Predicting online problem gambling treatment discontinuation: New evidence from cross-validated models.

Abstract

Objective: There are tens of millions of problem gamblers in the world, many of whom either do not seek treatment or fail to commit to it. Dropout rates are high, and not enough is known about factors predicting treatment adherence. We focus on an online cognitive behavioral therapy program for severe problem gambling to determine the likelihood of treatment discontinuation at three different treatment phases: pretreatment, before halfway, and before the end of the program. Method: Participants were Finnish adults (N = 1,139, 670 males, M age = 34.5) registered in the program between 2019 and 2021. Using logistic regression and five-fold crossvalidated naïve Bayes classification, we predicted discontinuation with demographic-, psychometric-, and other gambling-related variables, including the quality of one's social relations, time spent on the waiting list, and experienced readiness to behavioral change. Results: The models had acceptable predictive ability (area under the curve [AUC] values from .69 to .745; cross-validated balanced classification accuracy = 63.2%). In logistic regressions, treatment discontinuation was prominently associated with younger age ( p = .008), lower education ( p < .001), not being ready to change gambling behavior ( p < .001), problem gambling severity ( p < .0001), longer time spent on the treatment waiting list ( p < .0001), and fewer close social relationships ( p < .001). Conclusions: We found significant new real-world evidence on factors statistically predicting treatment discontinuation, which is crucial when existing programs are modified to better serve those in need. Public Health Significance StatementThis study found that long treatment wait-list periods, few good social relationships, and not being ready to change gambling behavior are highly significant predictors of online problem gambling treatment discontinuation. This knowledge is crucial when existing treatment programs are modified to better serve those in need.

Treatment discontinuation in pharmacological clinical trials for gambling disorder

“…This has been reported previously for a number of mental health disorders including in some gambling studies, albeit the main focus has been on psychotherapy rather than medications (e.g. Palomäki et al, 2023 ). People with relatively lower levels of education may be at risk of being disadvantaged when it comes to participation in clinical trials and also at risk of being excluded or dropping out from treatments per se.…”