Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study.

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout. Methods: The sample consisted of n =86 adults, mostly men ( n =79, 91.9%) and with a mean age of 45years old ( SD =16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown). Results: The risk of dropout during the complete observational period was R =32/86=0.372 (37.2%), the Incidence Density Rate ( IDR ) ratio T2/T1 being equal to 0.052/0.033=1.60 ( p =0.252). Shorter treatment duration ( p =0.007), lower anxiety ( p =0.025), depressive symptoms ( p =0.045) and lower use of adaptive coping strategies ( p =0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment ( p =0.001) and higher employment concerns ( p =0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods ( p =0.005 and p <0.001, respectively). Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.
Competing Interests: AH holds a position at Lund University, Sweden, sponsored by the state-owned Swedish gambling operator AB Svenska Spel and has funding from the research council of the same organization and from the research councils of the Swedish state-owned alcohol monopoly Systembolaget AB and the Swedish sports federation. MP notes the following disclosures. He has: consulted for and advised Game Day Data, the Addiction Policy Forum, AXA, Idorsia, and Opiant/Lakelight Therapeutics; received research support from the Veteran’s Administration, Mohegan Sun Casino, and the National Center for Responsible Gaming (on the International Center for Responsible Gambling); participated in surveys, mailings, or telephone consultations related to addictions, impulse-control disorders or other health topics; consulted for law offices and the federal public defender’s office in issues related to impulse-control and addictive disorders; provided clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; performed grant reviews for the National Institutes of Health and other agencies; edited journals and journal sections; given academic lectures in grand rounds, CME events and other clinical/scientific venues; and generated books or chapters for publishers of mental health texts. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2021 Baenas, Etxandi, Codina, Granero, Fernández-Aranda, Gómez-Peña, Moragas, Rivas, Potenza, Håkansson, del Pino-Gutiérrez, Mora-Maltas, Valenciano-Mendoza, Menchón and Jiménez-Murcia.)