Gambling Treatment Outcome Research Articles

A Resource Model of Change: Client Factors that Influence Problem Gambling Treatment Outcomes.

This study examined a resource-based model of change whereby poor problem gambling (PG) treatment outcomes and relapse are viewed as resulting from client coping resources being diminished or overwhelmed. Specifically, client factors that work like resources to facilitate treatment (i.e., social support, self-efficacy, motivation, readiness for change, and emotion-focused coping) or use up resources and hinder treatment (i.e., co-morbid depression and life stress) were examined. The 50 participants were followed for 4 months after entering treatment for PG and were assessed at baseline, 1 month into treatment, 2 months into treatment, and during a follow-up 4 months after treatment began. Of the 50 participants, 20 dropped-out of treatment and 24 completed the follow-up measure. The results suggest that self-efficacy and depression, measured at baseline, are good predictors of 1- and 2-month outcomes, whereas depression and life stress, measured after 2 months of treatment, are good predictors of 4-month outcomes. In the strongest of these models, baseline scores of client self-efficacy and depressed affect explained as much as 48.7% of the variance in gambling behaviors 2 months later.

The relationship of tobacco use with gambling problem severity and gambling treatment outcome.

This study sought to examine the impact of tobacco use on gambling treatment. Pathological gambling (PG) is a psychiatric condition associated with significant financial, emotional, and psychosocial consequences. Elevated rates of nicotine dependence have been associated with increased gambling severity and more frequent psychiatric problems. A total of 385 treatment-seeking pathological gamblers enrolled in one of 11 gambling treatment providers in Minnesota were assessed. Linear regression modeling was used to examine demographic and clinical variables at treatment entry and the relationship between those variables and the number of days gambled at a 6-month posttreatment. Logistic regression was utilized to assess predictors of treatment completion. Daily tobacco use was reported in 244 (63.4%) subjects. Tobacco users presented with significantly more severe gambling and mental health symptoms at treatment intake. Daily tobacco use, however, was not significantly associated with the number of days gambled or with treatment completion. Although tobacco users present with greater gambling problem severity, they had similar rates of treatment completion and treatment outcomes as nonusers.

Reliability and validity of the Sheehan disability scale modified for pathological gambling

BackgroundAn interview format version of the Sheehan Disability Scale (SDS) modified to assess gambling treatment outcomes was assessed for reliability and validity. The SDS assesses impairment in work, family and social functioning related to mental disorders.MethodsA pilot study (N = 21) determined the preferred wording for oral administration. Participants with pathological gambling in a relapse prevention clinical trial completed the scale and other validation measures at baseline, six and twelve month follow-ups (N = 169).ResultsConfirmatory factor analysis supported a one factor solution and the scale had good internal reliability for a three item scale. The SDS was sensitive to change and correlations with recent gambling behaviour and severity were moderate as expected. Similarly, correlations with self-efficacy, perceived control over gambling, and craving were moderate, but they were lower for less directly related constructs such as depression and perceived family and friend support.ConclusionsThe SDS is a brief, psychometrically sound, outcome measure of impairment associated with gambling disorders that can be administered by telephone.

Discounting of probabilistic rewards is associated with gambling abstinence in treatment-seeking pathological gamblers.

Individuals with addictive disorders, including substance abusers and pathological gamblers, discount or devalue rewards delayed in time more than controls. Theoretically, preference for probabilistic rewards is directly related to gambling, but limited empirical research has examined probabilistic discounting in individuals with pathological gambling. This study evaluated probability and delay discounting in treatment-seeking pathological gamblers and their association with gambling treatment outcomes during and after treatment. At time of treatment entry, 226 pathological gamblers completed probability and delay discounting tasks. They were then randomized to one of three treatment conditions, and gambling behavior was measured throughout treatment and at a 1-year follow-up assessment. After controlling for possibly confounding variables and treatment condition, more shallow probability discounting was associated with greater reductions in amounts wagered during treatment and likelihood of gambling abstinence at the end of treatment and throughout the follow-up period. No associations were noted between delay discounting and gambling treatment outcomes. These data suggest that probability discounting may be an important construct in understanding pathological gambling and its treatment.

The influence of depression and other co‐occurring conditions on treatment outcomes for problem gamblers: a cohort study

To examine the influence of co-occurring conditions on gambling treatment outcomes. Prospective cohort study of problem gamblers. Participants were recruited from consecutive referrals to a gambling therapy service in 2008. Inclusion criteria were: (i) assessed as a problem gambler based on a screening interview including DSM-IV criteria for pathological gambling, and (ii) suitable for admission to a treatment program. Cognitive-behavioural therapy was based on graded exposure-to-gambling urge. One-to-one treatment was conducted with 1-hour sessions weekly for up to 12weeks. Problem gambling screening and co-occurring conditions including depression, anxiety and alcohol use. Of 127problem gamblers, 69were males (54%), mean age was 43.09years, and 65(51%) reported a duration of problem gambling greater than 5years. Median time for participants' enrolment in the study was 8.9months. Results from mixed effects logistic regression analysis indicated that individuals with higher depression levels had a greater likelihood (13% increase in odds [95% CI, 1%-25%]) of problem gambling during treatment and at follow-up. Addressing depression may be associated with improved treatment outcomes in problem gambling; conversely, treatment of problem gambling improves affective instability. We therefore recommend a dual approach that treats both depression and problem gambling.

Client Engagement Characteristics Associated with Problem Gambling Treatment Outcomes

Previous research examining the factors associated with problem gambling treatment outcomes has examined client factors and to date, treatment characteristics, therapist factors, and client-therapist interactions have essentially remained unexplored. This study aimed to investigate how client engagement variables (client-rated therapeutic alliance, therapist-rated therapeutic alliance, number of sessions attended, and client commitment) relate to treatment outcomes (gambling and general functioning) in a sample of 475 treatment-seeking problem gambling clients using a series of hierarchical regression analyses. Client-rated therapeutic alliance predicted both gambling and general functioning outcomes, but therapist-rated therapeutic alliance only predicted general functioning outcomes. There was no significant relationship between number of sessions and outcomes, but client commitment predicted gambling outcomes. Client satisfaction only mediated the relationships between therapeutic alliance and treatment outcomes. Taken together, the findings indicate that client engagement characteristics, in particular the therapeutic relationship, are active agents of change in psychological interventions for problem gambling.

Pathological Gamblers Respond Equally Well to Cognitive-Behavioral Therapy Regardless of Other Mental Health Treatment Status

Data consistently demonstrate comorbidity between pathological gambling and psychiatric disorders. This study compares severity of gambling and psychosocial problems and gambling treatment outcomes in treatment-seeking pathological gamblers (n = 231) based on their self-reported mental health treatment utilization. As expected, participants currently receiving mental health treatment demonstrated the most psychiatric problems, and those with no mental health treatment the least. Although preferred gambling activity differed according to mental health treatment status, severity of gambling problems, and gambling treatment outcomes did not. Individual cognitive-behavioral therapy was efficacious in reducing gambling problems irrespective of mental health treatment utilization.

Social Support is Associated with Gambling Treatment Outcomes in Pathological Gamblers

Social Support is Associated with Gambling Treatment Outcomes in Pathological Gamblers

Significant Others and Gambling Treatment Outcomes

This study investigates the effect of significant others on treatment outcomes among treated pathological gamblers. This is a cohort study of individuals who received gambling treatment. Oregon Problem Gambling Services (OPGS) for gamblers and their family members. 4,410 adult gamblers who were discharged from treatment between August, 2001 and April, 2007. OPGS enrollment forms provided gambler gender, age, ethnicity, education level, employment status, gambling-related debt, and whether the gambler had a significant other at the time of enrollment. Termination forms provided information on the type of discharge (successful/unsuccessful) and treatment length (in days). Participation of the gambler's significant other in the family treatment program was identified. Results showed that age, ethnicity, gambling debt, and having a significant other are associated with the odds of successful treatment. Education level moderates the effect of having a significant other on treatment success. Age, ethnicity, education, employment, and having a significant other participate in treatment significantly impacted gamblers' length in treatment. These findings indicate that there may be a benefit to integrating significant others in gambling treatment methods. Significant others may act as social supports for gamblers seeking treatment, and involving loved ones in gambling treatment models may positively affect gambler treatment outcomes.

Behavioral interventions in the treatment of pathological gambling: A review of activity scheduling and desensitization.

Cognitive and behavioral interventions have been cautiously recommended as “best practice” in the treatment of pathological gambling. Behavioral interventions, using a range of techniques, have been the most commonly evaluated approach to the psychological treatment of pathological gambling. The recent literature evaluating behavioral treatments has shifted from aversive therapy to alternative behavioral techniques such as interventions based on desensitization and exposure procedures. A range of other behavioral techniques, such as alternative activity scheduling, problem solving training, financial planning and limit setting, social skills training, and relapse prevention, have been included as treatment components of standardized cognitive-behavioral programs. This paper reviews the published empirical literature investigating the efficacy of the behavioral intervention strategies of activity scheduling and desensitization in the treatment of pathological gambling. Although the findings for both intervention strategies are promising, they must be interpreted with caution given the methodological difficulties inherent in the pathological gambling treatment outcome literature.

Development and psychometric evaluation of the gambling treatment outcome monitoring system (GAMTOMS).

This article describes the development and initial reliability and validity estimates of the Gambling Treatment Outcome Monitoring System (GAMTOMS), a multi-instrument and multidimensional outcome assessment battery designed to measure gambling treatment outcomes. Reliability methods included both internal consistency of scales and a 1-week test-retest temporal stability procedure. Validity was examined with procedures to estimate content, convergent, discriminant, predictive, and construct validity. Data were collected from 2 separate studies, 1 on the questionnaire version and 1 on the interview version. The questionnaire study included 46 female and 41 male gambling treatment clients and 22 female and 2 male nonclinical participants. The interview study included 88 female and 62 male gambling treatment clients and 16 female and 9 male nonclinical participants. The GAMTOMS was found to yield satisfactory estimates of internal consistency, and 1-week test-retest reliability and was also found to demonstrate satisfactory content, convergent, discriminant, predictive, and construct validity.

The Relationship among Negative Affect, Distress Tolerance, and Length of Gambling Abstinence Attempt

The present study tested the theory that negative affect and one's ability to tolerate distress is associated with failure to quit gambling during an abstinence attempt. Specifically, 16 current pathological gamblers who had at least one sustained period of gambling abstinence lasting a minimum of 3 months (i.e., delayed relapsers) and 16 current pathological gamblers who had never remained abstinent for a period longer than 2 weeks (i.e., immediate relapsers), were assessed for baseline levels of negative affect and stress reactivity, as well as faced with a psychological (mental arithmetic) and physical (breath holding) stressor. Compared to the delayed relapsers, the immediate relapsers displayed higher levels of negative affect and stress reactivity. Immediate relapsers also were less likely to persist on the psychological stressor, suggesting that one's ability to tolerate the initial discomfort of an abstinence attempt may play an important role in gambling treatment outcome.

Alcohol Use and Prior Substance Abuse Treatment in Relation to Gambling Problem Severity and Gambling Treatment Outcome

Recent research has made it clear that problematic gambling is often accompanied by problematic alcohol use. Unfortunately, little is known about the nature of this association, especially as it relates to gambling treatment outcome. The purpose of this study is to explore the effect of current alcohol use level and previous substance abuse treatment on the symptoms of a large cohort of pathological gamblers as well as on their response to treatment for pathological gambling. The sample included 464 men and 301 women recruited at six gambling treatment programs in Minnesota. Gambling treatment patients were assessed on a number of gambling problem severity and related clinical variables using the Gambling Treatment Outcome Monitoring System (GAMTOMS). Patients with frequent alcohol use had greater gambling involvement at baseline than infrequent alcohol users. Patients with a previous history of substance abuse treatment had more severe psychosocial problems, ostensibly resulting from their gambling behavior, than patients without past substance abuse treatment. A MANOVA with repeated measures showed that neither pretreatment alcohol use, nor past substance abuse treatment exerted significant effects on gambling treatment outcome. While the level of pretreatment alcohol use and a history of substance abuse treatment are markers for greater gambling problem severity, treatment outcome for pathological gambling was not adversely impacted by these variables.

Review of the First Year of an Overseas Military Gambling Treatment Program

This study provides descriptive information and preliminary first-year outcome data on the only overseas military gambling treatment option currently available. Implemented in January 2003 within the Substance Abuse Rehabilitation Program, U.S. Naval Hospital, Okinawa, Japan, gambling treatment was developed as a specific track within the overall substance abuse program. The present study explores the various considerations and requirements for setting up such a program, as well as a description of individuals seeking gambling treatment and preliminary outcome data. Participants consisted of all gambling referrals (N = 35, 26 males; mean age, 33.2 years; SD = 8.93) obtained over the first year that gambling services were offered. A significant degree of depression, suicidality, and substance abuse problems were observed in the sample. Results revealed that the gambling program was easily implemented within an established substance abuse program. The program was effective in preventing suicides in both military members and eligible beneficiaries and was effective in facilitating the retention of military members with gambling problems.

Stages of Change in Treatment-Seeking Pathological Gamblers.

The transtheoretical model has been applied to many addictive disorders. In this study, psychometrics properties of the University of Rhode Island Change Assessment (URICA) scale were evaluated in 234 pathological gamblers initiating treatment. Four components were identified--reflective of precontemplation, contemplation, action, and maintenance stages--with internal consistency from .74 to .88. Cluster analyses identified 4 patterns of responding, ranging from ambivalent to active change. The 4 clusters differed with respect to baseline gambling variables and treatment engagement and outcomes assessed 2 months later. A continuous measure of readiness to change was also correlated with gambling severity and predictive of reductions in gambling. This study provides initial support for reliability and validity of the URICA in treatment-seeking gamblers, and it suggests that stage of change may have an impact on outcomes.

Self-efficacy in pathological gambling treatment outcome: development of a gambling abstinence self-efficacy scale (GASS)

A 21-item measure of gambling abstinence self-efficacy (GASS) was developed. A principal component analysis of 101 pathological gamblers supported the use of a total score that showed good internal (α=.93) and retest reliability (ICC (n=35)=.86) as well as four subscales: 1) winning/external situations (6 items, α=.91); 2) negative emotions (9 items, α=.87); 3) positive mood/testing/urges (3 items, α=.70); 4) social factors (3 items, α=.81). The total and subscales showed moderate relationships with single item ratings of confidence to abstain from gambling and weak or non-significance relationships with demographic and gambling-related variables. The total score and three of the subscales showed evidence of predictive validity for gamblers not currently involved with treatment. Higher self-efficacy was related to fewer days of gambling over a 12-month period. These results provide preliminary support for the reliability and validity of the GASS.

Treatment issues pertaining to pathological gamblers with a comorbid disorder.

Evidence of an increased risk for various psychiatric disorders among pathological gamblers far exceeds our understanding of the impact that this psychiatric comorbidity has on the outcome of treatment for pathological gambling. One major source of the problem is that treatment efficacy and effectiveness studies for pathological gambling typically have not addressed comorbidity's impact on outcome. This paper discusses epidemiological, clinical, health service delivery, and research issues pertaining to the intersection of pathological gambling treatment outcome and comorbid psychiatric disorders. It is argued that this topic suffers from major knowledge gaps in terms of the nature of comorbidity of pathological gambling and other psychiatric disorders and the role of client characteristics on treatment outcome for pathological gambling. Research priorities are identified.

Relationship between problem gambling and substance use in a methadone maintenance population

Few studies have examined the relationship between pathological gambling and substance abuse treatment outcome. This study assessed the gambling behavior of 62 patients enrolled in a methadone maintenance treatment program. Eleven (17.7%) met current SOGS criteria for probable pathological gambling. Patients with and without probable pathological gambling were compared on substance abuse treatment outcome measures including urine toxicology results for heroin and cocaine use, and clinic dropout. Results indicated that those who were probable pathological gamblers were more likely to use cocaine through therapy, and more likely to drop out of the clinic treatment program than non-pathological gamblers. Implications for substance abuse treatment are discussed.

Patterns of substance use in treatment-seeking problem gamblers: impact on treatment outcomes.

Accumulating evidence suggests that treatment-seeking problem gamblers have high rates of substance abuse. However, relatively little is known about the relation between gambling problems and specific psychoactive substances apart from alcohol and methadone-treated opiate addicts. In this study of 169 individuals seeking outpatient treatment for problem gambling, lifetime drug use and medication use were very high. Approximately half of the sample were using a psychiatric medication at the time they sought gambling treatment while very few individuals were using other drugs. Gambling treatment outcomes were unrelated to history of drug or medication use. No evidence was found for substitution of psychoactive substance use for gambling during the follow-up year. These findings indicate that gamblers are more likely to be involved with drug and medication use compared to the general population, but that such histories are not associated with gambling treatment outcomes.