« Jeu-contrôle », rationnel d'une application de soutien aux limites de jeux

Gambling disorder (GD) is characterized by persistent and recurrent maladaptive gambling behavior. This disorder was recently acknowledged in the DSM-5 as a behavioral addiction. GD is particularly associated with patterns of loss of control relating to time and money spent on gambling activities. Different factors are involved in this pattern of loss of control including arousal, dissociation and immersion during gambling, escaping from aversive affects and thoughts when in gambling sessions and attempts to recover from previous financial losses. In addition, specific cognitive distortions are associated with GD, mainly related to the illusion of control (over-estimation of one's own influence over the uncontrollable outcomes of gambling-related games). Furthermore, several game characteristics increase the loss of control during a game session. For example, near misses activate the brain regions related to wins, increase arousal and, unsurprisingly, increase people's involvement in subsequent game sessions. Although GD is a common disorder with serious psychological and social consequences, there is currently no approved pharmacological treatment. However, patients can be helped by psychotherapy. Studies on motivational interview and cognitive and behavioral therapy of GD have shown favorable outcomes on gambling behaviors, at least in the short term. Most of the studies available to date focus on gambling abstinence. Rather than focusing on abstinence from gambling activities, it seems that gambling in more controlled ways is a viable and attractive goal for numerous gamblers. In particular, it was found that many gamblers tend to change their own goals (abstinence versus control) in a one-year follow-up. Supporting such controlled gambling activities as defined by the gamblers is a promising avenue. Unfortunately, in spite of available treatment, only a very small proportion of people with GD ask for help. Internet delivered treatments provide new opportunities for GD help. A wide range of people with GD can be reached using such tools. In consideration of the wide diffusion of Internet gambling during recent years, it is very important for prevention and help resources to be available online. Some preliminary randomized controlled studies on Internet treatments for GD have shown promise. The rise of electronic lotteries and Internet gambling offer new opportunities to help people to increase gambling control and responsible gambling (e.g. gambling with adequate control of time and money spent on gambling-related activities). It seems easier to track a person's gambling activities and to give specific feedback. Such personalized feedback appears to be promising. In particular, feedback may help people to fix and adhere to their own pre-fixed gambling limits (time and money). It seems possible to offer options in electronic gambling venues. However, most people, particularly those suffering from GD, use different Internet and land-based gambling offers. Based on these observations, smartphone apps could possibly offer attractive opportunities. Apps for smartphones provide an increasing range of possibilities for helping people with mental health and addictive disorders. Different studies already support the feasibility and possible efficacy of such apps. The present paper gives an overview of the rationale and the description of an app specifically designed to help people with GD (“jeu-contrôle”) in fixing and adhering to their own time and money limits. A special emphasis on psychological needs related to the self-determination theory (autonomy, competence, and relatedness) was considered during the app design. In relation to limit-setting, such an app may help people by ecological momentary assessments and interventions to set limits, and personalized feedback in relation to the participant's own goal limits. The app, available in French and German, is associated with an Internet website (allowing access to some additional information and tools) and is available on Google Play (Android) and the App Store (iOS) at no charge. Future studies are planned to assess the usefulness and efficacy of the “Jeu-contrôle” app.