There is little available information on the factors that influence relapses and dropouts during therapy for pathological gambling (PG). The aim of this study was to determine socio-demographic, clinical, personality, and psychopathological predictors of relapse and dropout in a sample of pathological gamblers seeking treatment. A total of 566 consecutive outpatients diagnosed with PG according to DSM-IV-TR criteria were included. All patients underwent an individualized cognitive–behavioral treatment program. We analyzed predictors of relapse during 6 months of treatment and during the subsequent 6 months of follow-up, and predictors of dropout over the entire therapeutic program. Eighty patients (14.1%) experienced at least one relapse during the entire follow-up of the study: 50 (8.8%) within the treatment period and 12 (2.1%) during the subsequent 6-month follow-up period. The main predictors of relapse were single marital status, spending less than 100 euros/week on gambling, active gambling behavior at treatment inclusion, and high scores on the TCI-R Harm Avoidance personality dimension. One hundred fifty-seven patients (27.8%) missed 3 or more therapeutic sessions over the entire therapeutic program. The main predictors of dropout were single marital status, younger age, and high scores on the TCI-R Novelty Seeking personality dimension. The presence of these factors at inclusion should be taken into account by physicians dealing with PG patients.
There is evidence that cognitive–behavioral treatment is the most effective intervention for treating pathological gambling (PG) [1], [2] and [3]. In a meta-analysis including 1434 subjects in 22 articles, Pallessen et al. [4] concluded that psychological interventions for PG were more effective than no treatment and yielded favorable short- and long-term outcomes. Although individuals who begin therapy for PG may find considerable relief of symptoms, relapses and lack of adherence to treatment have been noted in many patients in two systematic reviews [5] and [6]. However, both reviews mentioned that few studies have directly examined relapses or dropouts, and those that have, include small samples.
Studies focused on PG relapses have reported differing results. Some authors have cited dissatisfaction with treatment, alcohol consumption, and high levels of neuroticism as the main factors related to relapse [7]. Others have additionally mentioned psychopathological distress as predictive of relapse [8] and [9]. Hodgins and el-Guebaly [10] concluded that optimism to make money, a need for more money, free time, boredom, negative mood, the desire to socialize, and excitement-seeking were factors contributing to relapses. All these factors have been described in retrospective studies, and there are no reports investigating relapses over a lengthy follow-up.
During PG treatment, patients often re-schedule, cancel, or fail to attend sessions, and some may ultimately drop out of treatment [5]. Although several studies have investigated the influences associated with dropout, the available results do not provide robust empirical evidence to identify the main factors with certainty [11]. Some authors have described a role for neuroticism [7], impulsivity [12] and [13], and sensation-seeking [14] and [15]. Melville et al. [5] reported a relationship of dropping out with age at gambling onset and poor coping with stressful situations. Jiménez-Murcia et al. [16] found no link between age at onset and a poor response to treatment (dropout or relapse), but in another study by the same group, a positive association between shorter duration of the disorder and treatment dropout was evident [14]. Issues such as motivation and adherence to treatment are core aspects of the therapeutic prognosis in PG patients [2], [17], [18] and [19]. Given the variability of these results, additional work is needed.
Most studies that have attempted to analyze relapses and dropouts in PG are based on small samples or have explored specific clinical and psychopathological variables. The aim of this study was to determine predictors of relapse and dropout in a large sample of pathological gamblers attending a dedicated PG unit. In addition, the time to the first relapse was investigated over an extended follow-up period.
