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Published in: Journal of Gambling Studies 4/2017

01-12-2017 | Original Paper

Gambling Disorder: Exploring Pre-treatment and In-treatment Dropout Predictors. A UK Study

Authors: Silvia Ronzitti, Emiliano Soldini, Neil Smith, Massimo Clerici, Henrietta Bowden-Jones

Published in: Journal of Gambling Studies | Issue 4/2017

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Abstract

The aim of this study was to identify predictors of treatment dropout in a sample of gamblers attending a specialist clinic for gambling disorder. We analysed data on 846 treatment-seeking pathological gamblers. Firstly, we investigated differences in socio-demographic and clinical variables between treatment completers and pre-treatment dropouts, as well as between treatment completers and during-treatment dropouts. Subsequently, variables were entered into a multinomial logistic regression model to identify significant predictors of pre-treatment and in-treatment dropout. Overall, 44.8% of clients did not complete the treatment: 27.4% dropped out before starting it, while 17.4% dropped out during the treatment. Younger age and use of drugs were associated with pre-treatment dropout, while family history of gambling disorder, a lower PGSI score, and being a smoker were related with in-treatment dropout. Our findings suggest that pre-treatment dropouts differ from in-treatment dropouts, and, thus, further research will benefit from considering these groups separately. In addition, this newly gained knowledge will also be helpful in increasing treatment retention in specific subgroups of problem gamblers.
Literature
go back to reference Alvarez-Moya, E. M., Ochoa, C., Jimenez-Murcia, S., Aymami, M. N., Gomez-Pena, M., Fernandez-Aranda, F., et al. (2011). Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling. Jouranl of Psychiatry & Neuroscience, 36, 165–175.CrossRef Alvarez-Moya, E. M., Ochoa, C., Jimenez-Murcia, S., Aymami, M. N., Gomez-Pena, M., Fernandez-Aranda, F., et al. (2011). Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling. Jouranl of Psychiatry & Neuroscience, 36, 165–175.CrossRef
go back to reference American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association.CrossRef American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association.CrossRef
go back to reference Aragay, N., Jimenez-Murcia, S., Granero, R., Fernandez-Aranda, F., Ramos-Grille, I., Cardona, S., et al. (2015). Pathological gambling: Understanding relapses and dropouts. Comprehensive Psychiatry, 57, 58–64.CrossRefPubMed Aragay, N., Jimenez-Murcia, S., Granero, R., Fernandez-Aranda, F., Ramos-Grille, I., Cardona, S., et al. (2015). Pathological gambling: Understanding relapses and dropouts. Comprehensive Psychiatry, 57, 58–64.CrossRefPubMed
go back to reference Bartley, C. A., & Bloch, M. H. (2013). Meta-analysis: Pharmacological treatment of pathological gambling. Expert Review of Neurotherapeutics, 13, 887–894.CrossRefPubMed Bartley, C. A., & Bloch, M. H. (2013). Meta-analysis: Pharmacological treatment of pathological gambling. Expert Review of Neurotherapeutics, 13, 887–894.CrossRefPubMed
go back to reference Blaszczynski, A., & Nower, L. (2002). A pathways model of problem and pathological gambling. Addiction, 97, 487–499.CrossRefPubMed Blaszczynski, A., & Nower, L. (2002). A pathways model of problem and pathological gambling. Addiction, 97, 487–499.CrossRefPubMed
go back to reference Braun, B., Ludwig, M., Sleczka, P., Buhringer, G., & Kraus, L. (2014). Gamblers seeking treatment: Who does and who doesn’t? Journal of Behavioral Addictions, 3, 189–198.CrossRefPubMedPubMedCentral Braun, B., Ludwig, M., Sleczka, P., Buhringer, G., & Kraus, L. (2014). Gamblers seeking treatment: Who does and who doesn’t? Journal of Behavioral Addictions, 3, 189–198.CrossRefPubMedPubMedCentral
go back to reference Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.CrossRefPubMed Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.CrossRefPubMed
go back to reference Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Archives of Internal Medicine, 158, 1789–1795.CrossRefPubMed Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Archives of Internal Medicine, 158, 1789–1795.CrossRefPubMed
go back to reference Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database Systematic Review, 11, CD008937. Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database Systematic Review, 11, CD008937.
go back to reference Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015a). The prevalence of comorbid personality disorders in treatment-seeking problem gamblers: A systematic review and meta-analysis. Journal of Personality Disorders, 29, 735–754.CrossRefPubMed Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015a). The prevalence of comorbid personality disorders in treatment-seeking problem gamblers: A systematic review and meta-analysis. Journal of Personality Disorders, 29, 735–754.CrossRefPubMed
go back to reference Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015b). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49, 519–539.CrossRefPubMedPubMedCentral Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015b). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49, 519–539.CrossRefPubMedPubMedCentral
go back to reference Dunn, K., Delfabbro, P., & Harvey, P. (2012). A preliminary, qualitative exploration of the influences associated with drop-out from cognitive-behavioural therapy for problem gambling: An Australian perspective. Journal of Gambling Studies, 28, 253–272.CrossRefPubMed Dunn, K., Delfabbro, P., & Harvey, P. (2012). A preliminary, qualitative exploration of the influences associated with drop-out from cognitive-behavioural therapy for problem gambling: An Australian perspective. Journal of Gambling Studies, 28, 253–272.CrossRefPubMed
go back to reference Dunn, C., Deroo, I., & Rivara, F. P. (2001). The use of brief interventions adapted from motivational interviewing across behavioral domains: A systematic review. Addiction, 96, 1725–1742.CrossRefPubMed Dunn, C., Deroo, I., & Rivara, F. P. (2001). The use of brief interventions adapted from motivational interviewing across behavioral domains: A systematic review. Addiction, 96, 1725–1742.CrossRefPubMed
go back to reference Echeburua, E., Baez, C., & Fernandez-Montalvo, J. (1996). Comparative effectiveness of three therapeutic modalities in the psyhcological treatment of pathological gambling: Long term outcome. Behavioural and Cognitive Psychotherapy, 24, 51–72.CrossRef Echeburua, E., Baez, C., & Fernandez-Montalvo, J. (1996). Comparative effectiveness of three therapeutic modalities in the psyhcological treatment of pathological gambling: Long term outcome. Behavioural and Cognitive Psychotherapy, 24, 51–72.CrossRef
go back to reference Echeburua, E., Fernandez-Montalvo, J., & Baez, C. (2001). Predictors of therapeutic failure in slot-machine pathological gamblers following behavioural treatment. Behavioural and Cognitive Psychotherapy, 29, 379–383.CrossRef Echeburua, E., Fernandez-Montalvo, J., & Baez, C. (2001). Predictors of therapeutic failure in slot-machine pathological gamblers following behavioural treatment. Behavioural and Cognitive Psychotherapy, 29, 379–383.CrossRef
go back to reference Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83, 1108–1122.CrossRefPubMed Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83, 1108–1122.CrossRefPubMed
go back to reference Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index: User manual. Toronto: Canadian Centre on Substance Abuse. Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index: User manual. Toronto: Canadian Centre on Substance Abuse.
go back to reference Hodgins, D. C., Currie, S., el-Guebaly, N., & Peden, N. (2004). Brief motivational treatment for problem gambling: A 24-month follow-up. Psychology of Addictive Behaviors, 18, 293–296.CrossRefPubMed Hodgins, D. C., Currie, S., el-Guebaly, N., & Peden, N. (2004). Brief motivational treatment for problem gambling: A 24-month follow-up. Psychology of Addictive Behaviors, 18, 293–296.CrossRefPubMed
go back to reference Hodgins, D. C., & Holub, A. (2015). Components of impulsivity in gambling disorder. International Journal of Mental Health and Addiction, 13(6), 699–711.CrossRefPubMedPubMedCentral Hodgins, D. C., & Holub, A. (2015). Components of impulsivity in gambling disorder. International Journal of Mental Health and Addiction, 13(6), 699–711.CrossRefPubMedPubMedCentral
go back to reference Holtgraves, T. (2009). Evaluating the problem gambling severity index. Journal of Gambling Studies, 25, 105–120.CrossRefPubMed Holtgraves, T. (2009). Evaluating the problem gambling severity index. Journal of Gambling Studies, 25, 105–120.CrossRefPubMed
go back to reference Jimenez-Murcia, S., Alvarez-Moya, E. M., Stinchfield, R., Fernandez-Aranda, F., Granero, R., Aymami, N., et al. (2010). Age of onset in pathological gambling: Clinical, therapeutic and personality correlates. Journal of Gambling Studies, 26, 235–248.CrossRefPubMed Jimenez-Murcia, S., Alvarez-Moya, E. M., Stinchfield, R., Fernandez-Aranda, F., Granero, R., Aymami, N., et al. (2010). Age of onset in pathological gambling: Clinical, therapeutic and personality correlates. Journal of Gambling Studies, 26, 235–248.CrossRefPubMed
go back to reference Jimenez-Murcia, S., Aymami, N., Gomez-Pena, M., Santamaria, J. J., Alvarez-Moya, E., Fernandez-Aranda, F., et al. (2012). Does exposure and response prevention improve the results of group cognitive-behavioural therapy for male slot machine pathological gamblers? British Journal of Clinical Psychology, 51, 54–71.CrossRefPubMed Jimenez-Murcia, S., Aymami, N., Gomez-Pena, M., Santamaria, J. J., Alvarez-Moya, E., Fernandez-Aranda, F., et al. (2012). Does exposure and response prevention improve the results of group cognitive-behavioural therapy for male slot machine pathological gamblers? British Journal of Clinical Psychology, 51, 54–71.CrossRefPubMed
go back to reference Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedPubMedCentral Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedPubMedCentral
go back to reference Kroenke, K., Spitzer, R. L., Williams, J. B., & Lowe, B. (2010). The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32, 345–359.CrossRefPubMed Kroenke, K., Spitzer, R. L., Williams, J. B., & Lowe, B. (2010). The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32, 345–359.CrossRefPubMed
go back to reference Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Lowe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325.CrossRefPubMed Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Lowe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325.CrossRefPubMed
go back to reference Leblond, J., Ladouceur, R., & Blaszczynski, A. (2003). Which pathological gamblers will complete treatment? British Journal of Clinical Psychology, 42, 205–209.CrossRefPubMed Leblond, J., Ladouceur, R., & Blaszczynski, A. (2003). Which pathological gamblers will complete treatment? British Journal of Clinical Psychology, 42, 205–209.CrossRefPubMed
go back to reference Lobo, D. S., & Kennedy, J. L. (2009). Genetic aspects of pathological gambling: A complex disorder with shared genetic vulnerabilities. Addiction, 104, 1454–1465.CrossRefPubMed Lobo, D. S., & Kennedy, J. L. (2009). Genetic aspects of pathological gambling: A complex disorder with shared genetic vulnerabilities. Addiction, 104, 1454–1465.CrossRefPubMed
go back to reference Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction, 106, 490–498.CrossRefPubMed Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction, 106, 490–498.CrossRefPubMed
go back to reference Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2007). Psychological treatment dropout among pathological gamblers. Clinical Psychology Review, 27, 944–958.CrossRefPubMed Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2007). Psychological treatment dropout among pathological gamblers. Clinical Psychology Review, 27, 944–958.CrossRefPubMed
go back to reference Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., Hallak, J. E., Trzesniak, C., de Azevedo Marques, J. M., et al. (2010). Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcoholism-Clincial and Experimental Research, 34, 1417–1424. Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., Hallak, J. E., Trzesniak, C., de Azevedo Marques, J. M., et al. (2010). Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcoholism-Clincial and Experimental Research, 34, 1417–1424.
go back to reference Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford Press. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford Press.
go back to reference Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97, 265–277.CrossRefPubMed Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97, 265–277.CrossRefPubMed
go back to reference Milton, S., Crino, R., Hunt, C., & Prosser, E. (2002). The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling. Journal of Gambling Studies, 18, 207–229.CrossRefPubMed Milton, S., Crino, R., Hunt, C., & Prosser, E. (2002). The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling. Journal of Gambling Studies, 18, 207–229.CrossRefPubMed
go back to reference Nagelkerke, N. J. D. (1991). A note on a general definition of the coefficient of determination. Biometrika, 78, 691–692.CrossRef Nagelkerke, N. J. D. (1991). A note on a general definition of the coefficient of determination. Biometrika, 78, 691–692.CrossRef
go back to reference Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. Applications to addictive behaviors. American Psychologist, 47, 1102–1114.CrossRefPubMed Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. Applications to addictive behaviors. American Psychologist, 47, 1102–1114.CrossRefPubMed
go back to reference Robson, E., Edwards, J., Smith, G., & Colman, I. (2002). Gambling decisions: An early intervention program for problem gamblers. Journal of Gambling Studies, 18, 235–255.CrossRefPubMed Robson, E., Edwards, J., Smith, G., & Colman, I. (2002). Gambling decisions: An early intervention program for problem gamblers. Journal of Gambling Studies, 18, 235–255.CrossRefPubMed
go back to reference Ronzitti, S., Lutri, V., Smith, N., Clerici, M., & Bowden-Jones, H. (2016a). Gender differences in treatment-seeking British pathological gamblers. Journal of Behavioral Addictions, 5, 231–238.CrossRefPubMedPubMedCentral Ronzitti, S., Lutri, V., Smith, N., Clerici, M., & Bowden-Jones, H. (2016a). Gender differences in treatment-seeking British pathological gamblers. Journal of Behavioral Addictions, 5, 231–238.CrossRefPubMedPubMedCentral
go back to reference Ronzitti, S., Soldini, E., Lutri, V., Smith, N., Clerici, M., & Bowden-Jones, H. (2016b). Types of gambling and levels of harm: A UK study to assess severity of presentation in a treatment-seeking population. Journal of Behavioral Addictions, 5, 439–447.CrossRefPubMedPubMedCentral Ronzitti, S., Soldini, E., Lutri, V., Smith, N., Clerici, M., & Bowden-Jones, H. (2016b). Types of gambling and levels of harm: A UK study to assess severity of presentation in a treatment-seeking population. Journal of Behavioral Addictions, 5, 439–447.CrossRefPubMedPubMedCentral
go back to reference Slutske, W. S. (2006). Natural recovery and treatment-seeking in pathological gambling: Results of two U.S. national surveys. American Journal of Psychiatry, 163, 297–302.CrossRefPubMed Slutske, W. S. (2006). Natural recovery and treatment-seeking in pathological gambling: Results of two U.S. national surveys. American Journal of Psychiatry, 163, 297–302.CrossRefPubMed
go back to reference Smith, D., Harvey, P., Battersby, M., Pols, R., Oakes, J., & Baigent, M. (2010). Treatment outcomes and predictors of drop out for problem gamblers in South Australia: A cohort study. Australian and New Zealand Journal of Psychiatry, 44, 911–920.CrossRefPubMed Smith, D., Harvey, P., Battersby, M., Pols, R., Oakes, J., & Baigent, M. (2010). Treatment outcomes and predictors of drop out for problem gamblers in South Australia: A cohort study. Australian and New Zealand Journal of Psychiatry, 44, 911–920.CrossRefPubMed
go back to reference Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefPubMed Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefPubMed
go back to reference Sylvain, C., Ladouceur, R., & Boisvert, J. M. (1997). Cognitive and behavioral treatment of pathological gambling: A controlled study. Journal of Consulting and Clinical Psychology, 65, 727–732.CrossRefPubMed Sylvain, C., Ladouceur, R., & Boisvert, J. M. (1997). Cognitive and behavioral treatment of pathological gambling: A controlled study. Journal of Consulting and Clinical Psychology, 65, 727–732.CrossRefPubMed
go back to reference Toneatto, T. (2005). A perspective on problem gambling treatment: Issues and challenges. Journal of Gambling Studies, 21, 73–80.CrossRefPubMed Toneatto, T. (2005). A perspective on problem gambling treatment: Issues and challenges. Journal of Gambling Studies, 21, 73–80.CrossRefPubMed
go back to reference Wulfert, E., Blanchard, E. B., Freidenberg, B. M., & Martell, R. S. (2006). Retaining pathological gamblers in cognitive behavior therapy through motivational enhancement: A pilot study. Behavior Modification, 30, 315–340.CrossRefPubMed Wulfert, E., Blanchard, E. B., Freidenberg, B. M., & Martell, R. S. (2006). Retaining pathological gamblers in cognitive behavior therapy through motivational enhancement: A pilot study. Behavior Modification, 30, 315–340.CrossRefPubMed
Metadata
Title
Gambling Disorder: Exploring Pre-treatment and In-treatment Dropout Predictors. A UK Study
Authors
Silvia Ronzitti
Emiliano Soldini
Neil Smith
Massimo Clerici
Henrietta Bowden-Jones
Publication date
01-12-2017
Publisher
Springer US
Published in
Journal of Gambling Studies / Issue 4/2017
Electronic ISSN: 1573-3602
DOI
https://doi.org/10.1007/s10899-017-9686-2

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