JMIR Publications

ABSTRACT

Background:

Several treatment-related challenges exist for DSM-5 Gambling Disorder, in particular at- scale dissemination within healthcare settings.

Objective:

The current study describes the introduction of a newly developed internet-delivered cognitive behavioral therapy (iCBT) program for Gambling Disorder (GD) within routine addiction care, in a nationally recruited sample in Sweden. The study describes the introduction of the iCBT program in terms of feasibility measures, and compares registry outcomes among iCBT patients with other GD patients at the clinic who received face-to-face psychological treatment-as usual.

Methods:

The study site was the Stockholm Addiction eClinic, which offers digital interventions for addictive disorders in routine care. The iCBT program was introduced nationally for treatment-seeking patients via the Swedish eHealth platform, in parallel with an initial feasibility study (n=23). After approximately two years of routine treatment provision, we conducted a registry study, including ordinary patients in routine digital care (n=218), and a reference sample receiving face-to-face psychological treatment for GD (n=216).

Results:

A statistically significant reduction in gambling symptoms was observed during the treatment window in both the feasibility sample (B=-1.39, SE=0.30, P=.0165) and the iCBT cohort sample (B=-1.33, SE=0.17, P<.001), with large within- group Cohen’s d effect sizes of d=1.69 and d=1.39, respectively. The iCBT program was rated high in satisfaction. A registry-based survival analysis, controlling for psychiatric comorbidity, showed that iCBT patients exhibited post-treatment outcomes similar to comparable patients that underwent face-to-face treatment-as- usual.

Conclusions:

A lack of randomized allocation notwithstanding, the iCBT program for GD evaluated in this study was well-received by patients in routine addiction care, was associated with the expected symptom decrease during the treatment window, and appears to result in post- treatment registry outcomes similar to face- to-face treatment. Future studies on treatment mechanisms and moderators are warranted. Clinical Trial: Pre-trial registration for the introductory feasibility study completed on May 10, 2019, at Clinical trials.gov (NCT03946098), with a published study protocol 1. The Swedish Ethical Review Authority granted approval to the feasibility (2019-05479) and registry (2022-04987-02) studies.