Client Views of Contingency Management in Gambling Treatment: A Thematic Analysis

Abstract

Low levels of treatment access and poor retention among those with gambling problems suggests a need to improve treatment. Contingency management (CM) is a behavioural intervention involving the identification of target behaviours and the provision of incentives when targets are met. There exists a substantial evidence base for CM increasing abstinence and attendance in substance misuse treatment, but this has not been widely extended to gambling treatment setting. This study sought to explore the views of clients about CM for the treatment of problematic and disordered gambling. We conducted semi-structured interviews with 25 gambling treatment clients who were, or had previously been, engaged in treatment in Great Britain. Participants were provided with an explanation of CM, two hypothetical scenarios, and two structured questionnaires to facilitate discussion. Thematic analysis was used to interpret findings. Some participants felt that clients could manipulate CM while in treatment to obtain money to gamble, and that mechanisms of CM could trigger recovering clients into relapse. Participants also identified potential benefits of CM to achieve treatment goals, by enhancing motivation and engagement while in treatment, and helping bring people into treatment earlier. Gambling treatment clients broadly supported the use of incentives for treatment. CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process.

Contingency Management for Dually Diagnosed Inpatients with Psychosis

“…., etc.). These staff and patient feedbacks are in line with recent qualitative studies showing that CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process [28,29]. Given the lack of a qualitative part in our study protocol, we cannot objectify these experiences, but it does hint at the possibility that abstinence might not be the most suitable outcome measure in this setting.…”

Voluntary Self-Exclusion and Contingency Management for the Treatment of Problematic and Harmful Gambling in the UK: An Exploratory Study

“…Overall, across two studies, participants shared positive attitudes on VSE methods for reducing gambling and the viability of CM to help those who experience PG/HG. Participants shared concerns about CM promoting gambling or fraud-related activities for some individuals, and such worries have been previously highlighted by practitioners [34,35]. Along with the support voiced for CM, such apprehensions should be addressed in future work that assesses the viability of incorporating VSE methods into a CM strategy for PG/HG tailored to individual needs.…”

“…Similarly, the amount and duration of reinforcement during CM should accommodate individual needs and vary according to gambling severity. Providers of CM for gambling may also feel the need to monitor clients closely, as some practitioners may think that such a program could trigger relapse or that patients may take advantage of CM to gain resources for gambling (e.g., vouchers sold as cash) [35].…”

“…Because similar neurobiological processes may underlie substance misuse and harmful gambling [33], it may be that providing alternative rewards via CM could help people reduce their gambling. Recent UK studies have assessed clients' and gambling treatment service providers' views on CM and validated a scale to measure the same; while providers were somewhat receptive to CM for gambling (if it was demonstrated effective), they shared various concerns, ranging from CM reinforcing similar behaviours to PG/HG, to decreasing trust with people seeking help for their harmful gambling [34][35][36]. That said, similar concerns are often voiced regarding CM for substance misuse [31].…”