Integrative Couple Treatment for Pathological Gambling or Individual Treatment: A Comparison of Efficacy
Phase: NA
Conditions: Pathological Gambling
Sponsor: Université du Québec à Trois-Rivières

1 
Study protocol: Integrative Couple Treatment for Pathological Gambling (ICT-PG) 
ID Clinical Trials: NCT02240485 
29-08-2018 version updated 2021-09-21 for respond to reviewers' comments 
 
Study Protocol 
 
Official title: Integrative Couple Treatment for Pathological 
Gambling or Individual Treatment: A Comparison of Efficacy  
   
NCT number: NCT02240485  
 
Document date: 2015-02-15  
 
Principal Investigator: Joël Tremblay (418) 659-2170, #2820  
 
  
This project has been approved by UQTR’s research ethics committee (CER-10-156-
06.13), the addiction research ethics committee (CÉRT 2010-112) and the research ethics 
committee at the Centre hospitalier universitaire de l’Université de Sherbrooke (10-171).  
 
 
 

2 
Study protocol: Integrative Couple Treatment for Pathological Gambling (ICT-PG) 
ID Clinical Trials: NCT02240485 
29-08-2018 version updated 2021-09-21 for respond to reviewers' comments 
 
Random distribution research design 
The efficacy study, using a longitudinal mixed methods approach, is conducted with a 
randomization process (n=80 problem gamblers) whereby participants are assigned to one of two 
treatment groups: a) an experimental group involving couple counselling (n = 44), and b) a control 
group involving individual counselling (n = 36). After the evaluation interview, the research officer 
applies randomization to ensure that each participant is randomly assigned to one of the two 
interventions. The method used is urn randomization (Wei and Lachin, 1988), combined with 
stratification for covariates thought to influence treatment outcome (Hedden, Woolson and 
Malcolm, 2006).  
Stratification criteria (covariates) for randomization 
 
Risky alcohol or drug use (yellow light) by player, detected with DEBA-Alcool and 
DEBA-Drogues 
 
Risky gambling patterns (yellow light) in the partner, detected with DEBA-Jeu 
 
Player’s sex 
 
Serious but stabilized mental health problem in the player, as assessed with the following 
questionnaires: 
o Indication of major depression (score 16 or over), detected with the Center for 
Epidemiologic Studies Depression Scale (Radloff, 1977; French translation by 
Fuhrer and Rouillon, 1989) 
o Significant psychological distress (85th percentile), detected with the 
Psychological Distress Index used in the Québec Health Survey – PDIQHS-29 
(Préville, Boyer, Potvin, Perreault and Légaré, 1992) 
o Antisocial personality disorder or moderate borderline personality disorder (score 
3 to 8), detected with the Borderline Conduct Scale and Conduct Disorder Scale 
in the Global Appraisal of Individual Needs – Initial (GAIN-I) instrument 
(Chestnut Health Systems, 2002-2006; translated by Tremblay and Savard, 2011) 
o Indication of another personality disorder (score 4 and over), detected with the 
Standardised Assessment of Personality – Abbreviated Scale (SAPAS) (Moran, 
Leese, Lee, Walters, Thornicroft and Mann, 2003; translated by Gordwoon) 
Participants 
Participants (problem gamblers) and their spouses are recruited in various alcohol and drug 
rehabilitation centres in various regions of Québec. More specifically, participating centres are in 
Montréal (Centre de réadaptation en dépendance de Montréal – Institut universitaire sur les 
dépendances, Centre de réadaptation en dépendance Foster), Montérégie (Centre de réadaptation 
en dépendance le Virage), Laurentides (Centre de réadaptation en dépendance des Laurentides), 
Estrie (Centre de réadaptation en dépendance de l’Estrie), Lanaudière (Centre de réadaptation en 
dépendance de Lanaudière), Québec (Centre de réadaptation en dépendance de Québec) and 
Chaudière-Appalaches (Centre de réadaptation en dépendance de Chaudière-Appalaches); as well 
as at Maison Jean Lapointe. 

3 
Study protocol: Integrative Couple Treatment for Pathological Gambling (ICT-PG) 
ID Clinical Trials: NCT02240485 
29-08-2018 version updated 2021-09-21 for respond to reviewers' comments 
 
Selection criteria  
Study eligibility criteria are the following: 
 
The couple has lived together at least 6 months. 
 
Pathological gambling (5 criteria) has been diagnosed in the past 12 months, as detected 
with WHM-CIDI (WHO; French translation by Gagnon, Tremblay, Ménard, Ferland, B-
Martin and Berthelot, 2007). 
 
The player has not been treated for gambling habits for at least 6 months (excluding GA). 
 
The player has engaged in gambling behaviours in the past 3 months. 
 
Both partners show sufficient levels of commitment (score 8 and under) indicating a 
desire to continue the relationship, as measured by the Marital Status Inventory (Weiss 
and Cerreto, 1980). 
Other characteristics emerge as being less favourable to participating in conjugal treatment. 
Therefore, participants with the following characteristics will be excluded from the study: 
 
The couple has lived together less than 6 months. 
 
The player has been treated for gambling habits in the past 6 months (excluding GA). 
 
The player has stopped gambling for 3 months or more. 
 
The player has alcohol or drug addiction problems (red light), as detected with DEBA-
Alcool or DEBA-Drogues (Tremblay, Rouillard and Sirois, 2003) 
 
The partner has alcohol or drug addiction problems (red light), as detected with  DEBA-
Alcool or DEBA-Drogues (Tremblay, Rouillard and Sirois, 2003) 
 
The partner has gambling problems (red light), as detected with DEBA-Jeu (Tremblay, 
Ménard and Ferland, 2005). 
 
Acts of serious violence endangering the safety of one of the partners have been committed 
in the past 12 months. 
 
One person in the couple has had serious, non-stabilized mental health problems requiring 
hospitalization for at least 24 hours in a psychiatric department or psychiatric emergency 
department in the past 12 months due to a psychotic spectrum disorder (schizophrenia, 
schizophreniform disorder, schizoaffective disorder, delusional disorder, psychotic 
disorder, bipolar disorder with psychotic features, major depressive disorder with psychotic 
features), or in the past 6 months for any other mental health problem (self-reported). 
 
An antisocial personality disorder or severe borderline personality disorder has been 
diagnosed, (score 9 or over) as detected with the Borderline Conduct Scale and Conduct 
Disorder Scale in the Global Appraisal of Individual Needs – Initial (GAIN-I) instrument 
(Chestnut Health Systems, 2002-2006; translated by Tremblay and Savard, 2011). 
 
The partner has had strong suicidal ideation with suicide scenario or suicide attempt in the 
past 30 days or less. 
 
Both partners show low levels of commitment (score 8 and over) indicating a risk of 
separation, as measured by the Marital Status Inventory (Weiss and Cerreto, 1980) 

4 
Study protocol: Integrative Couple Treatment for Pathological Gambling (ICT-PG) 
ID Clinical Trials: NCT02240485 
29-08-2018 version updated 2021-09-21 for respond to reviewers' comments 
 
 
Recruitment strategies 
Generally, practitioners propose the study to users following routine admission evaluations in the 
participating centres (see the research project description in Appendix A). Individuals interested in 
participating sign a form authorizing a research officer to contact them. A research assistant then 
reaches out to players who have accepted to be contacted and explains the research project in more 
detail to the person and the spouse; a first meeting with the couple is also set. During the meeting, 
once the questionnaires have been completed, randomization is carried out and the couple told 
about the intervention method to which they have been randomly assigned.  In all cases, spouses 
are informed that they can get support from the entourage program (individual or group) offered in 
all participating centres. 
In light of each centre’s usual service request process, the recruitment strategy has been adapted to 
the realities of each one so as to facilitate referrals.  
A poster describing the research project has also been produced and put up in the waiting rooms of 
all participating centres. A flyer based on the poster has also been made so clinicians can give out 
information about the study to anyone interested. 
Intervention requirements 
A) Experimental group: Couple therapy 
Couples take part in 8 to 12 weekly counselling sessions lasting 1 1/2 hours each. During 
the sessions, the player’s gambling problems are discussed as well as how the couple could 
improve communication and problem-solving skills.  Other topics discussed include shared 
moments of pleasure and mutual support during difficult times linked to gambling and their 
impacts on the couple’s life. The contents of couple therapy sessions are presented in 
Section 4, which focuses specifically on the couples therapy guide and its components. 
B) Control group: Usual therapy (individual or group sessions) 
 
Most of the time, the usual treatment provided in drug and alcohol rehabilitation centres 
consists of individual sessions based on the treatment method developed by the Centre 
québécois d’excellence en prévention et traitement du jeu – CQEPTJ (Ladouceur, Boutin, 
Lachance, Doucet and Sylvain, 2000). For a number of years now, practitioners in drug 
and alcohol rehabilitation centres have been trained to use this therapeutic model.  Non-
gambling partners have access to usual services offered to family members, that is, 
individual or group sessions aimed at this clientele. 

5 
Study protocol: Integrative Couple Treatment for Pathological Gambling (ICT-PG) 
ID Clinical Trials: NCT02240485 
29-08-2018 version updated 2021-09-21 for respond to reviewers' comments 
 
Research process 
In addition to therapy sessions, both members of the couple participate in four evaluation meetings 
with a research officer. The first meeting lasts about 2 1/2 hours and the other three about 1 1/2 
hours. The initial meeting takes place before therapy sessions begin; the second is held about three 
months after therapy begins, and the third about nine months after onset of therapy. A last meeting 
is held 18 months after the start of participation in the project. During the sessions, participants 
complete a series of questionnaires on lifestyle habits, personal state, and conjugal life. Following 
the first meeting with the research officer, the latter contacts the couple or referring practitioner 
again (depending on the outcome of the evaluation meeting) within 24 hours to confirm or reject 
the couple’s participation in the project.  
If a couple is chosen for the research project, the referring practitioner contacts them to inform 
them of treatment plan to which they are being referred and to schedule a meeting. If the couple 
has not been chosen (exclusion criteria), the research assistant who conducted the admission 
interview contacts the couple to inform them of the decision. In this case, the referring practitioner 
is also notified of the meeting’s outcome so the player and his or her spouse can benefit from the 
services which they could normally obtain in the centre where the initial request for help was made. 
If a couple is assigned to couple therapy, the research officer sends a summary of the evaluation 
findings to the clinician to help him or her better understand the couple’s situation and preclude 
having to ask for the same information a second time. Also, at the beginning of each treatment 
meeting, both members of the couple complete a few brief 15-minute questionnaires on lifestyle 
habits and certain aspects of conjugal life.  
The clinician films the couple sessions for supervision meetings with study researchers (a session 
every three weeks), so the therapist can intervene as effectively as possible to help the couple.  
For every meeting with the research officer, both people in the couple are given a gift certificate 
that can be used in a local store. The gift certificate is given at the end of each meeting with the 
research officer. In all, each person gets $250 in gift certificates for a box store in their region ($50 
after the first meeting, $50 after the second one, $75 after the third, and $75 after the last meeting). 
Training for clinicians 
The research team organized four half-day training sessions for participating clinicians. During 
these sessions, the clinical model was presented, including training on the use of functional analysis 
for gambling situations and situations presenting risks of relapse, basic principles of couple therapy, 
strategies to improve communication, quality of negotiation, reduction of behaviours that reinforce 
gambling habits, and bolstering behaviours incompatible with gambling.  
Treatment quality control  
Administration of the couple therapy model is assessed for quality using scales developed for the 
current study. This strategy, often used in well-known studies (Meyers, Miller, Smith and Tonigan, 

6 
Study protocol: Integrative Couple Treatment for Pathological Gambling (ICT-PG) 
ID Clinical Trials: NCT02240485 
29-08-2018 version updated 2021-09-21 for respond to reviewers' comments 
 
2002), employs a check list of key elements of the therapeutic approach. At the end of each 
interview, the clinician assesses the degree to which each essential component of the approach was 
used (e.g. review of gambling behaviours/cravings during the past week, work on communication 
skills, work on decreasing facilitating behaviours and improving gambling abstinence behaviours). 
Supervision sessions are also a way to verify the quality of application of the intervention model 
evaluated.