Helping Others Promote Engagement in Gambling Support (HOPE-Gam): a Feasibility Randomised Controlled Trial

Problem gambling (PG) causes significant harm yet help-seeking rates remain low. Concerned significant others (CSOs) may play a pivotal role in motivating treatment-refusing gamblers to seek help. The Helping Others Promote Engagement in Gambling Support (HOPE-Gam) intervention was developed to support CSOs in this role. This pilot randomised controlled trial assessed its feasibility and acceptability. Secondary aims included preliminary exploration of efficacy signals and refinement of trial procedures for a future large-scale study. The trial was registered retrospectively on 03/09/25 with ANZCTR: ACTRN12625000970448. Thirty adult CSOs were randomised to either HOPE-Gam or standard care (SC). Both interventions were manualised and delivered over six sessions by cognitive behaviour therapists. HOPE-Gam incorporated behavioural strategies informed by learning theory and contingency management principles. Feasibility outcomes included recruitment, retention, and data completeness. Secondary outcomes included gambler treatment entry and CSO well-being. Recruitment (65%; 95% CI: 50.8%–77.3%) was feasible via digital outreach; retention was moderate (33% lost to follow-up). Treatment entry was higher in the HOPE-Gam group (60% vs. 7%, p = 0.002). There was a greater reduction in K10 scores in the HOPE-Gam group at post-treatment (-6.99, 95% CI -12 to -1.90, p = 0.007) and 1-month follow-up (-8.20, 95% CI -3.4 to -13.2, p = 0.002). No adverse events were reported. HOPE-Gam shows promise as a feasible and potentially effective intervention for CSOs of treatment-refusing individuals with PG. Findings support progression to a fully powered trial to evaluate efficacy and safety. HOPE-Gam may offer a valuable addition to clinical practice, addressing the gap in support for CSOs and contributing to harm reduction in PG.