Psychological treatment dropout among pathological gamblers
Open accessAbstract
Premature dropout from treatments for pathological gambling is potentially of significant importance, if it occurs before substantial progress has been made in addressing the problem. A systematic review of current research on dropout from psychological treatments for pathological gambling identified 12 studies from five countries. Dropout ranged from 14% to 50%, with a median of dropout 26%. Overall, 31% of the participants dropped out of treatment. Few studies distinguish between dropouts at different stages of participation. The evidence on specific variables that predict dropout is limited or inconsistent, and is characterised by a lack of a coherent, gambling-specific model and by methodological problems. Two studies that attempted to apply motivational and compliance-enhancing techniques were found. Both showed promising effects on reduction of dropout and improvement of short-term impact of treatment, but inconsistent results on longer-term outcomes were obtained. The review highlighted a need for more rigorous investigation of the extent of dropout and of variables associated with dropout from pathological gambling treatment programs. Further research on interventions to enhance retention and reduce dropout from psychological treatment is also required.
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Melville et al. review found treatment dropout was not associated with gender, ethnicity, education, income, relationship status, money invested in gambling, gambling severity, type of gambling, motivation to stop gambling, gambling urges, self-efficacy, comorbid depression, social problem-solving skills, prior treatment experience, satisfaction with treatment and treatment motivation.
“In contrast, treatment dropout was not associated with gender, ethnicity, education, income, relationship status, money invested in gambling, gambling severity, type of gambling, motivation to stop gambling, gambling urges, self-efficacy, comorbid depression, social problem-solving skills, prior treatment experience, satisfaction with treatment and treatment motivation.”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al., 2007
The All Dropouts vs. Completers section (page unavailable) reports no significant differences for money spent on gambling, gambling urges, and self-efficacy. But the Pre-treatment dropouts vs. continuers section reports that higher spending predicted dropout before treatment began. The copy does not establish the claimed lack of association for many other listed factors, including ethnicity, income, and comorbid depression. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMelville et al. (2007) identified no significant association between dropout and gender, marital status, pre-treatment gambling symptom severity and depression.
“Melville et al. (2007) identified no significant association between dropout and gender, marital status, pre-treatment gambling symptom severity and depression.”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al. (2007)
The ‘All Dropouts vs. Completers’ section reports no significant differences in gambling spending or urge, which lends limited support to the gambling-related part of the claim. The passages found do not report dropout associations for gender, marital status, depression, or a measure explicitly identified as pre-treatment symptom severity. Moreover, ‘Pre-treatment dropouts vs. continuers’ reports that higher gambling spending significantly predicted dropout at that stage; the null finding should not be generalized across dropout stages. (LLM, conf=0.82)
Experimental — accuracy not yet measuredTo date, the only available systematic review of predictors of treatment outcomes from psychological treatment for disordered gambling has reviewed predictors of dropout (Melville et al., 2007).
“To date, the only available systematic review of predictors of treatment outcomes from psychological treatment for disordered gambling has reviewed predictors of dropout (Melville et al., 2007).”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al., 2007
The indexed text describes Melville et al. (2007) as a systematic review of dropout from psychological treatment for pathological gambling and says it examined variables associated with dropout (Abstract; References). It does not establish that this was the only available systematic review of treatment-outcome predictors. (LLM, conf=0.78)
Experimental — accuracy not yet measuredMelville, Casey, and Kavanagh (2007) conducted a systematic review examining predictors of dropout from psychological treatment for disordered gambling.
“Melville, Casey, and Kavanagh (2007) conducted a systematic review examining predictors of dropout from psychological treatment for disordered gambling.”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al., 2007
The focus of Melville et al. review was specifically on dropout, rather than broader outcomes of treatment response or success.
“Moreover, the focus of this review was specifically on the factors associated with dropout from psychological treatments for disordered gambling, rather than those associated with the broader outcomes of treatment response or success.”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al., 2007
Only ten studies were identified for inclusion in Melville et al. review.
“Only ten studies were identified for inclusion in this review, and the predictor variables included a range of sociodemographic and contextual, gambling-related, psychological and treatment-related variables.”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al., 2007
Melville et al. review found treatment dropout was significantly associated with older age, lack of full-time employment, stressful life events, lack of social support, younger age of gambling onset, longer duration of disordered gambling, greater amount of time invested in gambling, less gambling debt, comorbid anxiety and drug or alcohol disorder, and increased impulsivity.
“The findings of this review revealed that treatment dropout was significantly associated with older age, lack of full-time employment, stressful life events, lack of social support, younger age of gambling onset, longer duration of disordered gambling, greater amount of time invested in gambling, less gambling debt, comorbid anxiety and drug or alcohol disorder, and increased impulsivity.”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al., 2007
The available Abstract describes a CBT-program analysis and says evidence about variables associated with dropout was limited and inconsistent; it does not report the review’s claimed list of significant associations. The Discussion links dropout to money spent per day gambling and coping strategies, not the claimed time spent gambling or the other listed factors. Searches for the listed demographic, social, gambling-history, and comorbidity factors found no passage establishing the attributed findings. (LLM, conf=0.70)
Experimental — accuracy not yet measuredMelville et al. (2007) noted that lower gambling debts were associated with dropout.
“Melville et al. (2007) noted that lower gambling debts were associated with dropout”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al. (2007)
The Measures and Pre-treatment dropouts vs. continuers sections examine money spent per day on gambling, not gambling debt. A search for debt and indebtedness found no passage in our copy linking lower gambling debts to dropout; daily spending cannot establish that claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredMelville et al. (2007) identified that older age was associated with treatment dropout.
“Melville et al. (2007) identified that older age was associated with treatment dropout”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al. (2007)
The Abstract and Discussion identify coping strategies and gambling expenditure as factors associated with dropout, but the retrieved passages do not address whether older age was associated with it. Searches for “older age,” age-related dropout, and demographic differences did not locate a passage establishing the claimed association. (LLM, conf=0.72)
Experimental — accuracy not yet measuredLonger duration of gambling behaviour and higher anxiety levels were found to be potential predictors of treatment dropout in Melville et al. (2007).
“but were found to be potential predictors of treatment dropout (Melville et al., 2007).”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Melville et al., 2007
The Prediction of Dropout results and Discussion identify coping strategies and money spent per day gambling as predictors, but do not report longer gambling duration or higher anxiety as predictors. Searches for anxiety, gambling duration, and gambling history found no passage linking either claimed factor to dropout; the different predictors reported do not, by themselves, contradict the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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- Authors
- Melville, K. M., Casey, L. M., & Kavanagh, D. J.
- Affiliations
- Griffith University (AU)
- The University of Queensland (AU)
- Corresponding author
- Melville, Katherine M.
- ORCID
- Kavanagh, David J.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2007-12
- Volume
- 27
- Issue
- 8
- Pages
- 944-958
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2151189764
- Cited by
- 139
- References
- 70
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 2 · 2023: 10 · 2022: 7 · 2021: 13 · 2020: 4 · 2019: 11 · 2018: 13 · 2017: 8 · 2016: 11 · 2015: 9 · 2014: 11 · 2013: 9 · 2012: 6
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- green
- eprints.qut.edu.au
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- QUT ePrints (Queensland University of Technology) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Faculty of Health; Institute of Health and Biomedical Innovation
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- gambling addiction, treatment discontinuation, psychological intervention, treatment retention, predictors of dropout, motivation enhancement, medication adherence
- MeSH terms
- Adult, Behavior Therapy, Cross-Cultural Comparison, Female, Gambling, Humans, Disruptive, Impulse Control, and Conduct Disorders, Male, Models, Psychological, Patient Dropouts, Probability, Psychotherapy, Research, Research Design, Treatment Outcome
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