试行将应急管理添加到最佳实践咨询中，作为农村和偏远地区问题赌徒的辅助治疗方法：研究方案。

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

作者信息

Christensen Darren R, Witcher Chad S G, Leighton Trent, Hudson-Breen Rebecca, Ofori-Dei Samuel

机构信息

Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada.

Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, Hampshire, United Kingdom.

出版信息

BMJ Open. 2018 Apr 3;8(4):e018804. doi: 10.1136/bmjopen-2017-018804.

DOI:10.1136/bmjopen-2017-018804

PMID:29615445

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5892741/

Abstract

INTRODUCTION

Problematic gambling is a significant Canadian public health concern that causes harm to the gambler, their families, and society. However, a significant minority of gambling treatment seekers drop out prior to the issue being resolved; those with higher impulsivity scores have the highest drop-out rates. Consequently, retention is a major concern for treatment providers. The aim of this study is to investigate the efficacy of internet-delivered cognitive behavioural therapy (CBT) and internet-delivered CBT and contingency management (CM+) as treatments for gambling disorder in rural Albertan populations. 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. Furthermore, 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: CM and CBT (CM+) or CBT 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 symptomatology, and gambling urge. In addition, qualitative interviews assessing study experiences will be conducted with the supervising counsellor, graduate student counsellors, study affiliates, and a subset of treatment seekers. This is the first study to use CM as a treatment for gambling disorder in rural and remote populations.

ETHICS AND DISSEMINATION

This study was approved by the University of Lethbridge's 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.

摘要

引言

问题性赌博是加拿大一个重大的公共卫生问题，会对赌徒本人、其家庭及社会造成伤害。然而，相当一部分寻求赌博治疗的人在问题解决之前就退出了；冲动性得分较高的人退出率最高。因此，留住患者是治疗提供者的一个主要关切点。本研究的目的是调查通过互联网提供的认知行为疗法（CBT）以及通过互联网提供的CBT与权变管理（CM+）作为阿尔伯塔农村地区人群赌博障碍治疗方法的疗效。权变管理（CM）是一种成功的物质依赖治疗方法，通过小奖励来强化戒断。这种方法可能适用于赌博障碍的治疗。此外，通过互联网提供的CM在农村地区可能特别有前景，因为这些社区通常难以获得传统的基于诊所的咨询机会。

方法与分析

54名患有赌博障碍的成年人将被随机分为两种情况之一：CM与CBT（CM+）或仅CBT。在入组时、每次治疗期间、治疗后及随访时对赌博情况进行评估。主要结局指标包括治疗出勤率、戒赌情况、赌博行为、赌博症状及赌博冲动。此外，将与督导顾问、研究生顾问、研究附属人员以及一部分寻求治疗者进行定性访谈，以评估研究体验。这是第一项将CM用作农村和偏远地区人群赌博障碍治疗方法的研究。