Integrative Couple Treatment for Gambling/Substance Use Disorder

Efficacy Study of Two Types of Intervention for People in Couple Who Have Difficulties With Their Gambling Habits or Alcohol/Drug Use

The aim of the study is to compare couple-based treatment to individual treatment (treatment as usual) for addiction (gambling or substance use disorder).

Background:Couple-based intervention is one of the clinical innovations to increase access, retention and effectiveness of treatment in the field of addiction.Couple-based intervention for the treatment of problems related to gambling or substance use disorder (GD/SUD) is more effective than no treatment and the subjective experience of the members of the couple illustrates important clinical gains (better understanding addiction, resolve conflicts, etc.). A study conducted by the research team revealed a better effectiveness of couple-based treatment for GD than the individual treatment usually offered. Despite these positive results, this study highlighted a need to improve the couple intervention model (Integrative Couple Treatment for Pathological Gambling- ICT-PG). First of all, it did not allow to reach people having a SUD. Previous studies conducted by the research team also illustrated the need for more clinical work on serious relationship injuries caused by gambling. The investigators also accentuated their work on the strategies used by the partners and having an impact on the gambler's gambling behaviors.

Goal : Evaluate the effectiveness of a couple-based treatment (Integrative Couple Therapy for Addiction ICT-A; experimental group) compared to the individual treatment usually offer (control group) for people with GD/SUD.

Method/Design : A sample of at least 100 couples will be randomized to either ICT-A (experimental group) or the usual individual treatment (control group). The couple treatment called Integrative Couple Therapy for Addiction (ICT-A) is inspired by the "Alcohol Behavior Couple Therapy" from Epstein and McCrady, to which the team added diverse components to adjust to gamblers. During the sessions, the focus is on a) reducing/stopping gambling or substance use behaviors, b) helping the partner to stop behaviors facilitating gambling habits or substance use and rise the frequency of behaviors incompatible with gambling habits or substance use c) improve marital components (communication, sharing positive moments, negotiation, mutual support).The control group receives individual treatment as already offered by the specialized centers in addiction. All participants are recruited in Specialized Addiction Treatment Centers in Quebec Province, Canada. Repeated measures will be conducted at admission, 6, 12 and 18 months post-admission on the addiction's severity (primary outcome), on various couples' dimensions (secondary outcome) and various indicators of personal well-being (secondary outcome).In order to compare the effectiveness of the two treatment modalities, a series of regression analyzes will be carried out taking into account the correlation between the observations for the same individual and measurements repeated over time (linear mixed models; PROC MIXED of SAS).

Inclusion Criteria:

• The Gambler may have a gambling or substance use problem at the beginning of treatment AND is accepted for treatment by addiction rehabilitation centers (CRDs).
• The Gambler has engaged in gambling or substance use behaviors in the past three months (Time Line Follow-Back).
• The Partner may or may not engage in gambling, consume alcohol or other substances of abuse.
• Living in couple for at least six months OR report being in a significant relationship for at least two years.
• Neither member of the couple presents a mental health problem that could hinder their ability to participate in the therapeutic process.

Exclusion Criteria:

• The Gambler has been completely abstinent from any gambling or substance use problem for the past three months.
• The Gambler received treatment for gambling disorder or substance abuse disorder during the last six months (excluding Gamblers Anonymous, Alcoholics Anonymous or Narcotics Anonymous).
• Low level of marital commitment between the couple in the past 2 weeks indicating a high risk of short-term separation (Marital Status Inventory, score ≥9)
• Presence of serious acts of violence committed within the past year endangering the safety or life of one of the spouses (Modified Conflict Tactics Scales: Answer YES to any question from Q27-33) OR use of services for victims of domestic violence in the past year.
• Presence of an active mental health disorder in either partner hindering therapeutic participation, such as a psychotic disorder OR a suicide attempt in the last 30 days (Psychological Scale of the Addiction Severity Index) OR severe borderline personality disorder (BSL-23 ≥2.8) OR excessively extreme antisocial behaviors (Conduct Disorder Scale from the GAIN ≥ 9).