 8
sessions (70%) Mi: 43% attended all 4 GCBT: 29% attended all 8 More
to learn we need to do better with drop-out
Slide 20
Dowling at al. (2007) women in CBT Oei & Raylu (2010) both
genders in CBT- MI combo Treatment manual Slight advantages for 1:1
Implications?
Slide 21
Alcohol field appropriate goal for less severe dependence, more
socially stable clients; people choose appropriately over time
recovered individuals in community surveys are typically doing some
gambling (Slutske et al., 2010) Some treatment studies offer this
(e.g. Hodgins)
Slide 22
Dowling at al., (2009) 12 session CBT Abstinent goalCut down
goal Post treatment no diagnosis 84%83% Six month no diagnosis
89%83% Depression (BDI) 8.97.1 Gambling frequency 0.30.5
Slide 23
Toneatto & Dragonetti (2008) CBT (8 sessions) Abstinence
goal 35% Twelve-step facilitation (8 sessions) Abstinence goal 96%
No difference in treatments Clients choosing abstinence had more
severe problems, attended more treatment, and were more likely to
meet their personal goals at 12 mos.
Slide 24
Ladouceur at al. (2009) CBT (12 sessions) aimed at control No
diagnosis post treatment -63%, six months- 56%, 12 months -51% 66%
shifted goal to abstinence, more likely to meet their goal Offering
choice did not seem to reduce dropout. (31%)
Slide 25
People do move towards the appropriate goal does offering goal
choice increase treatment seeking? Moving in the right direction in
terms of offering better treatments, that people stick with. Both
RCTs and effective studies are useful Treatment system issues
largely unaddressed - < 10% treatment uptake how do we get
people to participate in self- directed recovery or attend
treatment?
Slide 26
Slide 27
General population knows about gambling problems Perceived
addictiveness Perceived prevalence
Reasons for seeking treatment studies Consistent findings
Trying it on your own is the first step (98%) Worries about future
consequences is a major motivator (Suurvali et al., 2010) Messages:
Early signs of problems Basic change strategies Nipping it in the
bud
Slide 31
Evidence that campaigns increase treatment-seeking Productivity
Commission Report, 2010 review Web-site and helpline spikes
Slide 32
Moving in the right direction in terms of offering better
treatments, that people stick with. Both RCTs and effective studies
are useful Treatment system issues largely unaddressed but research
suggests some strategies to get people to participate in
self-directed recovery or attend treatment