Couple treatment of pathological gambling: variables associated with better efficacy

Despite the many consequences of gambling on quality of couple relationship, most therapies for problem gambling favour an individual approach. Inspired by the McCrady & Epstein Alcohol Behavioral Couple Therapy (ABCT), our team developed the Integrative Couple Treatment for Pathological Gambling (ICT-PG). In a study aiming to evaluate the efficacy of this treatment, couples who were entering specialized treatment for the addiction of one member who was a pathological gambler were randomly assigned to individual or ICT-PG. Method. This real-life RCT, which is to our knowledge one of the first RCT studies of couple therapy for gambling, evaluates the effectiveness of ICT-PG. Eighty couples were recruited and randomized between ICT-PG (n = 44 couples) and individual treatment (n = 36 couples). The results concern follow-up at 22 month post-admission. Linear Mixed and GEE models for repeated measures were applied to take account the dependency of observations using SAS 9.4. Results. Globally, participants in both modalities improved over time. On many indices of gambling severity, the participants in ICT-PG showed a better improvement at follow-ups: better reduction in gambling addiction, capacity of control and erroneous cognitions. The couple modality is also associated with a better couple functioning observed on different variables at both follow- ups: Marital satisfaction, mutual support, communication skills and conflict resolution. Also, the gambler oriented in ICT-PG present less depressive symptoms and they use less avoidant/detached coping strategy. Partners in the couple modality are less depressed and present a lower degree of psychological distress. These promising results open research and clinical avenues in the field of pathological gambling treatment. They also illustrate the necessity to offer a better diversity of treatment modalities to gamblers and their partner. Further research should help understand how to improve this type of intervention by responding to questions like: What is the optimal number of couple sessions? Can we have a combination of couple and individual sessions?