Advertisement

Journal of Gambling Studies

, Volume 30, Issue 1, pp 89–103 | Cite as

Predictors of Treatment Outcome Among Asian Pathological Gamblers (PGs): Clinical, Behavioural, Demographic, and Treatment Process Factors

  • Song Guo
  • Victoria ManningEmail author
  • Kyaw Kyaw Wai Thane
  • Andrew Ng
  • Edimansyah Abdin
  • Kim Eng Wong
Original Paper

Abstract

Research on predictors of treatment outcome among pathological gamblers (PGs) is inconclusive and dominated by studies from Western countries. Using a prospective longitudinal design, the current study examined demographic, clinical, behavioural and treatment programme predictors of gambling frequency at 3, 6 and 12-months, among PGs treated at an addiction clinic in Singapore. Measures included the Hospital anxiety and depression scale, gambling symptom assessment scale (GSAS), personal well-being index (PWI), treatment perception questionnaire and gambling readiness to change scale. Treatment response in relation to changes in symptom severity, personal wellbeing and abstinence were also assessed. Abstinence rates were 38.6, 46.0 and 44.4 % at 3, 6 and 12-months respectively. Significant reductions in gambling frequency, GSAS, and improvement in PWI were reported between baseline and subsequent outcome assessments, with the greatest change occurring in the initial three months. No demographic, clinical, behavioural or treatment programme variable consistently predicted outcome at all three assessments, though treatment satisfaction was the most frequent significant predictor. However, being unemployed, having larger than average debts, poor treatment satisfaction and attending fewer sessions at the later stages of treatment were associated with significantly poorer outcomes, up to 1-year after initiating treatment. These findings show promise for the effectiveness of a CBT-based treatment approach for the treatment of predominantly Chinese PGs. Clinical implications and suggestions for future research are discussed. Taken together, the findings suggest early treatment satisfaction is paramount in improving short-term outcomes, with baseline gambling behaviour and treatment intensity playing a more significant role in the longer term.

Keywords

Pathological gambling Predictors Demographics Treatment 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Alegría, A. A., Petry, N. M., Hasin, D. S., Liu, S. M., Grant, B. F., & Blanco, C. (2009). Disordered gambling among racial and ethnic groups in the US: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. CNS Spectrums, 14(3), 132–142.PubMedCentralPubMedGoogle Scholar
  2. Battersby, M., Tolchard, B., Scurrah, M., & Thomas, L. (2006). Suicide ideation and behaviour in people with pathological gambling attending a treatment service. International Journal of Mental Health and Addiction, 4(3), 233–246.CrossRefGoogle Scholar
  3. Blaszczynski, A., Huynh, S., Dumlao, V. J., & Farrell, E. (1998). Problem gambling within a Chinese speaking community. Journal of Gambling Studies, 14(4), 359–380.PubMedCrossRefGoogle Scholar
  4. Crisp, B. R., Thomas, S. A., Jackson, A. C., & Thomason, N. (2001). The influence of demographic, behavioural and treatment characteristics on problem gambling counselling outcomes. Australian Journal of Primary Health, 7(2), 32–36.CrossRefGoogle Scholar
  5. Cummins, R. A., Eckersley, R., Pallant, J., Van Vugt, J., & Misajon, R. (2003). Developing a national index of subjective wellbeing: The Australian Unity Wellbeing Index. Social Indicators Research, 64, 159–190.CrossRefGoogle Scholar
  6. Department of Statistics Singapore. (2010). Census of population 2010 statistical release 1: Demographic characteristics, education, language and religion. Retrieved April 2, 2012, from http://www.singstat.gov.sg/pubn/popn/c2010sr1.html.
  7. Dowling, N. (2009). Client characteristics associated with treatment attrition and outcome in female pathological gambling. Addiction Research and Theory, 17(2), 205–219.CrossRefGoogle Scholar
  8. Dowling, N., & Cosic, S. (2011). Client engagement characteristics associated with problem gambling treatment outcomes. International Journal of Mental Health and Addiction, 9(6), 656–671.CrossRefGoogle Scholar
  9. Echeburúa, E., Fernández-Montalvo, J., & Báez, C. (2001). Predictors of therapeutic failure in slot-machine pathological gamblers following behavioural treatment. Behavioural and Cognitive Psychotherapy, 29(3), 379–383.CrossRefGoogle Scholar
  10. Foo, K. H., Merrick, P. L., & Kazantzis, N. (2006). Counseling/psychotherapy with Chinese Singaporean clients. Asian Journal of Counselling, 13(2), 271–293.Google Scholar
  11. Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall, W., et al. (1995). The severity of dependence scale (SDS): Psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction, 90(5), 607–614.PubMedCrossRefGoogle Scholar
  12. Grant, J. E., Kim, S. W., & Kuskowski, M. (2004). Retrospective review of treatment retention in pathological gambling. Comprehensive Psychiatry, 45(2), 83–87.PubMedCrossRefGoogle Scholar
  13. Higgins, L. T., Davey, G., Gao, X., & Ni, Z. J. (2008). Counselling in China: Past, present and future. Psychology and Developing Societies, 20(1), 99–109.CrossRefGoogle Scholar
  14. Hodgins, D. C., Stea, J. N., & Grant, J. E. (2011). Gambling disorders. The Lancet, 378(9806), 1874–1884.CrossRefGoogle Scholar
  15. Hounslow, V., Smith, D., Battersby, M., & Morefield, K. (2011). Predictors of problem gambling severity in treatment seeking gamblers. International Journal of Mental Health and Addiction, 9(6), 682–695.CrossRefGoogle Scholar
  16. Jackson, A., Thomas, S., & Blaszczynski, A. (2003). Best practice in problem gambling services. Melbourne: Gambling Research Panel.Google Scholar
  17. Jackson, A., Thomas, S., Thomason, N., & Ho, W. (2000). Longitudinal evaluation of the effectiveness of problem gambling counselling services, community education strategies and information productsvol 2: Evaluation of the effectiveness of the counselling interventions at breakeven problem gambling counselling services. Melbourne: Victorian Department of Human Services. Retrieved April 2, 2012, from http://www.edfac.unimelb.edu.au/problemgambling/docs/Publications/pg_volume2.pdf.
  18. Kee, C. H. Y. (2004). Cultural features as advantageous to therapy: A Singaporean perspective. Journal of Systemic Therapies, 23(4), 67–79.CrossRefGoogle Scholar
  19. Kim, S. W., Grant, J. E., Potenza, M. N., Blanco, C., & Hollander, E. (2009). The gambling symptom assessment scale (G-SAS): A reliability and validity study. Psychiatry Research, 166(1), 76–84.PubMedCentralPubMedCrossRefGoogle Scholar
  20. Lau, A. L. D., Cummins, R. A., & McPherson, W. (2005). An investigation into the cross-cultural equivalence of the Personal Wellbeing Index. Social Indicators Research, 72, 403–430.CrossRefGoogle Scholar
  21. LeBlond, J., Ladouceur, R., & Blaszczynski, A. (2003). Which pathological gamblers will complete treatment? British Journal of Clinical Psychology, 42(2), 205–209.PubMedCrossRefGoogle Scholar
  22. Lee, K. M. T., Guo, S., Manning, V., Thane, K., & Wong, K. E. (2011a). Are the demographic and clinical features of pathological gamblers seeking treatment in Singapore changing? Singapore Medical Journal, 52(6), 428–431.PubMedGoogle Scholar
  23. Lee, K. M. T., Manning, V., Teoh, H. C., Winslow, M., Lee, A., Subramaniam, M., et al. (2011b). Stress-coping morbidity among family members of addiction patients in Singapore. Drug and Alcohol Review, 30(4), 441–447.PubMedCrossRefGoogle Scholar
  24. Leung, C., & Tsang, S. (2011). The profiles of gamblers seeking counseling services: Evidence from Chinese gamblers in Hong Kong. Asia Pacific Journal of Social Work and Development, 21(2), 62–76.CrossRefGoogle Scholar
  25. Loo, J. M. Y., Raylu, N., & Oei, T. P. S. (2008). Gambling among the Chinese: A comprehensive review. Clinical Psychology Review, 28(7), 1152–1166.PubMedCrossRefGoogle Scholar
  26. Marsden, J., Bacchus, L., Stewart, D., Griffiths, P., Clarke, K., Gossop, M., et al. (1998). The treatment perceptions questionnaire (TPQ): A brief questionnaire for assessing service satisfaction (unpublished manuscript). London: National Addiction Centre.Google Scholar
  27. 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(2), 207–229.PubMedCrossRefGoogle Scholar
  28. Morasco, B. J., Pietrzak, R. H., Blanco, C., Grant, B. F., Hasin, D., & Petry, N. M. (2006). Health problems and medical utilization associated with gambling disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosomatic Medicine, 68(6), 976–984.PubMedCrossRefGoogle Scholar
  29. National Council of Problem Gambling. (2012). Report of survey on participation in gambling activities among Singapore residents. Retrieved April 2, 2012, from http://www.knowtheline.sg/pdf/2011_NCPG_Gambling_Participation_Survey_23_Feb_2012.pdf.
  30. Neighbors, C., Lostutter, T. W., Larimer, M. E., & Takushi, R. Y. (2002). Measuring gambling outcomes among college students. Journal of Gambling Studies, 18(4), 339–360.PubMedCentralPubMedCrossRefGoogle Scholar
  31. Oei, T. P. S., & Raylu, N. (2010). Gambling behaviours and motivations: A cross-cultural study of Chinese and Caucasians in Australia. International Journal of Social Psychiatry, 56(1), 23–34.PubMedCrossRefGoogle Scholar
  32. Petry, N. M. (2005). Stages of change in treatment-seeking pathological gamblers. Journal of Consulting and Clinical Psychology, 73(2), 312–322.PubMedCrossRefGoogle Scholar
  33. Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564–574.PubMedCrossRefGoogle Scholar
  34. Raylu, N., & Oei, T. (2007). Factors that predict treatment outcomes in a community treatment agency for problem gamblers. International Journal of Mental Health and Addiction, 5(2), 165–176.CrossRefGoogle Scholar
  35. Shek, D. T. L., Chan, E. M. L., & Wong, R. H. Y. (2012). Associations between pathological gambling and psychiatric comorbidity among help-seeking populations in Hong Kong. The Scientific World Journal, 2012, 1–15.Google Scholar
  36. Slutske, W. (2006). Natural recovery and treatment-seeking in pathological gambling: Results of two US national surveys. American Journal of Psychiatry, 163, 297–302.PubMedCrossRefGoogle Scholar
  37. Smith, S., Thomas, S., & Jackson, A. (2004). An exploration of the therapeutic relationship and counselling outcomes in a problem gambling counselling service. Journal of Social Work Practice, 18(1), 99–112.CrossRefGoogle Scholar
  38. Stinchfield, R., Kushner, M. G., & Winters, K. C. (2005). Alcohol use and prior substance abuse treatment in relation to gambling problem severity and gambling treatment outcome. Journal of Gambling Studies, 21(3), 273–297.PubMedCrossRefGoogle Scholar
  39. Tang, C. S., Wu, A. M. S., & Tang, J. Y. C. (2007). Gender differences in characteristics of Chinese treatment-seeking problem gamblers. Journal of Gambling Studies, 23(2), 145–156.PubMedCrossRefGoogle Scholar
  40. Toneatto, T., Skinner, W., & Dragonetti, R. (2002). Patterns of substance use in treatment-seeking problem gamblers: Impact on treatment outcomes. Journal of Clinical Psychology, 58(7), 853–859.PubMedCrossRefGoogle Scholar
  41. Vong, F. (2007). The psychology of risk-taking in gambling among Chinese visitors to Macau. International Gambling Studies, 7(1), 29–42.CrossRefGoogle Scholar
  42. Walker, M., Toneatto, T., Potenza, M. N., Petry, N., Ladouceur, R., Hodgins, D. C., et al. (2006). A framework for reporting outcomes in problem gambling treatment research: The Banff Alberta Consensus. Addiction, 101(4), 504–511.PubMedCrossRefGoogle Scholar
  43. Welte, J., Barnes, G., Wieczorek, W., Tidwell, M. C., & Parker, J. (2001). Alcohol and gambling pathology among US adults: Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol, 62(5), 706–712.PubMedGoogle Scholar
  44. Winslow, M., Subramaniam, M., Qiu, S., & Lee, A. (2010). Socio-demographic profile and psychiatric comorbidity of subjects with pathological gambling. Annals of the Academy of Medicine, 39(2), 122–128.Google Scholar
  45. Winters, K. C., & Kushner, M. G. (2003). Treatment issues pertaining to pathological gamblers with a comorbid disorder. Journal of Gambling Studies, 19(3), 261–277.PubMedCrossRefGoogle Scholar
  46. Yeo, C. (2004). Mind your mind: A preventive programme for the control of major mental disorders in Singapore. In S. Saxena & P. J. Garrison (Eds.), Mental health promotion: Case studies from countries (pp. 73–75). Geneva, Switzerland: World Health Organization.Google Scholar
  47. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Song Guo
    • 1
  • Victoria Manning
    • 1
    Email author
  • Kyaw Kyaw Wai Thane
    • 1
  • Andrew Ng
    • 1
  • Edimansyah Abdin
    • 1
  • Kim Eng Wong
    • 1
  1. 1.National Addictions Management ServiceInstitute of Mental Health (IMH)SingaporeSingapore

Personalised recommendations