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Abstract Background Despite the success of gold standard cognitive-behavioral therapy for problem and disordered gambling, the majority of individuals with gambling problems do not seek or receive professional treatment. Thus, the development of less intrusive self-directed interventions has been encouraged. Bibliotherapy for problem gambling has shown promise, both alone and in combination with motivational interviews, but there is still a lack of online self-directed intervention research. The current randomized controlled trial proposes to assess the additive benefit of a single digital motivational interview delivered in conjunction with an online self-directed treatment program for problem gambling and gambling disorder. Methods A two-arm randomized controlled trial will be conducted, wherein eligible participants (N=270) will be recruited across Canada via internet advertisements posted to several platforms. All participants will receive access to an online self-directed gambling intervention program. Participants will be randomly assigned to either complete the online program alone or receive a digital motivational interview, conducted through an online audioconferencing platform (i.e., Microsoft Teams) to supplement the online program. The primary outcomes of gambling severity, frequency, and expenditures will be tracked along with secondary outcomes (i.e., depression, anxiety, general distress, alcohol use, and online program user data) over a 24-month period. It is expected that participants in both groups will experience a reduction in symptoms across the board, but more substantial improvements will be observed in the group that receives a supplemental motivational interview. Discussion The results of this trial will expand upon prior gambling intervention research by informing best practices for the provision of online self-help for problem gambling. Trial registration ISRCTN ISRCTN13009468 . Registered on 7 July 2020.

Abstract Background The current randomized controlled trial seeks to evaluate whether providing access to an Internet intervention for problem drinking in addition to an Internet intervention for problem gambling is beneficial for participants with gambling problems who do or do not have co-occurring problem drinking. Methods Potential participants will be recruited online via a comprehensive advertisement strategy, if they meet the criteria for problem gambling. As part of the baseline measures, problem drinking will also be assessed. Eligible participants (N = 280) who agree to partake in the study and to be followed up for 6 months will be randomized into one of two versions of an Internet intervention for gamblers: an intervention that targets only gambling issues (G-only) and one that combines a gambling intervention with an intervention for problem drinking (G + A). For problem gamblers who exhibit co-occurring problem drinking, it is predicted that participants who are provided access to the G + A intervention will demonstrate a significantly greater level of reduction in gambling outcomes at 6 months compared to those provided access to the G-only intervention. Discussion This trial will expand upon the current research on Internet interventions for addictions and inform the development of treatments for those with co-occurring problem drinking and gambling. Trial Registration ClinicalTrials.gov, NCT03323606. Registered on 24 October 2017.

Abstract Background The majority of content in an Internet Support Group (ISG) is contributed by 1 % of the users (‘super users’). Computational methods, such as topic modelling, can provide a large-scale quantitative objective description of this content. Such methods may provide a new perspective on the nature of engagement on ISGs including the role of super users and their possible effect on other users. Methods A topic model was computed for all posts (N = 131,004) in the ISG BlueBoard using Latent Dirichlet Allocation. A model containing 25 topics was selected on the basis of intelligibility as determined by diagnostic metrics and qualitative investigation. This model yielded 21 substantive topics for further analysis. Two chi-square tests were conducted separately for each topic to ascertain: (i) if the odds of super users’ and other users’ posting differed for each topic; and (ii) if for super users the odds of posting differed depending on whether the response was to a super user or to another user. Results The 21 substantive topics covered a range of issues related to mental health and peer-support. There were significantly higher odds that super users wrote content on 13 topics, with the greatest effects being for Parenting Role (OR [95%CI] = 7.97 [7.85–8.10]), Co-created Fiction (4.22 [4.17–4.27]), Mental Illness (3.13 [3.11–3.16]) and Positive Change (2.82 [2.79–2.84]). There were significantly lower odds for super users on 7 topics, with the greatest effects being for the topics Depression (OR = 0.27 [0.27–0.28]), Medication (0.36 [0.36–0.37]), Therapy (0.55 [0.54–0.55]) and Anxiety (0.55 [0.55–0.55]). However, super users were significantly more likely to write content on 5 out of these 7 topics when responding to other users than when responding to fellow super users. Conclusions The findings suggest that super users serve the role of emotionally supportive companions with a focus on topics broadly resembling the consumer/carer model of recovery. Other users engage in topics with a greater focus on experiential knowledge, disclosure and informational support, a pattern resembling the clinical symptom-focussed approach to recovery. However, super users modify their content in response to other users in a manner consistent with being ‘active help providers’.

Abstract Background Comorbidity between problem gambling and depression or anxiety is common. Further, the treatment needs of people with co-occurring gambling and mental health symptoms may be different from those of problem gamblers who do not have a co-occurring mental health concern. The current randomized controlled trial (RCT) will evaluate whether there is a benefit to providing access to mental health Internet interventions (G + MH intervention) in addition to an Internet intervention for problem gambling (G-only intervention) in participants with gambling problems who do or do not have co-occurring mental health symptoms. Methods Potential participants will be screened using an online survey to identify participants meeting criteria for problem gambling. As part of the baseline screening process, measures of current depression and anxiety will be assessed. Eligible participants agreeing (N = 280) to take part in the study will be randomized to one of two versions of an online intervention for gamblers – an intervention that just targets gambling issues (G-only) versus a website that contains interventions for depression and anxiety in addition to an intervention for gamblers (G + MH). It is predicted that problem gamblers who do not have co-occurring mental health symptoms will display no significant difference between intervention conditions at a six-month follow-up. However, for those with co-occurring mental health symptoms, it is predicted that participants receiving access to the G + MH website will display significantly reduced gambling outcomes at six-month follow-up as compared to those provided with G-only website. Discussion The trial will produce information on the best means of providing online help to gamblers with and without co-occurring mental health symptoms. Trial registration ClinicalTrials.gov NCT02800096 ; Registration date: June 14, 2016.