'XGAMBLE'- The effect of counselling on gambling behaviours in four New Zealand population groups

INTERVENTION: Counselling provided face‐to‐face (on one‐to‐one basisi) Participants of ALL ethnicities were recruited from four specific locations‐ Auckland, Hawkes Bay, Nelson, and Christchurch where participants could receive either face‐to‐face or telephone interventions by the participating practitioners. Each practitioner was a currently practicing clinician within a Ministry funded problem gambling service, with the relevant training and years of experiences in working with individuals affected by problem gambling and their significant others. In other words, they were competent practitioners that provided support and treatment for the clients that presented to this trial. The study was described as “XGAMBLE” to all participants, who were aware that different groups would have different intervention modalities made available to them. Participants commenced interventions from one of the two treatment arms: face‐to‐face and telephone. The primary intervention model or intervention procedures adopted in this trial were informed by the Intervention Manual (citation: Manual Writing Group. (2006). Manual of procedures: Problem gambling intervention studies. Auckland: Centre for Gambling Studies, University of Auckland, please contact Tse for details, samsont@hku.hk). All of the services provided were free, strictly confidential and delivered in a professional manner. The writing of the manual was contributed to jointly, by a group of senior practitioners working in the field of problem gambling interventions. They were invited to join the group on the basis of: 1) practitioners’ experiences in the sector, 2) experiences in writing intervention manuals or protocols within their own organisation or professional groups; and, 3) expertise and insights in working with specific population groups. A two‐day workshop was held at the School of Population Health at Tamaki Campus, University of Auckland on 17th and 18th July 2006. The Manual includes helpful hints for problem gambling counselling and a list of common interventions used by most gambling practitioners (see below). Not every practitioner would use the same interventions for each client. Referring on Tikanga protocols (i.e. Maori customs and traditions) Budget advice Cognitive distortions/thinking errors Desensitization Bans and self‐exclusions High‐risk situations Early warning signs Developing safety plan Use of significant others Relationship counselling Stress release Lifestyle balance Gambling education Insight/Awareness‐raising Normalizing/validating Instilling hope Feeling identification Positive feedback Goal‐setting Review of progress Review of resources Coaching/Role‐plays Didactic interventions Face‐to‐face and Telephone services Intervention services were provided according to the Interventions Manual which outlined the assessments, major intervention approaches and activities/tasks to be performed by practitioners. These were identical for both face‐to‐face and telephone interventions. There was no restriction on the frequency or duration of counselling sessions ‐ that is, this trial evaluated the delivery of intervention services in a naturalistic setting. Similarly, if they were deemed to be appropriate, the services could offer any culturally‐specific interventions. * Definition: The major treatment models that are utilised in intervention services were defined (i.e. written in the Intervention Manual). * Formative evaluations: These were also conducted on the experiences of participants (in terms of both clients and practitioners). 1. Any reasons for termination (e.g. as planned, failure to attend, or “I am OK now”). The intensive part of the intervention lasted up to six sessions; intervention period could spread up to 3 months. Practitioners were asked to complete a form documenting the major elements and/or activities of the services provided for each client involved in this study. 'End of the intervention' was operationally defined as when clients completed their planned treatment, OR failed to attend 2 or more consecutive sessions, OR when clients advised that they no longer wish to continue. The evaluation of intervention integrity was performed by a multi‐disciplinary team comprising of experts on the two problem gambling treatment modalities and experienced researchers, including those from relevant ethnic backgrounds. The monitoring and evaluation process took place in the following steps: * Evaluation: Evaluative stages also included documentation and feedback from the participating practitioners upon the termination of intervention. Examples of information collected from the practitioners included: 2. A brief summary of what was covered over the course of the intervention. 3. Outcomes achieved. 4. Evaluation of efficacy of interventions: a. In respect to the goals set, which have been achieved? b. What was most helpful about the intervention? c. What did not CONDITION: Adults who were screened and they met the Diagnostic Statistical Manual‐version IV (DSM‐IV), Text Revision criteria‐ probable pathological gambling and/or pathological gambling PRIMARY OUTCOME: Total money spent on gambling over the last four weeks Total time spent on gambling over the last four weeks SECONDARY OUTCOME: Participants' attitude towards gambling activities Participants' motivation/ readiness to change their gambling behaviours INCLUSION CRITERIA: 1. They were aged 16 years or above; 2. They were currently experiencing problem gambling (as measured by DSM‐IV: a score of 3 or more); 3. They were residing in one of the locations ‐ Auckland, Hawkes Bay, Nelson, and Christchurch, where face‐to‐face interventions were available; 4. There was an appropriate practitioner available (choice of culture/gender); 5. They were able to attend face‐to‐face intervention sessions and receive telephone calls; 6. Their primary problem mode was pokie machines; and, 7. They provided informed consent.