•  

Intervention Summary

Back to Results Start New Search

Brief Self-Directed Gambling Treatment

Brief Self-Directed Gambling Treatment (BSGT) aims to help adults stop or cut back on problematic gambling, which is often chronic and long term. It is designed for individuals who choose not to enter or are unable to access face-to-face treatment. BGST uses a motivational interviewing and cognitive behavioral treatment model. Participants complete a 45-minute motivational interview by telephone with a doctoral-level therapist and then receive a self-help workbook through the mail. The goal of the telephone intervention is to help clients increase their motivational levels and confidence about making change, as well as to heighten interest in the contents of the workbook. The therapist uses a nonconfrontational style that elicits the participants' personal concerns about their gambling involvement. The 38-page workbook, which contains specific and practical cognitive and behavioral strategies, features the following five sections:

  1. Self-assessment, which focuses on increasing individuals' awareness of the consequences of the gambling and situations that commonly precipitate gambling
  2. Goal setting, which is designed to facilitate a cognitive appraisal of the perceived costs and benefits of gambling, with a discussion of abstinence or controlled gambling as a goal
  3. Strategies, which includes five cognitive behavioral strategies, such as dealing with urges to gamble and eliciting social support
  4. Maintenance, which is designed to help the individual prevent and cope with relapses, as well as identify other major life problems that may contribute to gambling
  5. A section containing information on accessing other resources if additional help is needed

Optional booster calls with the therapist may be added at 2, 6, 10, 16, 24, and 36 weeks to reinforce the motivational processes that are established in the initial motivational interview phone call. BSGT is designed to be adapted to local treatment systems. It also may be used by gambling help lines or by gambling venue intervention specialists.

Descriptive Information

Areas of Interest Mental health treatment
Substance abuse treatment
Outcomes Review Date: March 2011
1: Number of days spent gambling in past month
2: Dollars lost to gambling in past month
3: Dollars spent per gambling day
Outcome Categories No outcome categories are applicable.
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities Non-U.S. population
Settings Home
Other community settings
Geographic Locations Urban
Rural and/or frontier
Implementation History BSGT has been implemented in Oregon's Statewide Gambling Treatment System since 2001. It is also now offered by the New Zealand Problem Gambling Helpline. Evaluations of BSGT have been conducted in Brazil, Canada, Germany, and Sweden.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: Yes
Adaptations The workbook has been translated into Finnish (in progress), French, Japanese, Portuguese, and Spanish. It has been reviewed for cultural appropriateness for Maori and Pasifika populations in New Zealand.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: March 2011

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Hodgins, D. C., Currie, S. R., & el-Geubaly, N. (2001). Motivational enhancement for self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69(1), 50-57.  Pub Med icon

Hodgins, D. C., Currie, S. R., el-Geubaly, N., & Peden, N. (2004). Brief motivational treatment for problem gambling: A 24-month follow-up. Psychology of Addictive Behaviors, 18(3), 293-296.  Pub Med icon

Study 2

Hodgins, D. C., Ching, L. E., & McEwen, J. (2009). Strength of commitment language in motivational interviewing and gambling outcomes. Psychology of Addictive Behaviors, 23(1), 122-130.  Pub Med icon

Hodgins, D. C., Currie, S. R., Currie, G., & Fick, G. H. (2009). Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better. Journal of Consulting and Clinical Psychology, 77(5), 950-960.  Pub Med icon

Study 3

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.  Pub Med icon

Outcomes

Outcome 1: Number of days spent gambling in past month
Description of Measures Timeline Followback interviews were used at each follow-up assessment to collect information about participants' gambling history in the past month, including types of gambling engaged in, the number of days spent gambling, and the amount of money won or lost on each occasion. In the first study, interviews were conducted at baseline and at 1, 3, 6, and 12 months postintervention. In a second study, interviews were conducted at baseline and at 6, 12, 24, 36, and 52 weeks postintervention, and collaterals nominated by participants were interviewed at the 12-week follow-up. In a third study, interviews were conducted at baseline and at 1, 3, 6, and 12 months postintervention, and collaterals nominated by participants were interviewed at the 6-month follow-up.
Key Findings In one study, participants were randomly assigned to one of three groups: an intervention group that received the BSGT workbook after a motivational interview, an intervention group that received the BSGT workbook only, or a 1-month wait-list control group. At 1-month follow-up, the interview-plus-workbook group reported gambling significantly fewer days than the wait-list control group (p < .05), but the workbook-only group and wait-list control group did not differ significantly in the number of days spent gambling.

In a second study, participants were randomly assigned to one of four groups: an intervention group that received the BSGT workbook after a motivational interview; an intervention group that received the BSGT workbook after a motivational interview, plus six booster sessions; an intervention group that received the BSGT workbook only; or a 1-month wait-list control group. At 6-week follow-up, the group that received the interview, workbook, and booster sessions gambled significantly fewer days, on average, than the workbook-only and wait-list control groups (p < .01), and the same was true at 3-month follow-up (p < .001). At 6- and 9-month follow-ups, the interview-plus-workbook group reported significantly fewer gambling days compared with the wait-list control group (p < .0005 and p < .005, respectively), as did the booster session group (p < .0005 and p < .01, respectively). There were no significant differences across the groups at the 12-month follow-up.

In a third study, participants were randomly assigned to one of two groups: an intervention group that received the BSGT workbook after a motivational interview, or a comparison group that received a semistructured interview. The interview-plus-workbook group spent significantly fewer days gambling relative to the comparison group during all follow-up periods (all p values < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)
Outcome 2: Dollars lost to gambling in past month
Description of Measures Timeline Followback interviews were used at each follow-up assessment to collect information about participants' gambling history in the past 2 months, including types of gambling engaged in, the number of days spent gambling, and the amount of money won or lost on each occasion. In one study, interviews were conducted at baseline and at 1, 3, 6, and 12 months postintervention. In another study, interviews were conducted at baseline and at 1, 3, 6, and 12 months postintervention, and collaterals nominated by the participants were interviewed at 6-month follow-up.
Key Findings In one study, participants were randomly assigned to one of three groups: an intervention group that received the BSGT workbook after a motivational interview, an intervention group that received the BSGT workbook only, or a 1-month wait-list control group. At 1-month follow-up, the interview-plus-workbook group lost significantly fewer dollars to gambling in the past month than the wait-list control group (p < .03), whereas the workbook-only group did not differ significantly from the wait-list control group.

In another study, participants were randomly assigned to one of two groups: an intervention group that received the BSGT workbook after a motivational interview and a comparison group that received a semistructured interview. A significant main effect was found for the intervention, with the interview-plus-workbook group reporting fewer dollars lost to gambling in the past month during all follow-up periods than the comparison group (all p values < .05).
Studies Measuring Outcome Study 1, Study 3
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 3: Dollars spent per gambling day
Description of Measures Timeline Followback interviews were used at each follow-up assessment to collect information about participants' gambling history in the past 2 months, including types of gambling engaged in, the number of days spent gambling, and the amount of money won or lost on each occasion. Interviews were conducted at baseline and at 1, 3, 6, and 12 months postintervention.
Key Findings Participants were randomly assigned to one of three groups: an intervention group that received the BSGT workbook after a motivational interview, an intervention group that received the workbook only, or a 1-month wait-list control group. At 1-month follow-up, the interview-plus-workbook group spent significantly fewer dollars per gambling day than the wait-list control group (p < .04), while the workbook-only group did not differ significantly from the wait-list control group.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.5 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
52% Female
48% Male
100% Non-U.S. population
Study 2 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
55.4% Female
44.6% Male
100% Non-U.S. population
Study 3 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
57% Male
43% Female
100% Non-U.S. population

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Number of days spent gambling in past month 2.2 2.7 3.0 3.1 2.8 3.7 2.9
2: Dollars lost to gambling in past month 2.2 2.7 2.8 2.9 2.6 3.7 2.8
3: Dollars spent per gambling day 2.2 2.7 2.1 2.5 2.0 3.7 2.5

Study Strengths

The Timeline Followback interview has been shown to be a reliable and valid assessment, and collateral reports showed overall good agreement. Other measurement instruments used were appropriate for the primary outcome variables and have been validated in other studies. The self-help workbook was manualized with clear session content. No differences were found between intervention groups in the percentages of subjects who read the workbook. The motivational interviews were conducted by just two people using a protocol. In one study, the researchers provided intensive training to the therapists and used a checklist to monitor their motivational interviews. Follow-up rates were very good. Random assignment was used in all studies. Group differences were examined, and it was found that there were no baseline differences. Gender and severity of gambling problems were considered in the analyses. The data analysis methods used were appropriate to answer the study questions.

Study Weaknesses

Only single items were used in the outcome assessments, which used self-report data. The time of intervention varied, with only 56% of participants completing the workbook by 1-month follow-up, and 80% completing the workbook by 3-month follow-up. Participants were not tested on workbook content. No explanation was given for the wide range in the duration of the motivational interview (between 20 and 45 minutes). In one study, the research assistant conducting the baseline and follow-up survey was aware of the participants' treatment condition.

Readiness for Dissemination
Review Date: March 2011

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Hodgins, D. (2010) Therapist intervention manual: Alberta version. Alberta, Canada: Author.

Hodgins, D. C., & Makarchuk, K. (2009). Becoming a winner: Defeating problem gambling. A self-help manual for problem gamblers. Alberta, Canada: University of Calgary Addiction Centre, Addictive Behaviours Laboratory.

Quality assurance tools:

  • 12-Week Follow-Up Interview
  • 52-Week Follow-Up Interview
  • BGST Therapist Adherence Checklist for Interview Evaluation
  • Initial Interview Form
  • Online gambling measures and protocol, http://addiction.ucalgary.ca/researchers/instruments

Sample recruitment advertisements

Training materials:

  • Brief Self-directed Gambling Treatment Training [PowerPoint slides]
  • Brief Self-directed Gambling Treatment Training [DVD]

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.0 4.0 2.5 3.2

Dissemination Strengths

The intervention's high-quality self-help manual, which includes many checklists, worksheets, and self-monitoring tools, is an excellent resource for intervention participants. The well-developed and comprehensive training program makes use of role-play and trainer feedback to build proficiency in intervention delivery. Training videos support the presentation through illustration of key concepts. The developer provides consultation and technical assistance services to new implementation sites. A therapist adherence checklist is provided to help monitor practitioner use of motivational interviewing, the basis of the intervention. Additional client outcome monitoring forms are provided to support quality assurance.

Dissemination Weaknesses

The self-help manual includes resources that are specific to Canada, requiring some tailoring of this document for use elsewhere. The therapist manual and other materials include limited guidance to the practitioner to accompany concepts taught in training. The quality assurance tools may not be as well suited for use outside of a research setting, and limited guidance is provided on using these tools and data derived from them to improve program delivery.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Becoming a Winner: Defeating Problem Gambling (self-help workbook) $10 each Yes
3-day, on-site therapist training workshop (includes all therapist materials) $6,000 per site, plus travel expenses Yes
Program design consultation (in person or by phone) Cost varies depending on site needs and travel expenses Yes
Therapist interview protocols Free Yes
Follow-up questionnaires Free Yes

Additional Information

Program start-up and implementation costs were estimated in 2007 for a stand-alone service at $1,569 per client, based upon 100 total clients. Incremental costs (i.e., the cost of each additional client once the system is operating) were estimated to be $240 per client.

Contact Information

To learn more about implementation or research, contact:
David C. Hodgins, Ph.D., R.Psych.
(403) 220-3371
dhodgins@ucalgary.ca

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.