Brief motivational interventions for college student problem gamblers.

Most college students gamble, with estimates indicating that up to 23% gamble weekly or more1-3. Popular activities include betting on sports, casino games, cards, and the internet4-5. Although most college students who gamble do so without problems, some develop difficulties. Pathological gambling is characterized as “persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits”6. Problem gambling is sub-diagnostic behavior that causes negative or adverse consequences. Combined prevalence rates of problem and pathological gambling in college students are 3-14%1,3-5,7. Problem and pathological gambling are associated with poor academic performance, heavy alcohol consumption, illicit drug use, nicotine use, and suicide attempts1-3. Despite the prevalence and adverse consequences of problem and pathological gambling in college students, few studies have examined treatment strategies. Primarily, educational interventions have been evaluated8-12. Although some increased knowledge and decreased irrational beliefs, few impacted gambling behavior directly, and follow-up time frames for assessing behavior change were minimal. Efficacious interventions exist for other disorders common in college students, such as heavy drinking, and may be applicable to gambling13. They include brief, motivational and cognitive-behavioral interventions. Brief Advice is more effective than no treatment, and often as effective as extended treatment, in reducing heavy drinking in college students14,15, and its simple directive nature may encourage behavioral change. A recent study in adult problem and pathological gamblers found that a 15-minute Brief Advice condition was more efficacious than an assessment-only condition in reducing gambling16. Motivational Enhancement Therapy (MET) is efficacious in reducing heavy drinking in college students17,18. Based upon the trans-theoretical model of change, MET seeks to increase motivation to change19. In a trial for adult problem gamblers, MET delivered over the telephone in combination with a self-help workbook led to greater reductions in gambling than a wait-list control condition20. The workbook used Cognitive-Behavioral Therapy (CBT), which assumes cognitive restructuring and behavior modification can alter problem behaviors. CBT may be appropriate because students with greater gambling problems evidence more irrational beliefs21-24, and are more likely to use ineffective coping strategies25,26. In this study, we evaluated each of these three interventions in problem and pathological gambling college students. The Brief Advice condition provided information about prevalence rates, personalized feedback about gambling, and simple strategies for decreasing it. The second condition was a single session of MET, in which students discussed their gambling and how it fit in with their life goals. The third condition consisted of one MET session followed by 3 sessions of CBT. In an initial omnibus analysis, we evaluated the efficacy of the combined interventions compared to an assessment-only condition, with the hypothesis that receiving any intervention would improve outcomes relative to assessment only. If the omnibus analysis was significant, we planned to investigate the efficacy of each individual intervention versus assessment only. In exploratory analyses, we compared the three active interventions to assess if any was particularly efficacious in reducing gambling. Prognostic factors associated with clinically significant reductions in gambling were also investigated, including pretreatment severity of gambling problems and alcohol use, which is linked to problem and pathological gambling27.