Predictors of early dropout in treatment for gambling disorder: The role of personality disorders and clinical syndromes

• Published in: Psychiatry research 2017-11, Vol.257, p.540-545
• Main Authors: Maniaci, G., La Cascia, C., Picone, F., Lipari, A., Cannizzaro, C., La Barbera, D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antisocial Personality Disorder - psychology; Case-Control Studies; Clinical syndromes; Comorbidity; Disordered gambling; Dropout; Female; Gambling - psychology; Gambling - therapy; Gambling disorder; Humans; Male; Middle Aged; Pathological gambling; Patient Dropouts - psychology; Personality disorders; Personality Disorders - psychology; Psychiatric disorders; Psychotherapy - statistics & numerical data; Stress Disorders, Post-Traumatic - psychology; Substance-Related Disorders - psychology; Syndrome; Treatment Failure; Treatment outcome; Young Adult
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2017.08.003

Several treatment options for gambling disorder (GD) have been tested in recent years; however dropout levels still remain high. This study aims to evaluate whether the presence of psychiatric comorbidities predicts treatment outcome according to Millon's evolutionary theory, following a six-month therapy for GD. The role of severity, duration of the disorder, typology of gambling (mainly online or offline) and pharmacological treatment were also analysed. The recruitment included 194 pathological gamblers (PGs) to be compared with 78 healthy controls (HCs). Psychological assessment included the South Oaks Gambling Screen and the Millon Clinical Multiaxial Inventory-III. The “treatment failure” group (n = 70) comprised PGs who prematurely dropped out of the treatment whereas the “abstinent group” (n = 124) included PGs who completed the treatment regardless of whether the outcome was successful or not. As expected, the presence of psychiatric comorbidities was highlighted as a significant predictor in dropping out of the therapy. Specifically negativistic personality disorder, antisocial personality disorder, drug dependence and PTSD were associated with early dropout. These variables were predictive of treatment outcome independently from the typology of gambling, severity, duration of the disorder and pharmacological treatment. Implications for psychological and psychiatric care are discussed. •Comorbidities and predictors of early dropout in a six months therapy for gambling disorder (GD) were investigated.•194 pathological gamblers and 78 healthy controls were recruited.•High comorbidities were highlighted in the clinical group.•Negativistic personality disorder, antisocial personality disorder, drug dependence and PTSD were associated with dropout.•This association was controlled for severity and duration of GD, typology of gambling and psychopharmacological treatment.