Factors Associated with Treatment Dropout Among Individuals with Gambling Disorder: A Retrospective Cohort Study

Gambling disorder (GD) is a behavioral addiction frequently comorbid with mental health and substance use disorders. Its substantial individual and societal burden, explained by the impact of GD on multiple domains that include health, relationships, work or education, is compounded by high treatment dropout rates. Evidence on predictors of GD treatment dropout largely derives from controlled research settings, limiting generalizability to real-world contexts. This study is novel in evaluating service use and quality-of-care predictors of GD treatment dropout, alongside sociodemographic, clinical, and gambling-related factors, within a large public healthcare system.

Patients were eligible if they were diagnosed with GD between April 1, 2009, and March 31, 2021, and received at least one GD treatment episode in an addiction treatment center (ATC) in Quebec, Canada, during this period. The index date was the end date of the last treatment episode. ATC data were linked to provincial administrative health databases. Multivariable logistic regression estimated adjusted odds ratios (aOR) for treatment dropout.

Among 1,719 patients, the dropout rate during the index treatment episode was 46%. Prior treatment dropout (aOR=5.65), bipolar disorder (aOR=1.57), and residence in semi-urban or rural areas (aOR=1.33) were associated with higher odds of dropout. Factors associated with lower odds of dropout included history of homelessness or social issues (aOR=0.66), more than two GD treatment episodes (aOR=0.68), treatment duration longer than six months (aOR=0.45), and high intensity (aOR=0.62) or regularity (aOR=0.70) of outpatient care.

Enhancing access for individuals in non-urban areas through internet-delivered interventions, and providing intensive, regular outpatient care that fosters treatment motivation and a strong therapeutic alliance, may reduce dropout and improve outcomes.