Journal of Gambling Studies

, Volume 33, Issue 4, pp 1277–1292 | Cite as

Gambling Disorder: Exploring Pre-treatment and In-treatment Dropout Predictors. A UK Study

  • Silvia Ronzitti
  • Emiliano Soldini
  • Neil Smith
  • Massimo Clerici
  • Henrietta Bowden-Jones
Original Paper


The aim of this study was to identify predictors of treatment dropout in a sample of gamblers attending a specialist clinic for gambling disorder. We analysed data on 846 treatment-seeking pathological gamblers. Firstly, we investigated differences in socio-demographic and clinical variables between treatment completers and pre-treatment dropouts, as well as between treatment completers and during-treatment dropouts. Subsequently, variables were entered into a multinomial logistic regression model to identify significant predictors of pre-treatment and in-treatment dropout. Overall, 44.8% of clients did not complete the treatment: 27.4% dropped out before starting it, while 17.4% dropped out during the treatment. Younger age and use of drugs were associated with pre-treatment dropout, while family history of gambling disorder, a lower PGSI score, and being a smoker were related with in-treatment dropout. Our findings suggest that pre-treatment dropouts differ from in-treatment dropouts, and, thus, further research will benefit from considering these groups separately. In addition, this newly gained knowledge will also be helpful in increasing treatment retention in specific subgroups of problem gamblers.


Gambling disorder Pathological gambling Treatment dropout Treatment outcome Dropout predictors 


Compliance with Ethical Standards

Conflict of interests

The authors declare that there is no conflict of interest.


  1. Alvarez-Moya, E. M., Ochoa, C., Jimenez-Murcia, S., Aymami, M. N., Gomez-Pena, M., Fernandez-Aranda, F., et al. (2011). Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling. Jouranl of Psychiatry & Neuroscience, 36, 165–175.CrossRefGoogle Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association.CrossRefGoogle Scholar
  3. Aragay, N., Jimenez-Murcia, S., Granero, R., Fernandez-Aranda, F., Ramos-Grille, I., Cardona, S., et al. (2015). Pathological gambling: Understanding relapses and dropouts. Comprehensive Psychiatry, 57, 58–64.CrossRefPubMedGoogle Scholar
  4. Bartley, C. A., & Bloch, M. H. (2013). Meta-analysis: Pharmacological treatment of pathological gambling. Expert Review of Neurotherapeutics, 13, 887–894.CrossRefPubMedGoogle Scholar
  5. Blaszczynski, A., & Nower, L. (2002). A pathways model of problem and pathological gambling. Addiction, 97, 487–499.CrossRefPubMedGoogle Scholar
  6. Braun, B., Ludwig, M., Sleczka, P., Buhringer, G., & Kraus, L. (2014). Gamblers seeking treatment: Who does and who doesn’t? Journal of Behavioral Addictions, 3, 189–198.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.CrossRefPubMedGoogle Scholar
  8. Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Archives of Internal Medicine, 158, 1789–1795.CrossRefPubMedGoogle Scholar
  9. Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database Systematic Review, 11, CD008937.Google Scholar
  10. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015a). The prevalence of comorbid personality disorders in treatment-seeking problem gamblers: A systematic review and meta-analysis. Journal of Personality Disorders, 29, 735–754.CrossRefPubMedGoogle Scholar
  11. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015b). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49, 519–539.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Dunn, K., Delfabbro, P., & Harvey, P. (2012). A preliminary, qualitative exploration of the influences associated with drop-out from cognitive-behavioural therapy for problem gambling: An Australian perspective. Journal of Gambling Studies, 28, 253–272.CrossRefPubMedGoogle Scholar
  13. Dunn, C., Deroo, I., & Rivara, F. P. (2001). The use of brief interventions adapted from motivational interviewing across behavioral domains: A systematic review. Addiction, 96, 1725–1742.CrossRefPubMedGoogle Scholar
  14. Echeburua, E., Baez, C., & Fernandez-Montalvo, J. (1996). Comparative effectiveness of three therapeutic modalities in the psyhcological treatment of pathological gambling: Long term outcome. Behavioural and Cognitive Psychotherapy, 24, 51–72.CrossRefGoogle Scholar
  15. Echeburua, E., Fernandez-Montalvo, J., & Baez, C. (2001). Predictors of therapeutic failure in slot-machine pathological gamblers following behavioural treatment. Behavioural and Cognitive Psychotherapy, 29, 379–383.CrossRefGoogle Scholar
  16. Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83, 1108–1122.CrossRefPubMedGoogle Scholar
  17. Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index: User manual. Toronto: Canadian Centre on Substance Abuse.Google Scholar
  18. Hodgins, D. C., Currie, S., el-Guebaly, N., & Peden, N. (2004). Brief motivational treatment for problem gambling: A 24-month follow-up. Psychology of Addictive Behaviors, 18, 293–296.CrossRefPubMedGoogle Scholar
  19. Hodgins, D. C., & Holub, A. (2015). Components of impulsivity in gambling disorder. International Journal of Mental Health and Addiction, 13(6), 699–711.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Holtgraves, T. (2009). Evaluating the problem gambling severity index. Journal of Gambling Studies, 25, 105–120.CrossRefPubMedGoogle Scholar
  21. Jimenez-Murcia, S., Alvarez-Moya, E. M., Stinchfield, R., Fernandez-Aranda, F., Granero, R., Aymami, N., et al. (2010). Age of onset in pathological gambling: Clinical, therapeutic and personality correlates. Journal of Gambling Studies, 26, 235–248.CrossRefPubMedGoogle Scholar
  22. Jimenez-Murcia, S., Aymami, N., Gomez-Pena, M., Santamaria, J. J., Alvarez-Moya, E., Fernandez-Aranda, F., et al. (2012). Does exposure and response prevention improve the results of group cognitive-behavioural therapy for male slot machine pathological gamblers? British Journal of Clinical Psychology, 51, 54–71.CrossRefPubMedGoogle Scholar
  23. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Kroenke, K., Spitzer, R. L., Williams, J. B., & Lowe, B. (2010). The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32, 345–359.CrossRefPubMedGoogle Scholar
  25. Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Lowe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325.CrossRefPubMedGoogle Scholar
  26. Leblond, J., Ladouceur, R., & Blaszczynski, A. (2003). Which pathological gamblers will complete treatment? British Journal of Clinical Psychology, 42, 205–209.CrossRefPubMedGoogle Scholar
  27. Lobo, D. S., & Kennedy, J. L. (2009). Genetic aspects of pathological gambling: A complex disorder with shared genetic vulnerabilities. Addiction, 104, 1454–1465.CrossRefPubMedGoogle Scholar
  28. Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction, 106, 490–498.CrossRefPubMedGoogle Scholar
  29. Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2007). Psychological treatment dropout among pathological gamblers. Clinical Psychology Review, 27, 944–958.CrossRefPubMedGoogle Scholar
  30. Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., Hallak, J. E., Trzesniak, C., de Azevedo Marques, J. M., et al. (2010). Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcoholism-Clincial and Experimental Research, 34, 1417–1424.Google Scholar
  31. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford Press.Google Scholar
  32. Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97, 265–277.CrossRefPubMedGoogle Scholar
  33. 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, 207–229.CrossRefPubMedGoogle Scholar
  34. Nagelkerke, N. J. D. (1991). A note on a general definition of the coefficient of determination. Biometrika, 78, 691–692.CrossRefGoogle Scholar
  35. Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. Applications to addictive behaviors. American Psychologist, 47, 1102–1114.CrossRefPubMedGoogle Scholar
  36. Robson, E., Edwards, J., Smith, G., & Colman, I. (2002). Gambling decisions: An early intervention program for problem gamblers. Journal of Gambling Studies, 18, 235–255.CrossRefPubMedGoogle Scholar
  37. Ronzitti, S., Lutri, V., Smith, N., Clerici, M., & Bowden-Jones, H. (2016a). Gender differences in treatment-seeking British pathological gamblers. Journal of Behavioral Addictions, 5, 231–238.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Ronzitti, S., Soldini, E., Lutri, V., Smith, N., Clerici, M., & Bowden-Jones, H. (2016b). Types of gambling and levels of harm: A UK study to assess severity of presentation in a treatment-seeking population. Journal of Behavioral Addictions, 5, 439–447.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Slutske, W. S. (2006). Natural recovery and treatment-seeking in pathological gambling: Results of two U.S. national surveys. American Journal of Psychiatry, 163, 297–302.CrossRefPubMedGoogle Scholar
  40. Smith, D., Harvey, P., Battersby, M., Pols, R., Oakes, J., & Baigent, M. (2010). Treatment outcomes and predictors of drop out for problem gamblers in South Australia: A cohort study. Australian and New Zealand Journal of Psychiatry, 44, 911–920.CrossRefPubMedGoogle Scholar
  41. Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefPubMedGoogle Scholar
  42. Sylvain, C., Ladouceur, R., & Boisvert, J. M. (1997). Cognitive and behavioral treatment of pathological gambling: A controlled study. Journal of Consulting and Clinical Psychology, 65, 727–732.CrossRefPubMedGoogle Scholar
  43. Toneatto, T. (2005). A perspective on problem gambling treatment: Issues and challenges. Journal of Gambling Studies, 21, 73–80.CrossRefPubMedGoogle Scholar
  44. Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M., Constantine, R., & Pigott, S. (2011). British gambling prevalence survey 2010.
  45. Wulfert, E., Blanchard, E. B., Freidenberg, B. M., & Martell, R. S. (2006). Retaining pathological gamblers in cognitive behavior therapy through motivational enhancement: A pilot study. Behavior Modification, 30, 315–340.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Silvia Ronzitti
    • 1
    • 2
    • 6
  • Emiliano Soldini
    • 3
  • Neil Smith
    • 1
  • Massimo Clerici
    • 2
    • 4
  • Henrietta Bowden-Jones
    • 1
    • 5
  1. 1.NPGC, National Problem Gambling ClinicCentral North West London NHS Foundation TrustLondonUK
  2. 2.Department of Medicine and SurgeryUniversity of Milano-BicoccaMonzaItaly
  3. 3.Methodology and Statistics Laboratory (LABStat), Department of Business Economics, Health and Social CareUniversity of Applied Sciences and Arts of Southern SwitzerlandMannoSwitzerland
  4. 4.Department of Mental HealthSan Gerardo HospitalMonzaItaly
  5. 5.Department of MedicineImperial College LondonLondonUK
  6. 6.Yale UniversityNew HavenUSA

Personalised recommendations