GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions
Abstract
:1. Introduction
1.1. Internet-Based Interventions
1.2. Internet-Based Gambling Interventions
1.3. Characteristics of Gamblers Accessing Internet-Based Interventions
1.4. Factors Associated with Internet-Based Gambling Intervention Outcomes
1.5. Aims and Hypotheses
2. Methods
2.1. Trial Design
2.2. Participant Recruitment and Registration
2.3. Interventions
2.3.1. The GamblingLess Program
2.3.2. Guidance in the GSD condition
2.4. Data Collection
2.4.1. Outcome Measures
2.4.2. Descriptive and Diagnostic Measures
2.4.3. Process Measures
2.5. Randomisation
2.6. Statistical Analyses
2.7. Sample Size
3. Results
3.1. Participants
3.2. Profile of GamblingLess Users
3.2.1. Socio-Demographic Characteristics
3.2.2. Gambling Behaviour Characteristics
3.2.3. Psychological Characteristics
3.2.4. Treatment Characteristics
3.3. Effectiveness of the GamblingLess Program
3.3.1. Primary Outcome: G-SAS Gambling Symptom Severity
3.3.2. Secondary Outcomes
3.4. Subgroups Benefiting Most from the GamblingLess Program
3.4.1. Predictors of Short-Term Treatment Outcomes
3.4.2. Predictors of Long-Term Treatment Outcomes
3.4.3. Predictors of Treatment Engagement
3.4.4. Predictors of Post-Baseline Evaluation Completion
4. Discussion
4.1. Effectiveness of the GamblingLess Program
4.2. Profile of GamblingLess Users
4.3. Subgroups Benefiting Most from the GamblingLess Program
4.4. Study Limitations
4.5. Clinical Implications
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Socio-Demographic Characteristic | Pure Self-Directed (n = 105) | Guided Self-Directed (n = 101) | Total (n = 206) |
---|---|---|---|
Sex (n, % male) | 67 (63.8) | 66 (65.3) | 133 (64.6) |
Age group in years (n, %) | |||
18–24 | 17 (16.2) | 24 (23.8) | 41 (19.9) |
25–29 | 17 (16.2) | 20 (19.8) | 37 (18.0) |
30–34 | 15 (14.3) | 9 (8.9) | 24 (11.7) |
35–39 | 18 (17.1) | 11 (10.9) | 29 (14.1) |
40–44 | 11 (10.5) | 9 (8.9) | 20 (9.7) |
45–49 | 6 (5.7) | 10 (9.9) | 16 (7.8) |
50–54 | 10 (9.5) | 10 (9.9) | 20 (9.7) |
55+ | 11 (10.5) | 8 (7.9) | 19 (9.2) |
Country of birth (n, % Australia) | 81 (77.1) | 76 (75.3) | 157 (76.2) |
Employment (n, %) | |||
Work full time | 77 (73.3) | 70 (69.3) | 147 (71.4) |
Work part time/casual | 13 (12.4) | 22 (21.8) | 35 (17.0) |
Unemployed | 5 (4.8) | 2 (2.0) | 7 (3.4) |
Full time student | 3 (2.9) | 1 (1.0) | 4 (1.9) |
Full-time home duties | 1 (1.0) | 1 (1.0) | 2 (1.0) |
Retired | 3 (2.9) | 0 (0) | 3 (1.5) |
Sick or disability pension | 2 (1.9) | 4 (4.0) | 6 (2.9) |
Other | 1 (1.0) | 1 (1.0) | 2 (1.0) |
Annual personal net income (n, %) | |||
<AUD$25,000 | 13 (12.4) | 10 (9.9) | 23 (11.2) |
AUD$25,000–$39,999 | 18 (17.1) | 14 (13.9) | 32 (15.5) |
AUD$40,000–$64,999 | 28 (26.7) | 41 (40.6) | 69 (33.5) |
AUD$65,000–$79,999 | 20 (19.1) | 17 (16.8) | 37 (18.0) |
AUD$80,000–$129,999 | 18 (17.1) | 15 (14.9) | 33 (16.0) |
AUD$130,000+ | 8 (7.6) | 4 (4.0) | 12 (5.8) |
Internet use (hours) (n, %) a | |||
Less than 1 | 6 (5.7) | 2 (2.0) | 8 (3.9) |
1–7 | 25 (23.8) | 19 (18.8) | 44 (21.4) |
8–14 | 29 (27.6) | 28 (27.7) | 57 (27.7) |
15–21 | 15 (14.3) | 22 (21.8) | 37 (18.0) |
22–28 | 7 (6.7) | 7 (6.9) | 14 (6.8) |
29–35 | 8 (7.6) | 6 (5.9) | 14 (6.8) |
36–42 | 3 (2.9) | 9 (8.9) | 12 (5.8) |
More than 42 | 12 (11.4) | 8 (7.9) | 20 (9.7) |
Outcome | Baseline | 8 Weeks | 12 Weeks | 24 Months | ||||
---|---|---|---|---|---|---|---|---|
PSD (n = 50) | GSD (n = 51) | PSD (n = 22) | GSD (n = 28) | PSD (n = 26) | GSD (n = 29) | PSD (n = 28) | GSD (n = 30) | |
G-SAS gambling symptom severity a | 30.12 (7.92) | 27.94 (7.97) | 17.50 (11.91) | 19.45 (11.82) | 20.42 (10.63) | 15.14 (9.91) | 19.79 (10.90) | 13.87 (10.88) |
G-SAS gambling urges a | 10.18 (2.84) | 9.06 (2.77) | 6.13 (4.71) | 6.94 (4.17) | 7.15 (4.10) | 5.14 (3.54) | 6.89 (3.95) | 3.93 (3.94) |
Gambling frequency b | 13.20 (11.57) | 14.43 (19.64) | 6.14 (7.89) | 6.82 (8.58) | 7.88 (8.50) | 3.72 (4.71) | 14.89 (17.58) | 11.57 (21.23) |
Gambling expenditure (AUD$) b | 3590 (6923) | 2579 (5096) | 511 (1123) | 664 (1037) | 747 (973) | 272 (352) | 1511 (2497) | 1027 (1657) |
K6 psychological distress a | 16.74 (5.92) | 17.24 (5.56) | 12.50 (4.98 | 13.93 (5.96) | 14.00 (6.01) | 12.66 (6.30) | 13.64 (4.98) | 12.17 (4.57) |
EUROHIS quality of life a | 3.32 (1.15) | 3.35 (1.04) | 3.68 (0.84) | 3.57 (1.00) | 3.31 (1.01) | 3.79 (0.90) | 3.43 (1.03) | 3.83 (0.79) |
HSQ high-intensity help-seeking a,b | 0.32 (0.68) | 0.31 (0.73) | 0.32 (0.57) | 0.32 (0.72) | 0.58 (0.95) | 0.52 (0.78) | 0.46 (0.88) | 0.20 (0.41) |
HSQ low-intensity help-seeking a,b | 0.14 (0.40) | 0.20 (0.57) | 0.05 (0.21) | 0.32 (0.48) | 0.27 (0.53) | 0.28 (0.59) | 0.18 (0.55) | 0.10 (0.55) |
Outcome | Unadjusted Estimate (SE) | Estimated Between-Group Difference (95% CI) | p | |||
---|---|---|---|---|---|---|
Baseline | 8 Weeks | 12 Weeks | 24 Months | |||
G-SAS gambling symptom severity b | - | −0.32 (0.19) | −0.47 (0.29) | −3.78 (2.29) | −0.16 (−0.34, 0.03) c | 0.098 |
G-SAS gambling urges b | - | −0.18 (0.07) | −0.27 (0.10) | −2.17 (0.84) | −0.09 (−0.16, −0.02) c | 0.010 |
Gambling frequency | - | − | − | − | 0.95 (0.91, 1.00) d | 0.046 |
Gambling expenditure | - | − | − | − | 0.99 (0.94, 1.04) d | 0.667 |
K6 psychological distress b | - | −0.05 (0.10) | −0.08 (0.15) | −0.64 (1.18) | −0.03 (−0.12, 0.07) c | 0.585 |
EUROHIS quality of life b | - | 0.02 (0.02) | 0.03 (0.03) | 0.26 (0.21) | 0.01 (−0.01, 0.03) c | 0.210 |
HSQ high-intensity help-seeking b | - | − | − | − | 0.98 (0.91, 1.06) e | 0.660 |
HSQ low-intensity help-seeking b | - | − | − | − | 0.93 (0.83, 1.03) e | 0.157 |
Outcome | Treatment Group | Unadjusted Estimate (SE) | Estimated Within-Group Difference (95% CI) | p | |||
---|---|---|---|---|---|---|---|
Baseline | 8 Weeks | 12 Weeks | 24 Months | ||||
G-SAS gambling symptom severity b | PSD | 29.69 (1.39) | 21.50 (1.32) | 17.90 (1.59) | 18.43 (1.85) | −4.42 (−5.70, −3.15) c | <0.001 |
GSD | 27.92 (1.35) | 19.29 (1.22) | 15.48 (1.48) | 13.84 (1.68) | −4.66 (−5.90, −3.41) c | <0.001 | |
G-SAS gambling urges b | PSD | 10.05 (0.52) | 7.55 (0.50) | 6.45 (0.60) | 6.54 (0.65) | −1.35 (−1.81, −0.88) c | <0.001 |
GSD | 9.10 (0.47) | 6.63 (0.42) | 5.53 (0.52) | 3.95 (0.64) | −1.33 (−1.77, −0.89) c | <0.001 | |
Gambling frequency | PSD | - | −0.82 (0.31) | −1.17 (0.44) | −0.89 (0.46) | 0.64 (0.46, 0.89) d | 0.007 |
GSD | - | −1.76 (0.35) | −2.52 (0.50) | −1.38 (0.48) | 0.39 (0.27, 0.56) d | <0.001 | |
Gambling expenditure | PSD | - | −1.91 (0.41) | −2.75 (0.58) | −1.77 (0.60) | 0.35 (0.23, 0.55) d | <0.001 |
GSD | - | −1.84 (0.35) | −2.64 (0.50) | −1.70 (0.54) | 0.37 (0.25, 0.54) d | <0.001 | |
K6 psychological distress b | PSD | 16.57 (0.77) | 14.36 (0.75) | 13.38 (0.85) | 12.39 (0.91) | −1.19 (−1.76, −0.62) c | <0.001 |
GSD | 17.19 (0.76) | 13.89 (0.70) | 12.43 (0.85) | 12.11 (0.94) | −1.78 (−2.47, −1.09) c | <0.001 | |
EUROHIS quality of life b | PSD | 3.35 (0.15) | 3.44 (0.14) | 3.48 (0.16) | 3.57 (0.18) | 0.05 (−0.07, 0.17) c | 0.423 |
GSD | 3.35 (0.13) | 3.61 (0.12) | 3.73 (0.14) | 3.85 (0.16) | 0.14 (0.03, 0.25) c | 0.013 | |
HSQ high-intensity help-seeking b | PSD | −2.12 (0.64) | −1.51 (0.57) | −1.24 (0.65) | −1.88 (0.75) | 1.39 (0.84, 2.31) e | 0.199 |
GSD | −1.87 (0.52) | −1.38 (0.43) | −1.17 (0.51) | −1.96 (0.65) | 1.31 (0.84, 2.05) e | 0.239 | |
HSQ low-intensity help-seeking b | PSD | −2.26 (0.55) | −1.88 (0.45) | −1.71 (0.55) | −2.27 (0.72) | 1.23 (0.74, 2.06) e | 0.422 |
GSD | −1.84 (0.47) | −1.33 (0.37) | −1.12 (0.44) | −3.57 (1.11) | 1.33 (0.87, 2.04) e | 0.189 |
8 weeks | PSD (n = 24) | GSD (n = 31) | Total (n = 55) |
Recovered | 14 (58.3) | 12 (38.7) | 26 (47.3) |
Improved | 2 (8.3) | 6 (19.4) | 8 (14.6) |
Unchanged | 7 (29.2) | 12 (38.7) | 19 (34.6) |
Deteriorated | 1 (4.2) | 1 (3.2) | 2 (3.6) |
12 weeks | PSD (n = 26) | GSD (n = 29) | Total (n = 55) |
Recovered | 9 (34.6) | 18 (62.1) | 27 (49.1) |
Improved | 8 (30.8) | 2 (6.9) | 10 (18.2) |
Unchanged | 9 (34.6) | 8 (27.6) | 17 (30.9) |
Deteriorated | 0 (0.0) | 1 (3.5) | 1 (1.8) |
24 months | PSD (n = 28) | GSD (n = 30) | Total (n = 58) |
Recovered | 12 (42.9) | 21 (70.0) | 33 (56.9) |
Improved | 5 (17.9) | 2 (6.7) | 7 (12.1) |
Unchanged | 11 (39.3) | 7 (23.3) | 18 (31.0) |
Deteriorated | 0 (0.0) | 0 (0.0) | 0 (0.0) |
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Dowling, N.A.; Merkouris, S.S.; Rodda, S.N.; Smith, D.; Aarsman, S.; Lavis, T.; Lubman, D.I.; Austin, D.W.; Cunningham, J.A.; Battersby, M.W.; et al. GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions. J. Clin. Med. 2021, 10, 2224. https://doi.org/10.3390/jcm10112224
Dowling NA, Merkouris SS, Rodda SN, Smith D, Aarsman S, Lavis T, Lubman DI, Austin DW, Cunningham JA, Battersby MW, et al. GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions. Journal of Clinical Medicine. 2021; 10(11):2224. https://doi.org/10.3390/jcm10112224
Chicago/Turabian StyleDowling, Nicki A., Stephanie S. Merkouris, Simone N. Rodda, David Smith, Stephanie Aarsman, Tiffany Lavis, Dan I. Lubman, David W. Austin, John A. Cunningham, Malcolm W. Battersby, and et al. 2021. "GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions" Journal of Clinical Medicine 10, no. 11: 2224. https://doi.org/10.3390/jcm10112224
APA StyleDowling, N. A., Merkouris, S. S., Rodda, S. N., Smith, D., Aarsman, S., Lavis, T., Lubman, D. I., Austin, D. W., Cunningham, J. A., Battersby, M. W., & O, S. C. (2021). GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions. Journal of Clinical Medicine, 10(11), 2224. https://doi.org/10.3390/jcm10112224