Integrative Couple Treatment for Pathological Gambling ICTPG Jol

Integrative Couple Treatment for Pathological Gambling (ICT-PG) Joël Tremblay, Ph. D. , Psychoeducation Department, Université du Québec à Trois-Rivières (UQTR) Karine Bertrand, Ph. D. , Addiction Program, Medicine and Health Sciences Faculty, Sherbrooke University Magali Dufour, Ph. D. , Addiction Program, Medicine and Health Sciences Faculty, Sherbrooke University Annie-Claude Savard, Ph. D. , Social Work and Criminology, Laval University Marianne Saint-Jacques, Ph. D. , Addiction Program, Medicine and Health Sciences Faculty, Sherbrooke University Nadine Blanchette-Martin, Master of Social Work, Research Service in Addiction, CISSS de Chaudière-Appalaches / CIUSSS de la Capitale-Nationale Francine Ferland, Ph. D. , Research Service in Addiction, CIUSSS de la Capitale- Nationale/CISSS de Chaudière-Appalaches Mélissa Côté, ps. ed. , Ph. D. candidate, Psychoeducation, UQTR Addiction & the Family International Network (AFINet): 1 st International Conference, Friday 9 th to Sunday 11 th November 2018, Newcastle upon Tyne, UK

Integrative Couple Treatment for Pathological Gambling (ICT-PG) Treatment objectives • Reduce or stop gambling-related behaviours • Reduce psychological distress and improve the well-being of both partners • Increase relationship satisfaction and mutual support between partners Clinical process (based on ABCT model Mc. Crady & Epstein, 2009) • Start treatment with the couple, 1 st session. • ≈ 45 -60 min. with gambler • Partner expresses her point of view, while maintaining the focus on the gambling behaviours • ≈ 30 -45 min. relationship aspects • Mutual positive reinforcement in daily life • Communication and negotiation skills • Partner’s behaviours that facilitate gambling and those that reinforce its cessation 1

Session 1&2 3 4 5 6 7 Gambler Partner Couple Listening of expectations Mutual reinforcement Sequence of sessions in ICT-PG from each person Listening of expectations General objectives of sessions Verify recent gambling behaviour Stop draining money Rules/expectations from participants Feedback (evaluation, admission) Functional analysis of gambling behaviour or at-risk situations Clinical work related to gambling Clinical work related to gambling General objectives of sessions Feedback (evaluation, admission) Stop/reduce reinforcement of gambling situations Mutual reinforcement Communication skills Improving reinforcement of non-gambling situations Clinical work related to gambling Improving reinforcement of Prevent relapse/at-risk situations non-gambling situations Sessions 9 to 12 are an extension of previous sessions. The therapist spend more time on any given aspect. 9 to 12 Therapy can last up to 40 sessions 8

ICT-PG Integrity 2 Elements addressed Number of times the item has been addressed M (SD) Number of therapists who worked on this theme (n = 37) 1 Communication skills 6. 09 (3. 35) 89. 2% (33) 2 Mutual reinforcement 4. 26 (2. 26) 89. 2% (33) 3 Skills to resolve marital conflict 2. 82 (2. 91) 75. 7% (28) 4 Improve reinforcement of nongambling situations 2. 26 (1. 81) 73. 0% (27) 5 Reduce reinforcement of gambling situations 0. 88 (1. 15) 46. 0% (17)

Results: 18 month follow-up

Difference between the two treatment groups GAMBLING HABITS GAMBLERS Ind. $$ gambling – Last 3 months n. s. Frequency - Gambling habits * Proportion of personal income spent on gambling n. s. Gambling Symptom Assessment Scale (G-SAS) **** Number of times played in the last week n. s. Number of hours played in the last week n. s. Number of times played in the last week * Impaired Control Over Gambling (ICOG) ** Canadian Problem Gambling Index (CPGI) * Detection of the Need for Help Gambling (DÉBA-Jeu) ** Gambling related beliefs inventory (ICROLJ) ** Negative consequences n. s. Global improvement – Gambling habits P<0, 001***; P<0, 01**; P<0, 05*; P<0, 10£ Improvement over time * ICT-PG Yes No

Difference between the two treatment groups CONJUGAL ASPECTS GAMBLERS Improvement over time Ind. ICT-PG Dyadic Adjustment Scale (DAS-4) ** Yes Marital Status Inventory (MSI) * Yes Couples Support Questionnaire **** No Yes Marital Problem Solving Scale (MPSS) ** No Yes Interpersonal Communication Skills Inventory Self-Spouse (oneself evaluation) ** No Yes Interpersonal Communication Skills Inventory Self-Spouse (partner evaluation) ** No Yes Ind. ICT-PG PARTNERS Dyadic Adjustment Scale (DAS-4) ** Marital Status Inventory (MSI) * Couples Support Questionnaire n. s. Marital Problem Solving Scale (MPSS) n. s. Interpersonal Communication Skills Inventory Self-Spouse (oneself evaluation) n. s. Interpersonal Communication Skills Inventory Self-Spouse (partner evaluation) P<0, 001***; P<0, 01**; P<0, 05*; P<0, 10£ * Yes

Difference between the two treatment groups PERSONAL ASPECTS GAMBLERS Center for Epidemiologic Studies Depression scale (CES-D) Improvement over time Ind. ICT-PG * Oui Psychiatric symptom index (IDPESQ) n. s. Oui Ways of Coping Questionnaire – Seeking social support n. s. Oui Ways of Coping Questionnaire – Planful problem solving/Positive reappraisal n. s. Ways of Coping Questionnaire – Distancing/Escape avoidance Non * Oui Nombre consommation alcool/semaine n. s. Non Oui Binge drinking n. s. Non Oui Severity of Alcohol Dependence Data (SADD) n. s. Non Oui Drinking Impact Scale (DIS) n. s. P<0, 001***; P<0, 01**; P<0, 05*; P<0, 10£ Non

Difference between the two treatment groups PERSONAL ASPECTS PARTNERS Ind. Center for Epidemiologic Studies Depression scale (CES-D) * Psychiatric symptom index (IDPESQ) * Ways of Coping Questionnaire – Seeking social support * Ways of Coping Questionnaire – Planful problem solving/Positive reappraisal n. s. Ways of Coping Questionnaire – Distancing/Escape avoidance n. s. Nombre consommation alcool/semaine n. s. Binge drinking n. s. Severity of Alcohol Dependence Data (SADD) n. s. Drinking Impact Scale (DIS) n. s. P<0, 001***; P<0, 01**; P<0, 05*; P<0, 10£ Improvement over time ICT-PG Yes No Yes

Gambling Symptom Assessment Scale (G-SAS) Individual M (SD) T 1 T 2 T 3 T 4 Tot ICT-PG M (SD) Sig. 10 20 18 16 16, 66 (1, 20)abc 18, 52 (1, 08)abc n. s. 14 12 12, 39 (1, 31)a 6, 85 (1, 14)a ** *** 11, 08 (1, 44)b 4, 30 (1, 17)b 10, 80 (1, 53)c 4, 01 (1, 21)c *** 8, 77 **** 13, 17 Individual 10 ICT-PG 8 6 4 2 0 T 1 T 2 T 3 T 4 P<0, 0001****; P<0, 001***; P<0, 01**; P<0, 05* (Kim, Grant, Potenza, Blanco, & Hollander, 2009)

Impaired control over gambling (ICOG) Individual M (SD) T 1 T 2 T 3 T 4 Tot ICT-PG M (SD) 37, 92 (1, 44)abc 35, 95 (1, 29)abc Sig. n. s. 22, 31 (1, 58)a 17, 89 (1, 34)a * 20, 59 (1, 69)b 16, 11 (1, 41)b * 18, 26 (1, 86)c 15, 69 (1, 45)c n. s. 25, 89 21, 85 ** 11 50 45 40 35 Indiviudal 30 ICT-PG 25 20 15 10 T 1 T 2 T 3 T 4 P<0, 0001****; P<0, 001***; P<0, 01**; P<0, 05* (Baron & Dickerson, 1994)

Canadian Problem Gambling Index (CPGI) Individual M (SD) T 1 T 2 T 3 T 4 Tot ICT-PG M (SD) 15, 68 (0, 82)abc 14, 85 (0, 74)abc Sig. 18 16 n. s. 14 12 6, 97 (0, 89)a 5, 86 (0, 77)a 12 n. s. Indiviudal 10 ICT-PG 8 n. s. 5, 31 (0, 97)b 3, 98 (0, 80)b 4, 91 (1, 08)c 4, 26 (0, 83)c n. s. 8, 91 7, 43 * 6 4 2 0 T 1 T 2 T 3 T 4 P<0, 0001****; P<0, 001***; P<0, 01**; P<0, 05* (Ferris & Wynne, 2001)

Dyadic Adjustment Scale (DAS-4) - Gamblers Individual M (SD) T 1 T 2 T 3 T 4 Tot ICT-PG M (SD) Sig. 20 Marital satisfaction 19 18 11, 20 (0, 53)ab 11, 96 (0, 48)abc n. s. 13 17 16 14, 29 (0, 58)ac 14, 49 (0, 61)bd 12, 30 (0, 70)cd 12, 96 15, 09 (0, 49)a 16, 08 (0, 51)b 15, 43 (0, 55)c 14, 52 n. s. * ** 15 Indiviudal 14 ICT-PG 13 12 Marital dissatisfaction 11 10 T 1 T 2 T 3 T 4 P<0, 0001****; P<0, 001***; P<0, 01**; P<0, 05* (Sabourin, Valois et Lussier, 2005)

Dyadic Adjustment Scale (DAS-4) - Partners 14 20 Individual M (SD) T 1 T 2 T 3 T 4 Tot ICT-PG M (SD) Sig. Marital satisfaction 18 11, 29 (0, 35)abc 11, 67 (0, 32)abc n. s. 13, 28 (0, 37)ad 15, 42 (0, 32)a **** 14, 76 (0, 38)bde 15, 35 (0, 34)b 19 n. s. 17 16 15 Indiviudal 14 ICT-PG 13 12 12, 38 (0, 41)ce 15, 05 (0, 35)c **** Marital dissatisfaction 11 10 12, 74 14, 16 ** T 1 T 2 T 3 T 4 P<0, 0001****; P<0, 001***; P<0, 01**; P<0, 05* (Sabourin, Valois et Lussier, 2005)

Psychiatric symptom index - Gamblers Individual M (SD) T 1 T 2 T 3 T 4 Tot ICT-PG M (SD) Sig. 30 15 Psychological distress 25 20, 58 (1, 58)abc 18, 83 (1, 43)abc n. s. 14, 04 (1, 73)a 14, 45 (1, 48)ad n. s. 15 15, 26 (1, 84)b 10, 19 (1, 53)bd * 10 20 13, 43 (2, 04)c 12, 24 (1, 59)c n. s. 5 16, 38 14, 20 n. s. 0 Indiviudal ICT-PG T 1 T 2 T 3 T 4 P<0, 0001****; P<0, 001***; P<0, 01**; P<0, 05* (Ilfeld, 1976)

Psychiatric symptom index - Partners Individual M (SD) T 1 T 2 T 3 T 4 Tot ICT-PG M (SD) 22, 38 (1, 08)abc 23, 75 (0, 97)abc Sig. 30 Psychological distress 25 n. s. 16 20 16, 40 (1, 13)a 12, 76 (0, 99)a * 15 17, 03 (1, 16)b 11, 94 (1, 01)b *** 10 16, 96 (1, 25)c 13, 45 (1, 04)c * 5 18, 84 16, 13 * Indiviudal ICT-PG 0 T 1 T 2 T 3 T 4 P<0, 0001****; P<0, 001***; P<0, 01**; P<0, 05* (Ilfeld, 1976)

Group discussion

Group discussion • Further research should help understand how to improve this type of intervention by responding to questions like: 1. How can we help gamblers to participate into couple treatment? 2. Can we have a combination a couple and individual sessions? 3. What are the adaptations needed to conduct ICT-PG with gamblers presenting with concomitant SUD? 18