Randy Stinchfield, PhD and Ken Winters, PhD

This is the fourth report that describes the results from an evaluation of six state-supported pathological gambling treatment programs in Minnesota. This report describes a longitudinal study representing all clients who were recruited from the six programs between April 1992 and January 1996. Because this is a longitudinal study, at the time of this report, some clients are at different points along the follow-up continuum, i.e., some have reached their one-year follow-up anniversary while others have not. A summary of the findings are provided below.

During the study period (April, 1992 to January, 1996) 1342 clients were recruited for the study and 944 were admitted to treatment. The general trend is that admission rates increased from the inception of the gambling treatment project and have levelled off at about an average of 20 admissions per month. This levelling off is probably due to current treatment demand and the treatment system capacity. The treatment programs attempt to provide treatment on demand, but at any given time, one or two of the six programs is likely to have clients on a waiting list.

• Of the 1342 recruited clients, 398 were not admitted to treatment, primarily because they either did not return to treatment after their intake assessment or because they came to a treatment program for only an assessment. These clients who were not admitted to treatment reported less frequent gambling and fewer problems associated with gambling, and showed less acknowledgement of a gambling problem than admitted clients, however their average scores on the South Oaks Gambling Screen (SOGS) were in the clinical range.
• Among the 944 clients admitted to treatment, 658 completed treatment (70%). Clients were administered follow-up assessments at 6 and 12 months after treatment. The follow-up response rates were 75% and 62% at 6 and 12 months follow-up, respectively. These follow-up response rates are similar to those obtained for drug abuse treatment outcome studies.

a) 61% were male;
b) the average age was 39;
c) the sample was predominantly white (93%);
d) 93% were high school graduates and 16% were college graduates; and
e) over two-thirds were employed full-time.

a) almost half (49%) of the sample had previously sought help for their gambling problem;
b) over one-third (33%) had received chemical dependency services and 47% have used mental health services;
c) 52% had a co-existing psychiatric disorder; and
d) nearly all clients received a diagnosis of pathological gambling and obtained a South Oaks Gambling Screen (SOGS) score in the probable pathological gambler range. The SOGS is a screening instrument and it is currently undergoing a reliability and validity study in Minnesota.

• Most clients began gambling before adulthood (57% before age 19) and began to gamble regularly soon afterwards (49% before age 30).
• The three most preferred gambling activities were cards (37%), gambling machines (37%), and pull tabs (14%). However, the lottery, which was rated by less than 1% as the game of choice, was played about as frequently as the most preferred games.
• In the six months prior to treatment, over one-third of the sample gambled on a daily basis (36%) and over half gambled at a weekly rate (53%).
• The majority of the sample (94%) had experienced at least one gambling related financial problem in their lifetime. Lifetime gambling debt ranged from zero to hundreds of thousands of dollars with an average of $47,855 and a median of $19,000. Recent (i.e., past six months) debt also ranged from zero to hundreds of thousands of dollars with an average of $10,008 and a median of $4,500.
• Over half of the sample (58%) reported that they had been absent from work due to gambling on one or more days during the six months prior to treatment.
• One in five clients reported they had a legal status of either being on parole, probation, or pending as a result of gambling-related legal problems, and at least 10% had been arrested for a gambling-related offense in the six-months prior to treatment.
• In terms of substance use, 69% report daily tobacco use, and almost one third are weekly to daily alcohol users. Very few reported a history of illicit drug use.
• Almost two-thirds reported having a poor self-image (64%), and over half reported experiencing poor emotional health (58%) during the six months prior to treatment.
• Most clients readily acknowledged that they have a gambling problem, that their gambling has caused harm to others, and that they want help to recover from their gambling addiction.
• Clients who completed treatment (n=658) exhibited significant improvements from pre-treatment to post treatment in the following areas:

a) There was a statistically significant decline in both gambling frequency and gambling problem severity from pre-treatment to post treatment. While most of the sample was gambling at a daily or weekly rate before treatment, 79% reported no gambling at discharge from treatment, and 43% and 42% reported no gambling at 6 and 12-months follow-up, respectively. If treatment success is defined in terms of either abstinence or less than monthly gambling, about 70% of treatment completers fall in this range at 6 and 12 months follow-up. Almost the entire sample (98%) had five or more problem signs before treatment and only 36% and 41% reported five or more problem signs at 6-months and at 12-months after treatment, respectively. Four out of five treatment completers moved from gambling on a weekly or daily frequency before treatment to a monthly or less frequent gambling after treatment. In terms of gambling problem severity (SOGS), 65% of treatment completers moved from the clinical range before treatment to the normal range after treatment.

b) Improvement also occurred in the following areas of functioning: better psychosocial functioning, less gambling debt, fewer friends who are gamblers, and fewer financial problems were reported at follow-up.

• No predictors of treatment completion were found and only modest predictors of treatment outcome were identified. Gambling frequency during treatment, client satisfaction with treatment, psychosocial problems at intake, age, and recovery orientation at discharge were moderately predictive of gambling frequency and gambling problem severity (SOGS scores) at six months follow-up.
• In other words, low frequency of gambling during treatment, higher levels of client satisfaction with treatment, fewer psychosocial problems, older clients, and a positive recovery orientation were slightly predictive of a positive outcome at six months follow-up.
• The majority of clients participated in an aftercare program and/or attended Gamblers Anonymous meetings after treatment.
• The majority of clients were satisfied with the treatment services they received and attributed their improvement to the treatment program.
• The six treatment programs were not significantly different from each other in the amount of reduction in gambling frequency and problem severity between pre-treatment and post treatment assessments. There are more similarities than differences between the six programs on client variables and treatment outcome.

You may request a free copy of the full report from:
Jay Bambery Minnesota Department of Human Services
444 Lafayette Road North
St. Paul, mn 55155-3828 Phone: (612) 296-3923
Fax: (612) 296-7731.

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