Dropout from face-to-face, multi-session psychological treatments for problem and disordered gambling: A systematic review and meta-analysis.

Abstract

Objective: The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates. Method: A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates. Results: The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators. Conclusions: A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. Public Health Significance StatementThis review suggests that a significant proportion of individuals drop out of psychological treatments for problem gambling and gambling disorder. This review also recommends that the field adopt symptombased dropout definitions to determine the adequate dosage of psychological treatment for problem gambling and gambling disorder.

Client Views of Contingency Management in Gambling Treatment: A Thematic Analysis

“…This suggests that there is potential to influence clients if engaged through CM. Clients also recognized the importance of shortening duration of harmful active gambling prior to help seeking, and of retaining people in treatment or peer groups; this corresponds with what is known about low rates of treatment seeking and high dropout rates [ 2 , 3 , 13 ].…”

“…Gambling is a growing international public health issue that can have negative, harmful consequences across several domains [ 1 ]. Treating difficulties that arise due to harmful gambling requires effective, evidence-based intervention, yet most individuals do not seek treatment and a large proportion drop out before completion [ 2 ]. For example, in 2019, 9008 people in Great Britain accessed treatment from the National Gambling Treatment Service, which is less than 5% of adults who might benefit [ 3 ].…”

Predicting online problem gambling treatment discontinuation: New evidence from cross-validated models.

“…Several demographic and psychological factors predict dropping out of treatment, although findings across studies are inconsistent due to small sample sizes and different methodological definitions of dropout (Melville et al, 2007; Pfund et al, 2021). For example, dropping out may be defined as the discontinuation of treatment before finishing all or just some of the prescribed sessions of a treatment protocol (Pfund et al, 2021; Pickering et al, 2018), or based on therapist judgment (Smith et al, 2015). Pretreatment dropout refers to those who sign up for treatment but do not start it (Dowling, 2009).…”

Latent Classes for the Treatment Outcomes in Women with Gambling Disorder and Buying/Shopping Disorder

“…Several cognitive and behavioral techniques are included in CBT programs, such as stimulus control, self-reinforcement, live exposure with response prevention, skills training and relapse prevention strategies (through other activities that are also rewarding and non-harmful). However, despite a significant body of literature assessing the efficacy of CBT for men diagnosed with GD, few treatment studies have focused on exploring the treatment outcomes for women with GD [57] and BSD [58]. This study is intended to provide new scientific evidence on the response to CBT in a clinical sample of women with behavioral addictions, specifically for the GD and the BSD subtypes.…”