Stability and Progression of Disordered Gambling: Lessons from Longitudinal Studies

Abstract

W La Revue canadienne de psychiatrie, vol 53, no 1, janvier 2008 52Objective: Few studies have explicitly examined the stability (that is, the tendency for individuals to stay at one diagnostic level as opposed to moving to another improved or worsened level) or progression of disordered gambling; however, conventional wisdom holds that disordered gambling is intractable and escalating. The objective of this study was to examine these assumptions. Method:We reviewed 5 recent prospective studies of gambling behaviour among nontreatment samples for evidence related to the stability and progression of disordered gambling.Results: Our review found no evidence to support the assumption that individuals cannot recover from disordered gambling (that is, the persistence assumption), no evidence to support the assumption that individuals who have more severe gambling problems are less likely to improve than individuals who have less severe gambling problems (that is, the selective-stability assumption), and no evidence to support the assumption that individuals who have some gambling problems are more likely to worsen than individuals who do not have gambling problems (that is, the progression assumption). Conclusion:Contrary to professional and conventional wisdom suggesting that gambling problems are always progressive and enduring, this review demonstrates instability and multidirectional courses in disordered gambling. Can J Psychiatry 2008;53(1):52-60Information on funding and support and author affiliations appears at the end of the article. Clinical Implications· There is considerable movement in and out of more severe and less severe levels of gambling disorder. · The current evidence suggests that the general course of disordered gambling is in the direction of improved classifications: for individuals who experience maladaptive behaviour patterns (that is, Level 2 and Level 3 gamblers), the likelihood of improvement is high. · To avoid positively biasing treatment-outcome research, research that involves estimating treatment outcome should measure or, if a controlled experiment is not possible, acknowledge the extent to which people with disorders improve on their own. Limitations· More research is needed to characterize the nature, determinants, and stability of the worsening of disordered gambling. · Future research should use prospective designs to examine correlates of recovery patterns. · It is possible that, even though the individuals in the studies tended toward improvement in their gambling behaviour, they might have replaced their disordered gambling with a different type of disordered behaviour (for example, smoking, compulsive shopping, or excessive drinking).

Problem Gambling and the Youth-to-Adulthood Transition: Assessing Problem Gambling Severity Trajectories in a Sample of Young Adults

“…At the individual level of analysis, problem gambling emerges as unstable and multidirectional in its course (LaPlante et al 2008). In their review of five longitudinal studies of gambling behavior among non-treatment samples, LaPlante et al (2008: 58) conclude that the evidence indicates ''considerable movement in and out of severe and less severe levels of gambling disorder'', and that people with gambling problems may improve on their own, although, ''improvement is not a certainty and the rates of worsening are still substantial''.…”

Does the look matter? The impact of casino servicescape on gaming customer satisfaction, intention to revisit, and desire to stay

“…Unfortunately the latter set of motivations also influences gambler's duration of stay and willingness to revisit a casino. Prior research shows that the proportion of addicted gamblers is relatively small and has been estimated to be around 0.2-2.1% of the adult population (LaPlante et al, 2008).…”

Disordered Gambling: Etiology, Trajectory, and Clinical Considerations

“…The conventional response to these issues has been to encourage everyone with a gambling problem to enter treatment. This places an unnecessary burden on the health care system because the epidemiological evidence shows that excessive gamblers change more rapidly than observers expect (LaPlante et al 2008a) and that about half already are in treatment for other problems (Kessler et al 2008). As a result, it is imperative that we provide clinical tools (e.g., brief public health screens; guides for self-directed change; e-health resources) and public policies that allow and, under the proper circumstances, encourage individuals with gambling problems to recover on their own (i.e., self-help).…”

“…PG is a more complex and unstable disorder (LaPlante et al 2008a) than originally and traditionally thought (e.g., American Psychiatric Association 2000; Gamblers Anonymous 2010;…”