School of Psychology, Swansea University, Singleton Campus, Swansea, SA2 8PP, UK.
Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada.
Harm Reduct J. 2022 Feb 25;19(1):19. doi: 10.1186/s12954-022-00600-0.
There is a need to improve retention and outcomes for treatment of problem gambling and gambling disorder. Contingency management (CM) is a behavioural intervention involving identification of target behaviours (such as attendance, abstinence, or steps towards recovery) and the provision of incentives (such as vouchers or credits towards the purchase of preferred items) contingent on objective evidence of these behaviours. Contingency management for abstinence and attendance in substance misuse treatment has a substantial evidence base but has not been widely adopted or extended to other addictive behaviours such as gambling. Potential barriers to the widespread adoption of CM may relate to practitioners' perceptions about this form of incentive-based treatment. The present study sought to explore United Kingdom (UK) gambling treatment providers' views of CM for treatment of problem gambling and gambling disorder.
We conducted semi-structured interviews with 30 treatment providers from across the UK working with people with gambling problems. Participants were provided with an explanation of CM, several hypothetical scenarios, and a structured questionnaire to facilitate discussion. Thematic analysis was used to interpret findings.
Participants felt there could be a conflict between CM and their treatment philosophies, that CM was similar in some ways to gambling, and that the CM approach could be manipulated and reduce trust between client and therapist. Some participants were more supportive of implementing CM for specific treatment goals than others, such as for incentivising attendance over abstinence due to perceived difficulties in objectively verifying abstinence. Participants favoured providing credits accruing to services relevant to personal recovery rather than voucher-based incentives.
UK gambling treatment providers are somewhat receptive to CM approaches for treatment of problem gambling and gambling disorder. Potential barriers and obstacles are readily addressable, and more research is needed on the efficacy and effectiveness of CM for gambling.
需要提高治疗赌博问题和赌博障碍的保留率和结果。 条件管理（CM）是一种行为干预措施，涉及确定目标行为（如出勤、戒断或恢复步骤），并根据这些行为的客观证据提供激励（如代金券或积分以购买首选物品）。 物质滥用治疗中用于戒断和出勤的条件管理有大量的证据基础，但尚未广泛采用或扩展到其他成瘾行为，如赌博。 广泛采用 CM 的潜在障碍可能与从业者对这种基于激励的治疗形式的看法有关。 本研究旨在探讨英国（UK）赌博治疗提供者对 CM 治疗赌博问题和赌博障碍的看法。
我们对来自英国各地的 30 名治疗提供者进行了半结构化访谈，这些治疗提供者为有赌博问题的人提供服务。 参与者获得了关于 CM 的解释、几个假设情景和一份结构化问卷，以促进讨论。 我们使用主题分析来解释研究结果。
参与者认为 CM 可能与他们的治疗理念存在冲突，CM 在某些方面与赌博相似，并且 CM 方法可能会被操纵，从而降低客户与治疗师之间的信任。 一些参与者比其他人更支持实施 CM 来实现特定的治疗目标，例如，通过激励出勤率而不是戒断率，因为他们认为客观验证戒断率存在困难。 参与者更喜欢提供与个人康复相关的服务积分，而不是基于代金券的激励。
英国赌博治疗提供者对 CM 治疗赌博问题和赌博障碍的方法持有些接受的态度。 潜在的障碍和问题是可以解决的，并且需要更多关于 CM 治疗赌博的疗效和有效性的研究。
