Transcript Predictors of Treatment Engagement of Problem Gamblers

PREDICTORS OF TREATMENT
ENGAGEMENT OF PROBLEM
GAMBLERS CALLING THE STATE OF
MICHIGAN GAMBLING HELPLINE
David M. Ledgerwood, Ph.D.
Department of Psychiatry and Behavioral Neuroscience
Wayne State University School of Medicine
Acknowledgements
• Wayne State
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Cynthia Arfken
Ken Bates
Joi Moore
Ashley Weidemann
Lisa Sulkowsky
Deb Kish
Jessica Butzin
Caren Steinmiller
• State of Michigan –
Deborah Hollis
• NSO
– Don Holmes
– LaNiece Jones
– Helpline Staff
Joe Cada, a 21-year old poker professional from Michigan, poses with
bundles of cash after winning $8.5 million in prize money at the World
Series of Poker tournament at the Rio hotel-casino in Las Vegas, Nevada
November 9, 2009. Darvin Moon, a 45-year-old logger from Maryland,
came in second place.
Photograph by: Steve Marcus, Reuters
Role of Helplines
• Open 24 hours per day
• Provide brief counseling for problem gambling
and concurrent problems
• Sometimes provide crisis call contact
• Provide treatment referral
State of Michigan Helpline
• Funded by the State of Michigan
• Operated by Neighborhood Services
Organization
• In 2007, 1171 callers were referred for
gambling treatment and 894 were referred to
Gambler’s Anonymous or Gamanon
NSO Gambling Treatment Mission
• The mission of the Gambling Treatment Program is to provide
comprehensive treatment services to compulsive gamblers and
their families. The philosophy of consumer care is based upon
consumer participation and decision making.
• The Michigan Department of Community Health funds the
Gambling Treatment Program. It is a statewide program for
compulsive gamblers and their families. Through this program,
consumers needing assistance with problem and/or compulsive
gambling can receive a referral to a trained treatment provider.
Research on Gambling Helplines
• Potenza and colleagues – Connecticut State
Helpline (several studies)
– Characterized problem gamblers calling the state
helpline, examining differences based on gender,
race/ethnicity, age, presence of suicidal ideation,
gambling-related illegal behaivors and other
factors
Research on Gambling Helplines
• Griffiths et al. 1999, characterized callers of a
helpline in the UK
• Heatter & Patton, 2006, gender differences of
callers to a helpline in Canada
• Shandley & Moore, 2008, evaluation of an
Australian helpline from consumer
perspective
• Reports completed by states or countries
Research on Gambling Helplines
• Few, if any studies have examined factors that
contribute to whether the helpline caller
pursues treatment
• No studies examine factors such as treatment
motivation and barriers that have the
potential to keep individuals from following
through
Our Study
• Wanted to re-contact a portion of the callers
to the helpline to answer the following:
– What are the socio-economic and legal (i.e., crime)
consequences of problem gambling among callers to the
State of Michigan problem gambling helpline
– How many people calling the gambling helpline sought
treatment, and what are the perceived and actual barriers
they encountered
Our Study
• Wanted to re-contact a portion of the callers
to the helpline to answer the following:
– What are the socio-economic and legal (i.e., crime)
consequences of problem gambling among callers to the
State of Michigan problem gambling helpline
– How many people calling the gambling helpline sought
treatment, and what are the perceived and actual barriers
they encountered
Study Sample
• N = 188 problem gamblers
• N = 78 men (42%) and N = 110 women (58%)
(Helpline data:45 and 55%)
• 50% Caucasian, 43% African American
(Helpline data: 57% and 36%)
• 2% Latino
• N = 41% Married
• N = 46.2% Employed
Our follow-up sample so far…
• So far, we have re-contacted 98 participants at
least 2 months following the original call
• Anticipate eventually contacting 75-80% of
the original sample
Our follow-up sample so far…
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69% have engaged in treatment
Just under 1/3 did not attend a single session
Very similar to data reported by the helpline
From Oct 08 – Sept 09: 61.5% attended
From Oct 09 – Jan 10: 65.9% attended
So, what might be getting in the way of
attending treatment?
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Demographic factors?
Gambling severity?
Psychiatric/Substance use problems?
Satisfaction their helpline call?
Motivation for treatment?
Barriers to treatment?
Demographic Predictors?
• Slightly more of the women (72%) than of the
men (63%), but not significant
• Race and ethnicity were not factors
• Marital status and employment were not
factors
• Education, personal and household income
were not factors
Problem Gambling Severity
• Past research has indicated that problem
gamblers with more severe problems are
more likely to go to treatment.
Co-occurring Psychiatric/Substance
Abuse?
• Family history of drug, alcohol or gambling problems
were not a factor
• Depression, anxiety, suicidality were not factors
• Personal drug and alcohol problems were not factors
• Past problem gambling treatment and past use of GA
significantly predicted current treatment
What did they think of the helpline
call?
• Asked 3 Questions, on a scale of 1 to 10
– …how helpful was the counseling you received
from the helpline?
– …rate the extent to which the counseling you
received was enough (i.e., that you didn’t need
any more counseling for your gambling problems).
– …how likely are you to follow up on the treatment
referral you received from the helpline?
Motivation
• Treatment Readiness – to what extent is the
caller “ready” for treatment?
• Does the individual believe he/she has a
problem?
• Are the consequences of the problem
sufficient to result in significant changes?
• Stages of Change Model (aka Transtheoretical
model)
Stages of Change
• Pre-Contemplation - The patient does not consider
him/herself to have a problem with drugs and does not
want treatment
• Contemplation - The patient is beginning to feel that
drugs/alcohol are becoming a problem, but he/she has
not begun to act on this feeling
• Action – The Patient is actively working toward recovery
• Maintenance - The patient is fully in recovery and
continues to engage in activities that lead to further
growth
Perceived Treatment Barriers
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Availability
Cost
Stigma
Uncertainty
Avoidance
Most frequently reported barriers to
treatment
• Asked participants to answer the following
question:
– Whether or not you followed up on your
treatment referral, what factors made it less likely
that you would seek treatment for your gambling
problems? (e.g., factors that made it difficult or
that turned you off of treatment)
Most Prominent Differences
• Callers who do not go to treatment:
– Don’t believe they have a problem or feel they can
handle it on their own.
– Don’t want to stop gambling.
– Report not being ready for treatment.
Most frequently reported reasons for
going to treatment
• Asked participants to answer the following
question:
– What factors made it more likely that you would
seek treatment for your gambling problems? (e.g.,
factors that made seeking treatment easier or that
made treatment more appealing)
What are the implications?
What are the implications?
• Motivation for changing problem gambling behaviors is
very important
• Participants mostly knew that they were unlikely to
follow through on their referral
– Interventions that address motivation (e.g., Motivational
Interviewing) can be used to improve the chances a problem
gambler will attend treatment
– Telephone counselors at the helpline can be trained to do these
interviews
What are the implications?
• Treatment barriers are also very important in
understanding treatment non-compliance
– Availability, Cost, Stigma and Uncertainty differ
between gamblers who do and don’t seek
treatment
– Interventions can address the ambivalence
– In some cases, treatment providers may be a
distance away
What are the implications?
• Those who went to treatment saw treatment
as believe that they had a significant gambling
problem, saw treatment as a potentially
effective alternative, believed therapy to be a
supportive/non-judgmental environment, and
appreciated the opportunity to discuss their
problems with others
What are the implications?
• These findings are also important for
therapists, once the helpline client is seen in
therapy
• Those who experience less motivation for
treatment, or who have more barriers to
treatment may be less likely to continue in
treatment beyond a few sessions
Thank You!