Evaluating the impact of motivational interviewing on engagement and outcomes in a web-based self-help intervention for gambling disorder: A randomised controlled trial.

Background: Self-paced internet interventions for gambling problems offer cost-effective, accessible, and private alternatives to traditional psychotherapy for a population that rarely seeks help. However, these interventions have been relatively slow to develop, evaluate, and deploy at scale relative to those for other addictive behaviors. Moreover, user engagement remains low despite the high interest. Motivational interviews have improved the effectiveness gambling bibliotherapy but have not been augmented with an analogous web-based self-guided program. Objectives: This trial aimed to replicate and extend prior work by translating a paperback workbook to the internet and pairing it with a single motivational interview. It was hypothesized that the motivational interview would enhance program engagement and gambling outcomes. Methods: A two-arm randomised controlled trial was conducted. Treatment-seeking Canadian adults recruited solely via social media received one year of access to a web-based self-guided program, either alone (N = 158) or in combination with a virtual motivational interview completed upon enrolment (N = 155). The program was based on principles of cognitive-behavioral therapy and motivational interviewing. Gambling severity, expenditures, frequency, and duration were assessed via online questionnaires at baseline and 3-, 6-, and 12-months post-baseline, along with secondary outcomes (i.e., depression, anxiety, nonspecific psychological distress, alcohol consumption). Results: Baseline characteristics were indicative of severe gambling problems and concurrent mental health problems but not problematic alcohol consumption in this sample. Both treatment groups demonstrated roughly equal improvements across all gambling outcomes and most secondary outcomes over time, except alcohol consumption, which did not meaningfully change. Changes were most prominent by 3 months, followed by more gradual change by 6 and 12 months. Only 57 % of gamblers who were assigned to receive a motivational interview completed that interview. About 40 % of users did not complete any program modules and 11 % completed all four. No group differences in program engagement were observed, although the number of modules completed was associated with greater reductions in gambling behaviors in both groups. Discussion: The problem of user engagement with web-based self-help programs remains. There is a dose-response relationship between engagement and outcomes when engagement is measured in terms of therapeutic content completed. Conclusions: The addition of a motivational interview to a web-based self-help program for gambling problems was unsuccessful in improving engagement or outcomes. Future work should aim to make self-guided programs more engaging rather than solely making users more engaged. Trial registration: Registered on 7 July 2020 (ISRCTN13009468).

User engagement with technology-mediated self-guided interventions for addictions: scoping review protocol.

INTRODUCTION: Technology-mediated self-guided interventions (TMSGIs) for addictive disorders represent promising adjuncts and alternatives to traditional treatment approaches (eg, face-to-face psychotherapy). However, meaningful evaluation of such interventions remains elusive given the lack of consistent terminology and application. Preliminary findings suggest that TMSGIs are useful but engagement remains modest for various reasons reported by users, including lack of personalisation. The aim of this review is to explore how TMSGIs have been defined and applied in addictions populations with an emphasis on technical and logistical features associated with greater user engagement. METHODS AND ANALYSIS: This scoping review protocol was developed in accordance with the Arksey and O'Malley framework. Articles from electronic databases (ie, PsycINFO, Embase, MEDLINE and CINAHL) will be included if they targeted adolescents or adults with one or more substance or behavioural addictions, excessive behaviours or aspects thereof (eg, cravings) using a privately accessible technology-mediated intervention. Two independent reviewers will screen titles and abstracts for relevance before commencing full-text reviews. Extracted data will be presented in descriptive, tabular and graphical summaries as appropriate. ETHICS AND DISSEMINATION: Ethics committee approval is not required for this study. Review findings will be used to guide the development of preliminary recommendations for real-time addiction intervention development and provision. Emphasis will be placed on practical considerations of user engagement, accessibility, usability and cost. Knowledge users, including clinicians, researchers and people with lived experience, will be engaged for development of one such intervention following publication of review findings. REGISTRATION: This scoping review was registered with the Open Science Framework on 15 April 2022 and can be located at http://www.osf.io/3utp9/.

Psychometric evaluation of the NORC diagnostic screen for gambling problems (NODS) for the assessment of DSM-5 gambling disorder.

The National Opinion Research Center (NORC) Diagnostic Screen for Gambling Problems (NODS) is one of the most used outcome measures in gambling intervention trials. However, a screen based on DSM-5 gambling disorder criteria has yet to be developed or validated since the DSM-5 release in 2013. This omission is possibly because the criteria for gambling disorder only underwent minor changes from DSM-IV to DSM-5: the diagnostic threshold was reduced from 5 to 4 criteria, and the illegal activity criterion was removed. Validation of a measure that captures these changes is still warranted. The current study examined the psychometric properties of an online self-report past-year adaptation of the NODS based on DSM-5 diagnostic criteria for gambling disorder (i.e., NODS-GD). A diverse sample of participants (N = 959) was crowdsourced via Amazon's TurkPrime. Internal consistency and one-week test-retest reliability were good. High correlations (r = 0.74-0.77) with other measures of gambling problem severity were observed in addition to moderate correlations (r = 0.21-0.36) with related but distinct constructs (e.g., gambling expenditures, time spent gambling, other addictive behaviors). All nine of the DSM-5 criteria loaded positively on one principal component, which accounted for 40% of the variance. Classification accuracy (i.e., sensitivity, specificity, predictive power) was generally very good with respect to the PGSI and ICD-10 diagnostic criteria. Future studies are encouraged to establish a gold standard self-report measure of gambling problems and develop agreed-upon recommendations for the use and interpretation of crowdsourced addiction data.

Augmenting an online self-directed intervention for gambling disorder with a single motivational interview: study protocol for a randomized controlled trial.

BACKGROUND: Despite the success of gold standard cognitive-behavioral therapy for problem and disordered gambling, the majority of individuals with gambling problems do not seek or receive professional treatment. Thus, the development of less intrusive self-directed interventions has been encouraged. Bibliotherapy for problem gambling has shown promise, both alone and in combination with motivational interviews, but there is still a lack of online self-directed intervention research. The current randomized controlled trial proposes to assess the additive benefit of a single digital motivational interview delivered in conjunction with an online self-directed treatment program for problem gambling and gambling disorder. METHODS: A two-arm randomized controlled trial will be conducted, wherein eligible participants (N=270) will be recruited across Canada via internet advertisements posted to several platforms. All participants will receive access to an online self-directed gambling intervention program. Participants will be randomly assigned to either complete the online program alone or receive a digital motivational interview, conducted through an online audioconferencing platform (i.e., Microsoft Teams) to supplement the online program. The primary outcomes of gambling severity, frequency, and expenditures will be tracked along with secondary outcomes (i.e., depression, anxiety, general distress, alcohol use, and online program user data) over a 24-month period. It is expected that participants in both groups will experience a reduction in symptoms across the board, but more substantial improvements will be observed in the group that receives a supplemental motivational interview. DISCUSSION: The results of this trial will expand upon prior gambling intervention research by informing best practices for the provision of online self-help for problem gambling. TRIAL REGISTRATION: ISRCTN ISRCTN13009468 . Registered on 7 July 2020.