Measuring treatment outcomes in gambling disorders: a systematic review

Abstract

Background and AimsConsiderable variation of outcome variables used to measure recovery in the gambling treatment literature has precluded effective cross‐study evaluations and hindered the development of best‐practice treatment methodologies. The aim of this systematic review was to describe current diffuse concepts of recovery in the gambling field by mapping the range of outcomes and measurement strategies used to evaluate treatments, and to identify more commonly accepted indices of recovery.MethodsA systematic search of six academic databases for studies evaluating treatments (psychological and pharmacological) for gambling disorders with a minimum 6‐month follow‐up. Data from eligible studies were tabulated and analysis conducted using a narrative approach. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) were adhered to.ResultsThirty‐four studies were reviewed systematically (RCTs = 17, comparative designs = 17). Sixty‐three different outcome measures were identified: 25 (39.7%) assessed gambling‐specific constructs, 36 (57.1%) assessed non‐gambling specific constructs, and two instruments were used across both categories (3.2%). Self‐report instruments ranged from psychometrically validated to ad‐hoc author‐designed questionnaires. Units of measurement were inconsistent, particularly in the assessment of gambling behaviour. All studies assessed indices of gambling behaviour and/or symptoms of gambling disorder. Almost all studies (n = 30; 88.2%) included secondary measures relating to psychiatric comorbidities, psychological processes linked to treatment approach, or global functioning and wellbeing.ConclusionsIn research on gambling disorders, the incorporation of broader outcome domains that extend beyond disorder‐specific symptoms and behaviours suggests a multi‐dimensional conceptualization of recovery. Development of a single comprehensive scale to measure all aspects of gambling recovery could help to facilitate uniform reporting practices across the field.

Impulsividad y conciencia del problema predicen la adherencia terapéutica y el abandono del tratamiento en el trastorno por juego de azar

“…Por ejemplo, Weinstock et al (2011) concluyeron que los factores sociodemográficos, la severidad del juego, el endeudamiento, y el nivel de coerción ejercido por parte de las redes legales y sociales son predictores de la aceptación o rechazo al tratamiento. Los patrones de juego (Pickering, Keen, Entwistle y Blaszczynski, 2018), las comorbilidades (Maniaci et al, 2017), y el apoyo interpersonal también han surgido como índices valiosos del curso del tratamiento y de sus resultados.…”

Commentary on Pickering et al. (2018): Problems with measurement consistency—unique to gambling or widespread in addictions?

“…In a systematic review, Pickering et al . concluded that treatment outcomes for gambling disorder remain defined poorly and assessed inconsistently. Few studies captured variables identified within the Walker et al .…”

“…In studies that Pickering et al . reviewed, assessment of non‐gambling constructs was in many ways better than assessment of gambling‐related constructs. Indices administered to evaluate psychological distress and symptoms, for example, are used widely and have substantial evidence of reliability and validity.…”

“…As Pickering et al . point out, measurement inconsistencies impact the ability to compare across studies. They also mitigate against drawing firm conclusions regarding efficacy of interventions within a study.…”

“…Of studies that Pickering et al . reviewed, only approximately half presented data specifically on gambling behaviors, and fewer than a third evaluated clinical harms based on diagnostic criteria. Using somewhat broader criteria, we found a higher proportion of studies included a behavior index alone or in conjunction with clinical harms .…”