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Assessing the Need for Higher Levels of Care Among Problem Gambling Outpatients

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Most treatment for gambling disorder is provided on an outpatient basis. Only a small number of jurisdictions in North America provide higher levels of gambling treatment, such as residential or intensive outpatient (IOP) care, despite the potential need for these services. Further, there appear to be few guidelines for determining appropriate level of gambling treatment. The aim of the present study was to assess the appropriateness of higher levels of problem gambling care among clients receiving outpatient treatment. Problem gamblers and their therapists independently completed questionnaires that assessed the need and desire for residential and IOP treatment. About 42% of problem gambling outpatients noted that they would be “probably” or “definitely” willing to attend residential treatment, and about half indicated they would be equally likely to attend IOP. Therapists recommended about a third of their clients as appropriate for higher levels of care. For both client and therapist assessments, there was a significant association between desire or recommendation for level of treatment and severity of gambling and co-occurring problems. Further, therapist recommendations for level of care were significantly associated with client willingness to attend higher levels of treatment. Our data reveal the potential need for higher levels of care for problem gambling, as evaluated by clients and their therapists. Policy implications for the funding of residential and IOP treatment are discussed.

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We thank Deborah Hollis, Erica Waltz, Lori Mello, Dolores Carter, Hayley Devoli, Lisa Sulkowski, Elorie Eggleston, and Jacob Ledgerwood who provided assistance on this project. Individual Board members of the Michigan Association on Problem Gambling provided feedback regarding questionnaire items and study methodology. We thank Lori Rugle for her advice on applying ASAM criteria to problem gamblers, and Tim Fong and Mike Campos from the UCLA Gambling Studies Program for providing the therapist ASAM-based measure. We thank the therapists and clients who participated. The Michigan Department of Health and Human Services, Bureau of Substance Abuse and Addiction Services (now Office of Recovery Oriented Systems of Care) provided funding for this project.

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Correspondence to David M. Ledgerwood.

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This study involved human subjects research.

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All participants underwent appropriate informed consent processes and the study procedures were approved by the Wayne State University and State of Michigan Institutional Review Boards.

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Ledgerwood, D.M., Arfken, C.L. & Michigan Association on Problem Gambling. Assessing the Need for Higher Levels of Care Among Problem Gambling Outpatients. J Gambl Stud 33, 1263–1275 (2017).

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