Efficacy of a web-based self-help tool to reduce problem gambling in Switzerland: study protocol of a two-armed randomised controlled trial.

INTRODUCTION: The past-year prevalence of problem gambling worldwide averages 2.3%. Switzerland exhibits a slightly lower past-year prevalence rate, of 1.1%, among adults. Only a minority of these adults attend outpatient treatment. Surveyed problem gamblers have explained that they wanted to handle the problem on their own. The option of a web-based self-help programme could potentially reach those users who hesitate to approach treatment centres and help them to reduce or stop their problem gambling. The effectiveness of such web-based interventions has been shown in other countries. METHODS AND ANALYSIS: This two-armed randomised controlled trial (RCT) will examine the efficacy of a web-based self-help intervention, relative to an active control condition with a self-help manual, at reducing problem gambling. The active intervention programme, spanning 8 weeks, consists of nine modules developed to reduce gambling and attenuate psychopathological comorbidity, including depression, anxiety and stress-related disorder symptoms, relying on motivational interviewing and cognitive behavioural therapy. With a target sample size of 352, questionnaire data will be collected at baseline, and at 8 and 24 weeks after baseline. Primary outcomes will be the number of days one has gambled in the last 30 days. Secondary outcomes will include money and time spent on gambling activities, changes in gambling-related problems (Problem Gambling Severity Index, Gambling Symptom Assessment Scale), use of alcohol and cigarettes, and psychopathological comorbidity. All data analysis will comply with the intention-to-treat principle. ETHICS AND DISSEMINATION: The RCT will be conducted in accordance with the Declaration of Helsinki; the consort eHealth Guidelines for studies on medical devices; the European Directive on medical devices 93/42/EEC, Swiss Law and Swiss Regulatory Authority requirements. The study was approved by the ethics committee of the Canton of Zurich. Results will be published in a scientific peer-reviewed journal. Participants will be informed via e-mail about study results via a lay-person-friendly summary of trial findings. TRIAL REGISTRATION NUMBER: Current Controlled Trials registry (ISRCTN16339434).

Treatment of substance-related problems in Switzerland: implementing a new harmonised monitoring system.

OBJECTIVES: In the past, five different monitoring systems were used in the various areas of the care supply for substance-related problems in Switzerland, without any real coordination between them. In 1999, a project aiming at the harmonisation of these five monitoring systems was launched by federal agencies. A further aim was to ensure compatibility with the Treatment Demand Indicator (TDI) adopted as European standard. METHODS: The different steps of the conceptualisation process and their rationales are described. They involve a first phase of consultation among all key players, a second phase of preliminary realisation according to the target criteria, a third phase of probation by the application of a pilot survey, and a last phase of consolidation and adjustments before the official implementation. RESULTS: A comprehensive and flexible monitoring system was settled for all fields of the addiction care in Switzerland. It consists of a fully standardised pool of core items to be shared by the five treatment sectors as well as optional items intended for specific needs. The practical aspects of the implementation, like data protection, organisation of data collection, and valorisation of the results are presented. The first experiences in the different treatment sectors are also reported. CONCLUSION: The implementation of "act-info" is still an ongoing process that began in 2003. Since 2005, the new monitoring system is well implemented in three out of five treatment sectors, whereas its introduction proves more challenging in the two remaining sectors. Perspectives of improvement regarding coverage and data quality are proposed.

The relationship between legal status, perceived pressure and motivation in treatment for drug dependence: results from a European study of Quasi-Compulsory Treatment.

This paper reports on intake data from Quasi-Compulsory Treatment in Europe, a study of quasi-compulsory treatment (QCT) for drug dependent offenders. It explores the link between formal legal coercion, perceived pressure to be in treatment and motivation amongst a sample of 845 people who entered treatment for drug dependence in five European countries, half of them in quasi-compulsory treatment and half 'voluntarily'. Using both quantitative and qualitative data, it suggests that those who enter treatment under QCT do perceive greater pressure to be in treatment, but that this does not necessarily lead to higher or lower motivation than 'volunteers'. Many drug-dependent offenders value QCT as an opportunity to get treatment. Motivation is mutable and can be developed or diminished by the quality of support and services offered to drug-dependent offenders.