RESEARCH QUESTION
How effective is a brief motivational enhancement telephone intervention for problem gambling with a self help workbook compared to a workbook only group and a control (i.e., no treatment) group?
PURPOSE
One challenge for treatment providers is the difficulty of attracting problem gamblers, particularly women, to formal treatment programs. This is especially true of individuals with earlier stage or less severe problems who are concerned about lack of privacy and convenience and want to handle the problem on their own. To such individuals, self-help workbooks may be an attractive, accessible, and cost-effective alternative to attending treatment programs or self-help groups. This study evaluated the effectiveness of a workbook only treatment (group 1) compared to a workbook plus motivational enhancement telephone enhancement (group 2) and a one month waitlist control group (group 3).
HYPOTHESES
Participants in both treatment conditions would show greater reduction in gambling at one month than would those assigned to the control group; participants receiving the motivational interview would show greater improvement than those receiving only the self-help workbook. Women would show greater reductions in gambling than men and individuals with more severe problems would be more likely to benefit from the motivational interview condition than would those with less severe problems.
PARTICIPANTS
One hundred and two participants drawn from rural and urban areas of Alberta, Canada with a minimum age of 18 (mean age = 46), a perception of a gambling problem, and no present involvement in treatment.
PROCEDURE
Participants were randomly assigned to one of the three groups ensuring equal numbers of men and women in each. Group 1 received the self-help workbook through the mail after a brief telephone interview during which some background information was obtained, group 2 participants received the self-help workbook in the mail after a motivational style telephone interview, and group 3 participants were assigned to a one-month waiting list control after the brief intake interview. The self-help workbook, Becoming a Winner: Defeating Problem Gambling, was based on a cognitive-behavioural model of PG whereas the motivational interview attempted to build a commitment to change by using the principles of motivational enhancement therapy. The South Oaks Gambling Screen (SOGS) was administered to assess the severity of the gambling problem and a brief gambling history was obtained along with administration of a timeline interview of types of gambling, frequency, and money spent in the past 2 months. Follow-up interviews were conducted at 1, 3, 6 and 12 months post treatment.
MAIN OUTCOME MEASURES
At each follow-up assessment, a timeline follow-back interview captured the number of days of gambling during the follow-up period and the amount of money won or lost on each occasion. Participants were asked whether they had met their goal during the follow-up period, whether they had any treatment or Gamblers Anonymous involvement and what their present goal was. At the 1, 3 and 12 month assessments they were also asked whether they had read the workbook and if they had followed the procedures. At the 12 month follow-up the SOGS was re-administered.
KEY RESULTS
Reduction of gambling. All three groups showed an improvement; for each variable, the group receiving the motivational interview (group 2) showed greater improvement than the waiting-list control (group 3). They gambled fewer days, lost less money and spent less per gambling day. The group receiving the workbook only (group 1) did not differ significantly from the waiting-list control group. At the 12-month follow-up, 67% of participants in groups 1 and 2 showed decreased SOGS scores and 30% fell below the SOGS cut-off for PG. Gender and severity.Neither gender nor the severity of the gambling problem was found to affect treatment outcome. Process and satisfaction evaluation. At one month, 56% of participants reported having read the workbook completely and by 3 months, 80% reported having read it completely. Approximately 80% of the participants reported that they did follow at least some of the recommended procedures and 84% had retained the workbook at 12 months. In terms of satisfaction, 45% were mostly or completely satisfied, 40% stated that their needs were met and 78% said they would recommend the program to a friend with a gambling problem.
CONCLUSIONS
The results of this study indicate that brief, self-help treatments can reduce the severity of gambling, leading in some cases to complete abstinence. It would be useful for future research to examine the impact of this type of treatment on other aspects of clinical significance (e.g. family and social functioning).
