AN OUTCOME STUDY OF A PROBLEM GAMBLING BRIEF
AN OUTCOME STUDY OF A PROBLEM GAMBLINGBRIEF TELEPHONE INTERVENTION: THREE YEARSLATERProvider Number: 467589Agreement Number: 326673/00, 01 and 02FINAL REPORT23 October 2015Prepared for:Ministry of HealthPO Box 5013WELLINGTONAuthors:Professor Max AbbottDr Maria BellringerKatie Palmer Du PreezDr Maheswaran RohanDr Nick GarrettDr Jason LandonProfessor David Hodgins
ACKNOWLEDGEMENTSThis report has been prepared by the Gambling and Addictions Research Centre, NationalInstitute for Public Health and Mental Health Research, School of Public Health andPsychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University ofTechnology, Private Bag 92006, Auckland 1142, New Zealand.The authors are highly appreciative of Gambling Helpline Ltd (now part of Lifeline Auckland)which was the partner organisation for this research. Without Gambling Helpline’scommitment to the study, this research would not have been possible.Grateful acknowledgement is made of all the gamblers who continued to participate in thisstudy at the 36 month follow-up interview.Thanks are due to Professor Malcolm Battersby and Dr James Westphal who peer reviewed thereport and provided helpful comments.The Ministry of Health provided the funding for this research project. Thanks go to Dr TaiKake for Ministry review of the report.DisclaimerThis report was prepared under contract to the New Zealand Ministry of Health. The copyrightin this article is owned by the Crown and administered by the Ministry. The views of theauthors do not necessarily represent the views or policy of the New Zealand Ministry of Health.The Ministry makes no warranty, express or implied, nor assumes any liability or responsibilityfor use of or reliance on the contents of this report.An outcome study of a problem gambling brief telephone intervention: Three years laterProvider No: 467589, Contract Nos: 326673/00, 01and 02Auckland University of Technology, Gambling and Addictions Research CentreFinal Report, 23 October 20151
CONTENTSACKNOWLEDGEMENTS . 1EXECUTIVE SUMMARY . 41BACKGROUND . 122LITERATURE REVIEW . 133RESEARCH METHODOLOGY . 223.1Ethics approval. 223.2Study design . 223.2.1 Study aims . 223.2.2 Overview . 223.2.3 Study population . 233.2.4 Eligibility criteria . 233.2.5 Setting and location . 243.2.6 Schedule of assessments . 243.2.7 Data analyses . 254RESULTS . 274.1Descriptive statistics . 274.1.1 Socio-demographic characteristics at each assessment point . 274.1.2 Time trends . 274.2Predictors of successful problem gambling outcomes - PGSI . 364.2.1 PGSI-12 change - univariate analyses . 364.2.2 PGSI-12 change - multivariate analyses . 394.3Predictors of successful problem gambling outcomes - days gambled . 404.3.1 Days gambled - univariate analyses . 404.3.2 Days gambled - multivariate analyses . 414.4Predictors of successful gambling outcomes - money lost . 424.4.1 Money lost - univariate analyses . 424.4.2 Money lost - multivariate analyses . 444.5Predictors of successful problem gambling outcomes - control over gambling . 444.5.1 Control over gambling - univariate analyses . 444.5.2 Control over gambling - multivariate analyses . 474.6Predictors of successful problem gambling outcomes - treatment success . 484.6.1 Treatment success - univariate analyses . 485OVERVIEW, DISCUSSION AND CONCLUSIONS . 506REFERENCES . 57APPENDIX 1 Ethical approval . 64APPENDIX 2 Descriptive statistics . 65APPENDIX 3 Predictors of successful problem gambling outcomes: PGSI . 70APPENDIX 4 Predictors of successful problem gambling outcomes: Days gambled . 73APPENDIX 5 Predictors of successful problem gambling outcomes: Money lost . 77APPENDIX 6 Predictors of successful problem gambling outcomes: Control over gambling. 81APPENDIX 7 Predictors of successful problem gambling outcomes: Treatment success . 84An outcome study of a problem gambling brief telephone intervention: Three years laterProvider No: 467589, Contract Nos: 326673/00, 01and 02Auckland University of Technology, Gambling and Addictions Research CentreFinal Report, 23 October 20152
LIST OF TABLESTable 1: Number and percentage of participants at each assessment point . 27Table 2: Individual additional assistance access . 35Table 3: Formal service access by assessment point - number of respondents, median,minimum and maximum number of sessions . 36Table 4: Change in PGSI-12 by assessment point - unadjusted values . 37Table 5: Change in PGSI-12 by uptake of formal services - unadjusted values . 37Table 6: Change in PGSI-12 at 36 months by employment status - unadjusted values . 37Table 7: Change in PGSI-12 at 36 months by baseline gambling and related behaviours unadjusted values . 38Table 8: Change in PGSI-12 at 36 months by other baseline covariates - unadjusted values . 39Table 9: Change in PGSI-12 - adjusted values . 40Table 10: Change in number of days gambled by assessment point - unadjusted values . 41Table 11: Change in number of days gambled at 36 months by uptake of formal services unadjusted values . 41Table 12: Change in money lost by assessment point - unadjusted values . 42Table 13: Change in money lost at 36 months by uptake of formal services - unadjustedvalues . 42Table 14: Change in money lost at 36 months by baseline PGSI-12 - unadjusted values. 43Table 15: Change in money lost at 36 months by baseline quality of life - unadjusted values 44Table 16: Change in control over gambling by assessment point - unadjusted values . 45Table 17: Change in control over gambling at 36 months by uptake of formal services unadjusted values . 45Table 18: Change in control over gambling at 36 months by marital status - unadjusted values. 45Table 19: Change in control over gambling at 36 months by baseline gambling and relatedbehaviours - unadjusted values. 46Table 20: Change in control over gambling at 36 months by other baseline covariates unadjusted values . 47Table 21: Change in control over gambling at 36 months by New Zealand Deprivation Index adjusted values . 48Table 22: Univariate logistic regression for treatment success by assessment point . 48Table 23: Univariate logistic regression for treatment success by uptake of formal services . 49LIST OF FIGURESFigure 1: Days gambled, money lost and control over gambling by assessment point . 28Figure 2: Treatment goal by assessment point . 29Figure 3: PGSI by assessment point . 29Figure 4: PGSI-12 categorisation by assessment point . 30Figure 5: Psychological distress by assessment point . 31Figure 6: Major and minor depressive disorder, dysthymia, bipolar disorder by assessmentpoint . 31Figure 7: Alcohol abuse/dependence and smoking by assessment point . 32Figure 8: Drug abuse by assessment point . 32Figure 9: Aspects of life affected by gambling by assessment point . 33Figure 10: Assistance received for gambling problem by assessment point . 34An outcome study of a problem gambling brief telephone intervention: Three years laterProvider No: 467589, Contract Nos: 326673/00, 01and 02Auckland University of Technology, Gambling and Addictions Research CentreFinal Report, 23 October 20153
EXECUTIVE SUMMARYBrief summary of main findings at 36 monthsGambling and problem gambling outcomes Median days gambled per month and dollars lost per day gambling decreasedsubstantially at 3 months and stayed at the lower level at 36 months.Median control over gambling increased at 3 months and stayed at the higher levelat 36 months.Problem gambling severity (past 12 month time frame) median score reduced to 5 at36 months compared with a baseline score of 17. At baseline 97% were problemgamblers, at 36 months 38% were problem gamblers, 27% were moderate-riskgamblers, 8% were low-risk gamblers and 27% were non-problem gamblers.Other outcomes At baseline, 56% of participants had a high level of psychological distress; thisdecreased to 3% at 36 months.At baseline, 58% of participants had major depressive disorder; this decreased to22% at 36 months. The corresponding results for minor depressive disorder were12% to 0%, and for dysthymia were 42% to 32%.At baseline, 60% of participants smoked tobacco; this decreased to 43% at36 months. Participants with drug use problems decreased from 23% to 13%. Thepercentage of people with alcohol abuse/dependence was similar at baseline and36 months (62%, 64%).Life aspects affected by problem gambling (i.e. work, social and family life, andhealth) substantially improved at 3 months and showed slight continuedimprovement at 36 months.Additional assistance At 36 months, 13% of participants reported seeking additional assistance in the past6 months, both from formal and informal sources. Over the whole study, 36%received additional formal assistance at some time, and 52% received informalassistance (e.g. from a family member, friend or another person).Predictors of successful problem gambling outcomes at 36 months Improved outcomes on problem gambling severity were noted for people who werepartnered, or who had not previously received treatment for a gambling or mentalhealth problem.Low quality of life and high deprivation were associated with less change in controlover gambling.An outcome study of a problem gambling brief telephone intervention: Three years laterProvider No: 467589, Contract Nos: 326673/00, 01and 02Auckland University of Technology, Gambling and Addictions Research CentreFinal Report, 23 October 20154
BackgroundThis report presents the findings from the three year (36 month) follow-up of participants of astudy investigating the outcomes of a brief telephone intervention for problem gambling. Fullmethodological details are presented in the report for the outcome study covering the first12 months after intervention delivery (Abbott et al., 2013). Therefore, only a brief summary ofthe methods is detailed in this report.The study was designed as an outcome study with participants recruited from gamblers callingthe national gambling helpline for assistance. Recruitment occurred in parallel with, and usingthe same entry criteria, as a randomised controlled trial (RCT) of four different helplineinterventions, the control (or ‘Treatment as Usual’) arm of which was recruited into theoutcome study cohort. The inclusion criteria were the same as those used in the RCT and arefully detailed in the report for that trial (Abbott et al., 2012).Additional to the 116 participants from the RCT, a further 34 participants were recruited makinga total of 150 callers recruited and followed for 36 months. After giving consent, participantsreceived a baseline assessment followed by a manualised version of the helpline’s standardcare. This included brief screening, reflective listening to clients’ concerns and, in the case offirst-time callers or regular callers who were experiencing persistent difficulties, referral toface-to-face problem gambling counselling services and/or suggestions for self-care.Study participants could choose their own treatment goal (quit some or all forms of gambling,or control their gambling). Outcome measures were self-reports of days gambled, money lostgambling and treatment goal success. Other outcome measures included problem gamblingseverity, control over gambling, gambling impacts, psychiatric comorbidity, generalpsychological distress and quality of life. Although some baseline information was obtainedby counsellors pre-intervention, additional information1 was obtained by a research teammember within seven days post-intervention.PurposeThe primary purpose of the 36 month follow-up was to assess the durability of participantoutcomes and to identify predictors of successful outcomes.ParticipantsAt baseline, there were slightly more females (57%) than males. Just over a quarter (27%) wereaged 34 to 44 years, a quarter were aged 25 to 34 years and a fifth were aged 45 to 54 years.Both the youngest (18 to 24 years) and oldest (55 years and older) categories had 14% ofparticipants. Most participants reported their primary ethnicity as Māori (43%) or European(42%) with smaller proportions of Pacific (10%) and Asian or Other (5%). Slightly over a half(51%) were single. Twenty-seven percent had no educational qualification, 32% a secondaryschool qualification only, 18% a technical or trade qualification and 23% a tertiary orprofessional qualification. Over half were either in full time (44%) or part-time (12%)employment.1More detailed gambling/problem gambling history, the mood module of the Primary Care Evaluationof Mental Disorders, and the New Zealand Index of Socio-economic Deprivation for Individuals.An outcome study of a problem gambling brief telephone intervention: Three years laterProvider No: 467589, Contract Nos: 326673/00, 01and 02Auckland University of Technology, Gambling and Addictions Research CentreFinal Report, 23 October 20155
At baseline, most participants (89%) cited electronic gaming machines (EGMs) as their mainmode of problem gambling with 76% mentioning pub EGMs, nine percent club EGMs andthree percent casino EGMs. The great majority (96.5%) scored as problem gamblers on thePGSI-12 (a past 12 month measure). The remainder scored in the moderate-risk category. Themedian PGSI-12 score was 17, substantially above the cut-score of eight for problem gamblingassessment. The median PGSI-3 (a past 3 month measure) score was 18. Most participantshad very serious gambling problems at intake. They also had high rates of psychologicaldistress (56% high; 41% medium), affective disorders (major depression 58%, dysthymia 42%,minor depression 12%, bipolar disorder 3.0%) and substance misuse (alcohol abuse ordependence 62%, other drug problems 23%). A majority of participants (60%) smokedtobacco. Moderate to severe effects on family and home, social life and health were reported,with somewhat less severe effects on work.ResultsFollow-up and attritionEight-six percent of participants were re-assessed at three months, 79% at six months and66% at 12 months. Forty percent were re-assessed at 36 months. There was no evidence ofmajor differential attrition based on socio-demographic variables at any follow-up assessment.Consequently no adjustments were made to the data when assessing outcomes and predictorsof outcomes.Treatment goalsAt baseline, the majority of participants (61%) reported that their treatment goal was to quit allforms of gambling. A fifth wanted to quit some but not all forms, 13% wanted to gamble in acontrolled manner and five percent wanted to maintain gambling abstinence. Treatment goalschanged over the 36 month follow-up period. From baseline to 12 months, a lower proportionsought to stop all forms of gambling. From 12 to 36 months there was no change (27% and29% respectively). These changes were accompanied by a corresponding increase inparticipants who sought to maintain gambling abstinence, with an increase from five percent atbaseline to 21.5% at three-months, 30% at both six- and 12-months and 28% at 36 months.Participants who sought to control rather than stop gambling increased slightly from baseline(13%) to 12 months (19%) and somewhat more substantially at 36 months (28%). By36 months, similar proportions had treatment goals of stopping all gambling, maintainingabstinenc
Oct 23, 2015 · BRIEF TELEPHONE INTERVENTION: THREE YEARS LATER Provider Number: 467589 Agreement Number: 326673/00, 01 and 02 FINAL REPORT 23 October 2015 Prepared for: Ministry of Health PO Box 5013 WELLINGTON Authors: Professor Max Abbott Dr Maria Bellringer Katie Palmer Du Preez Dr Maheswaran Roha
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