Contingency Management to Reinforce Attendance to Cognitive Behavioral Treatment for Gambling Disorder

A Randomized Clinical Trial of Contingency Management for Gambling Disorder: Enhancing Treatment Retention and Outcomes

The aim of this study is to conduct a trial to investigate the effectiveness of adding contingency management treatment (CM) to standard care cognitive behavioral therapy (CBT) for the treatment of gambling disorder to increase attendance to treatment. CM will be used to incentivize therapy session attendance with a therapist and engagement in recovery-related engagement with a peer recovery specialist. The proposed research will evaluate whether CM can enhance the overall effectiveness of CBT, the most widely tested treatment for individuals with gambling disorder.

Cognitive behavioral therapy (CBT) has been established as the most efficacious treatment for gambling disorder. Unfortunately, 39% of those who seek treatment dropout before completing the prescribed treatment dose, a rate that is markedly higher than found with substance use treatment (30%) and mental health treatment (20%). Increasing attendance means more time to learn the skills needed to create and sustain change and, therefore, enhance treatment outcomes. To date, there has been a dearth of research on how to keep people in CBT for gambling disorder. A logical and promising option is using contingency management (CM), where tangible incentives (i.e., vouchers) are provided upon completion of a target behavior, such as treatment attendance. CM has robust support for increasing attendance to substance use treatment (68% of participants receiving CM increase their attendance). Surprisingly, CM has not been tested to motivate attendance in gambling treatment. The current project proposes to conduct a randomized controlled trial to establish the preliminary effectiveness of CM for the treatment of gambling disorder. CM will be used to incentivize attendance to CBT therapy sessions and engagement in peer recovery specialist (PRS)-facilitated recovery support activities. PRS are individuals with lived experience with recovery who use their personal experience and training to create opportunities for tailored support as a client seeking treatment navigates recovery. The selected CM protocol will provide direct gift card payments each time the participant attends a scheduled therapy or recovery activity session. Payments will start at $30 for a therapy session and $10 for a PRS-led activity session and escalate over 8 weeks of treatment. Participants will be recruited from those seeking treatment at our well-established gambling treatment center. All participants will receive a standard course of CBT treatment that includes weekly therapy sessions and PRS-support activities. Participants will be randomized to receive either CBT treatment as usual or CM+CBT, where participants will attend treatment as usual, and each session attended will be monetarily reinforced. The investigators will explore between treatment group changes in gambling behavior, treatment engagement, and other clinical covariates in these individuals at post-treatment and at a 3-month follow-up. Treatment gains will not be limited to strictly abstinence-focused outcomes and will allow for the coding of quantitative and qualitative decreases in gambling behavior and harm, and a calculation of the percentage of individuals who meet their self-selected treatment goal (which can range from abstinence to harm reduction). Results will instrumentally further our present understanding of how to enhance motivation for treatment attendance and clarify the mechanisms of CBT for gambling disorder.

Inclusion Criteria:

1. Adults age 18 or older
2. Seeking treatment for gambling-related concerns at The Gambling Clinic
3. Available to meet weekly for eight treatment sessions without a known structural barrier to continuation that could interfere with study conclusions (e.g., planned relocation out of state).
4. Proficient in English (assumed by request of gambling treatment in English).
5. Must be physically present in the US.

Exclusion Criteria:

1. Minors under the age of 18.
2. Recent history of psychotic symptoms or suicidal intent
3. Not proficient in English.
4. Seeking gambling treatment for someone other than themselves (e.g., a loved one).
5. Will not be available for a full eight weeks of study participation.
6. Not physically present in the US.