Three Years of Care Trajectories Among Patients with Gambling Disorder

Given the limited evidence on care received over time by patients with gambling disorder (GD), this study examined care trajectories and their associations with patients' conditions, gambling characteristics, and quality of care. Data from 14 Quebec addiction treatment centers were collected for 907 patients with at least 3 years of GD, then linked to provincial administrative databases (1979-2022). Group‑based multi‑trajectory modeling identified 3‑year care trajectories (2009-2022) for GD, mental disorders (MDs), substance‑related disorders (SRDs), and physical health problems, considering most patients had co‑occurring disorders. Multiple multinomial logistic regression assessed covariates. Of the five trajectories identified, only Trajectories 3 and 5 received substantial GD treatment throughout the 3‑year period-less than one-third of the cohort. Trajectory 3 had the most GD treatment and the lowest dropout rates, though about half still discontinued care. These patients were older (similar to Trajectories 2 and 4) and had comparatively better conditions (similar to Trajectory 1), although most had co‑occurring disorders and made minimal use of services that could address these issues. MD‑SRD service use was especially low in Trajectories 1-3 (70% of the cohort), although most of these patients had those disorders. Conversely, Trajectory 4 patients showed low GD treatment but high use of other services, while gambling characteristics were not associated with any trajectory. Patients with the worst conditions received the most overall care (Trajectories 4-5), including acute care. GD and MD‑SRD care could be substantially improved to better address the cohort's substantial unmet needs, including screening, motivational interventions, and referral to treatment, especially for patients in Trajectories 1, 2, and 4.