Reasons for dropping out of internet-based problem gambling treatment, and the process of recovery – a qualitative assessment

Abstract

Problem gambling (PG) is a condition affecting the economy, mental health, and relationships of both the individuals with gambling problems, and concerned significant others (CSOs). While PG is treatable, few individuals with gambling problems seek treatment, and many drop out of treatment. This qualitative study aims to investigate a) the reasons for individuals with gambling problems to drop-out from Internet-based PG treatment, and b) what individuals with gambling problems and CSOs find helpful and unhelpful processes in PG recovery. A total of 16 participants (8 individuals with gambling problems and 8 CSOs) who had participated in an Internet-based PG treatment were interviewed over the telephone in a semi-structured interview. The interviews were analyzed using thematic analysis. Drop-out from treatment was one aspect of an overarching theme identified as unstable path to recovery, where alternating periods of progress and setbacks delineate several aspects of PG. Relapses, negative emotions, and changing life circumstances were identified to separately, and in combination, contribute to drop-out. Drop-outs were also explained by participants’ experiences of a reduced need for treatment. Openness and a support from CSOs and peers were identified as themes important for recovery. The results suggest that PG treatments should consider the emotional state, and comorbidities of the patients, in order to reduce drop-out and improve chances of recovery.

Treatment for the concerned significant others of gamblers: A systematic review

“…Out of these, 6 were eligible but 3 were not retrieved: 2 CCT reports undergoing review, and unpublished data (5-step method) (B. Lee, personal communication, 15th June 2021; R. Velleman, personal communication, 14th May 2021). Thus, 3 unpublished studies ( Bastardo Gaelzer, 2019 ; Nilsson, 2020 ; Shi, 2021 ) were included as a result of contacting experts.…”

“…After the completion of the systematic review, the publication alerts set for the databases identified 2 relevant records (last update 19.11.2021). Namely, a previously unpublished manuscript by Nilsson (2020) was published ( Nilsson, Simonsson, & Hellner, 2021 ). Additionally, 1 new record was identified ( Marionneau & Järvinen-Tassopoulos, 2021 ) which dealt with how gamblers and CSOs had experienced changes in services as a consequence of the COVID-19 pandemic; this article however was not deemed eligible due to the primary focus being the effects of the pandemic.…”

“…5 studies were RCTs ( Lee & Awosoga, 2015 ; Magnusson et al, 2019 ; Nayoski & Hodgins, 2016 ; Nilsson et al, 2018 , 2020 ), 4 were case studies ( Bastardo Gaelzer, 2019 ; Lee, 2012 , 2015 ; Shi, 2021 ), 2 were explorative surveys ( Rodda et al, 2013 , 2017 ), and 2 were based on post-treatment/follow-up interviews ( Nilsson, 2020 ; Tremblay et al, 2018 ). One study (2 reports) utilized a mixed method approach ( Kourgiantakis, 2017 ; Kourgiantakis, Saint-Jacques, & Tremblay, 2018 ), one utilized within-subject quantitative data ( Orford et al, 2017 ), and one was a feasibility study ( Buchner et al, 2019 ).…”

“…The ICS subscales concerning CSOs (emotional and behavioral consequences) were selected as an additional outcome measure, because it was used in 3 studies ( Magnusson et al, 2019 ; Nilsson et al, 2020 ; Peden, 2011 ). The subscale-specific scores from Nilsson et al (2020) study were provided by the corresponding author. The effect size estimates for ICS subscales were of small to medium magnitude (0.1–0.3).…”

“…BCT: Nilsson et al, 2018Nilsson et al, , 2020Nilsson et al, , 2021. Online Behavioral Couples Therapy (BCT) consisted of 2 studies documented in 3 reports: 1 pilot RCT report (Nilsson et al, 2018), 1 RCT report (Nilsson et al, 2020) and 1 qualitative study (Nilsson et al, 2021).…”