Client characteristics associated with treatment attrition and outcome in female pathological gambling
Abstract
The current study was an exploratory investigation of client factors associated with treatment attrition and failure 6 months following treatment by female pathological gamblers. The sample comprised 77 females attending a cognitive-behavioural treatment program for pathological gambling. Participants were compared on selected client factors that have been traditionally associated with attrition and outcome in the alcohol and substance dependence literature. The results indicate that although treatment dropouts and completers did not differ on any client factor, participants displaying uncontrolled treatment outcomes reported significantly more severe gambling behaviour than participants achieving abstinent or controlled treatment outcomes. Clinicians can respond to these indicators of higher risk of treatment failure by increasing the emphasis of relapse prevention approaches in pathological gambling interventions.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
There are several studies that examine the influence of post-treatment client characteristics on follow-up treatment outcomes.
“there are several studies that examine the influence of post-treatment client characteristics on follow-up treatment outcomes (Dowling, 2009;Petry & Weiss, 2009;Sander & Peters, 2009).”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Dowling, 2009
Each of these studies found promising results consistent with the substance abuse literature, with post-treatment gambling frequency, post-treatment social support and post-treatment psychological distress and quality of life significantly associated with treatment outcomes at follow-up evaluations.
“Each of these studies found promising results consistent with the substance abuse literature, with post-treatment gambling frequency (Dowling, 2009), post-treatment social support (Petry & Weiss, 2009) and post-treatment psychological distress and quality of life (Sander & Peters, 2009) significantly associated with treatment outcomes at follow-up evaluations.”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Dowling, 2009
The severity of gambling behaviour is one of the strongest predictors of outcome in treatment.
“These findings are consistent with a growing body of evidence that the severity of the gambling behaviour is one of the strongest predictors of outcome in the treatment (Dowling, 2009;Merkouris, Thomas, Browning, & Dowling, 2016).”
From Early risk and protective factors for problem gambling: a systematic review and meta-analysis of longitudinal studies (2017) · cites this paper as Dowling, 2009
Cites
Motivational interviewing: preparing people for change.
Miller, W. R., & Rollnick, S. (2002) · Cited by 7,002 · see citing works
State-Trait Anxiety Inventory for Adults
Spielberger, C. D. (2012) · PsycTESTS Dataset · doi:10.1037/t06496-000 · Cited by 3,479 · see citing works
International Journal of Mental Health and Addiction
(2013) · International Journal of Mental Health and Addiction · doi:10.1007/11469.1557-1882 · Cited by 1,058 · see citing works
Reliability Generalization of Scores on the Spielberger State-Trait Anxiety Inventory
Barnes, L. L. B., Harp, D., & Jung, W. S. (2002) · Educational and Psychological Measurement · doi:10.1177/0013164402062004005 · Cited by 947 · cited 3× · see citing works
“Test-retest coefficients were noticeably lower for the state anxiety scale (0.70) than for the trait anxiety scale (0.88) (Barnes et al. 2002), which is consistent with the theoretical model that characterizes state anxiety as a temporary state that is more susceptible to temporal fluctuations…”
BackgroundResultInfluentialDropping out of substance abuse treatment: A clinically oriented review.
Stark, M. J. (1992) · Clinical Psychology Review · doi:10.1016/0272-7358(92)90092-m · Cited by 636 · see citing works
Mclellan, A., Alterman, A., Metzger, D. S., Grissom, G. R., Woody, G. E., Luborsky, L., & O'Brien, C. (1994) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.62.6.1141 · Cited by 395 · see citing works
Brewer, D. D., Catalano, R. F., Haggerty, K. P., Gainey, R. R., & Fleming, C. B. (1998) · Addiction · doi:10.1046/j.1360-0443.1998.931738.x · Cited by 392 · see citing works
Psychotherapy and Pharmacotherapy for Ambulatory Cocaine Abusers
Carroll, K. M. (1994) · Archives of General Psychiatry · doi:10.1001/archpsyc.1994.03950030013002 · Cited by 348 · see citing works
Retention and patient engagement models for different treatment modalities in DATOS
Joe, G. W., Simpson, D. D., & Broome, K. M. (1999) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(99)00088-5 · Cited by 323 · see citing works
The Role of Psychiatric Disorders in Predicting Drug Dependence Treatment Outcomes
Compton, W. M., Cottler, L. B., Jacobs, J., Abdallah, A. B., & Spitznagel, E. L. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.5.890 · Cited by 309 · see citing works
Efficacy of disulfiram: a reply to Hughes and Cook.
Brewer, C. L. (1998) · PubMed · Cited by 240 · see citing works
Predictors of substance abuse treatment retention among women and men in an HMO
Mertens, J. R., & Weisner, C. M. (2000) · Alcoholism: Clinical and Experimental Research · doi:10.1111/j.1530-0277.2000.tb04571.x · Cited by 225 · see citing works
Green, C. A., Polen, M. R., Dickinson, D. M., Lynch, F. L., & Bennett, M. D. (2002) · Journal of Substance Abuse Treatment · doi:10.1016/s0740-5472(02)00278-7 · Cited by 201 · cited 3× · see citing works
“…evidence of gender differences in the factors affecting treatment attrition and outcomes in the treatment of alcohol and substance dependence (e.g., Green et al. 2002; Compton et al. 2003), it cannot be assumed that findings relevant to male pathological gambling can be generalized as equally…”
BackgroundCompletion rates of clients discharged from drug and alcohol treatment programs in Washington State.
Wickizer, T. M., Maynard, C. C., Atherly, A. J., Frederick, M., Koepsell, T. D., Krupski, A., & Stark, K. D. (1994) · American Journal of Public Health · doi:10.2105/ajph.84.2.215 · Cited by 191 · see citing works
Utility and validity of the STAI with anxiety disorder patients
Oei, T. P. S., Evans, L., & Crook, G. M. (1990) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.1990.tb00906.x · Cited by 170 · see citing works
New Measures for Assessing Alcohol and Drug Abuse With the MMPI-2: The APS and AAS
Weed, N. C., Butcher, J. N., McKenna, T., & Ben‐Porath, Y. S. (1992) · Journal of Personality Assessment · doi:10.1207/s15327752jpa5802_15 · Cited by 169 · see citing works
Okun, A., Stein, R. E. K., Bauman, L. J., & Silver, E. J. (1996) · Psychological Reports · doi:10.2466/pr0.1996.79.3.1059 · Cited by 162 · see citing works
Dickerson, M. (1993) · Journal of Gambling Studies · doi:10.1007/bf01015920 · Cited by 148 · see citing works
Short-term alcohol and drug treatment outcomes predict long-term outcome
Weisner, C. M. (2003) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(03)00167-4 · Cited by 147 · see citing works
Which pathological gamblers will complete treatment?
Leblond, J., Ladouceur, R., & Blaszczynski, A. (2003) · British Journal of Clinical Psychology · doi:10.1348/014466503321903607 · Cited by 123 · cited 6× · see citing works
“Studies examining the correlates of treatment attrition in pathological gambling have generally found that few client factors are associated with treatment attrition (Echeburúa et al. 2001; Toneatto et al. 2002; Leblond et al. 2003; Grant et al. 2004).”
BackgroundResultInfluentialOutpatient alcoholism treatment: Predictors of outcome after 3 years
Bottlender, M., & Soyka, M. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2005.03.011 · Cited by 115 · see citing works
Treatment approaches for pathological gamblers
Viets, V. L. (1997) · Clinical Psychology Review · doi:10.1016/s0272-7358(97)00031-7 · Cited by 110 · see citing works
Control versus abstinence in the treatment of pathological gambling: a two to nine year follow‐up
Blaszczynski, A. P., McConaghy, N., & Frankova, A. (1991) · British Journal of Addiction · doi:10.1111/j.1360-0443.1991.tb01782.x · Cited by 110 · see citing works
Milton, S., Crino, R., Hunt, C., & Prosser, E. (2002) · Journal of Gambling Studies · doi:10.1023/a:1015580800028 · Cited by 103 · see citing works
Understanding relapse in the broader context of post‐treatment functioning
Connors, G. J., Maisto, S. A., & Zywiak, W. H. (1996) · Addiction · doi:10.1046/j.1360-0443.91.12s1.8.x · Cited by 87 · see citing works
The Family Functioning of Female Pathological Gamblers
Dowling, N. A., Smith, D. I., & Thomas, T. (2007) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-007-9126-0 · Cited by 84 · see citing works
Self-citationBehavior Completion Versus Stimulus Control in Compulsive Gambling
McConaghy, N., Armstrong, M. S., Blaszczynski, A. P., & Allcock, C. (1988) · Behavior Modification · doi:10.1177/01454455880123004 · Cited by 81 · see citing works
Predictors of dropout from psychosocial treatment of cocaine dependence
Siqueland, L., Crits-Christoph, P. F., Frank, A. F., Daley, D. C., Weiss, R. D., Chittams, J. L., BLAINE, J. D., & Luborsky, L. B. (1998) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(98)00039-8 · Cited by 81 · see citing works
Dowling, N. A., Smith, D. I., & Thomas, T. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.11.003 · Cited by 76 · see citing works
Self-citationClient Demographics and Outcome in Outpatient Cocaine Treatment
Means, L. B., Small, M., Capone, D. M., Capone, T. A., Condren, R., Peterson, M., & Hayward, B. (1989) · International Journal of the Addictions · doi:10.3109/10826088909047312 · Cited by 70 · see citing works
Echeburúa, E., Fernández-Montalvo, J., & Báez, C. (2001) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465801003113 · Cited by 66 · see citing works
Treatment of Female Pathological Gambling: The Efficacy of a Cognitive-Behavioural Approach
Dowling, N. A., Smith, D. I., & Thomas, T. (2006) · Journal of Gambling Studies · doi:10.1007/s10899-006-9027-3 · Cited by 63 · see citing works
Self-citationPredictors of deterioration among patients with substance‐use disorders
Moos, R. H., Moos, B. S., & Finney, J. W. (2001) · Journal of Clinical Psychology · doi:10.1002/jclp.1105 · Cited by 62 · see citing works
Retrospective review of treatment retention in pathological gambling.
Grant, J., Kim, S.-W., & Kuskowski, M. (2004) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2003.12.005 · Cited by 57 · see citing works
Understanding relapse in the broader context of post-treatment functioning
Connors, G. J., Maisto, S. A., & Zywiak, W. H. (1996) · Addiction · doi:10.1111/j.1360-0443.1996.tb02337.x · Cited by 50 · see citing works
Blaszczynski, A. P., McConaghy, N., & Frankova, A. (1991) · British Journal of Addiction · doi:10.1111/j.1360-0443.1991.tb01734.x · Cited by 49 · see citing works
Stinchfield, R. D., Kushner, M. G., & Winters, K. C. (2005) · Journal of Gambling Studies · doi:10.1007/s10899-005-3100-1 · Cited by 42 · see citing works
Attributional style in pathological gamblers in treatment.
McCormick, R. A., & Taber, J. I. (1988) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.97.3.368 · Cited by 40 · see citing works
Patterns of substance use in treatment‐seeking problem gamblers: Impact on treatment outcomes
Toneatto, T., Skinner, W., & Dragonetti, R. (2002) · Journal of Clinical Psychology · doi:10.1002/jclp.2011 · Cited by 40 · see citing works
Attributional style in pathological gamblers in treatment.
McCormick, R. A., & Taber, J. I. (1988) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.97.3.368 · Cited by 40 · see citing works
Dowling, N. A., & Smith, D. I. (2007) · Journal of Gambling Studies · doi:10.1007/s10899-007-9064-6 · Cited by 32 · see citing works
Self-citationMcCormick, R. A., & Taber, J. I. (1991) · Journal of Gambling Studies · doi:10.1007/bf01014525 · Cited by 32 · see citing works
Using the MMPI-2 to detect substance abuse in an outpatient mental health setting.
Stein, L. A. R., Graham, J. R., Ben‐Porath, Y. S., & McNulty, J. L. (1999) · Psychological Assessment · doi:10.1037/1040-3590.11.1.94 · Cited by 30 · see citing works
Haver, B., Dahlgren, L., & Willander, A. (2001) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2001.tb02165.x · Cited by 29 · see citing works
Validity of the Substance Abuse Scales of the MMPI-2 in a College Student Sample
Svanum, S., McGrew, J. H., & Ehrmann, L. C. (1994) · Journal of Personality Assessment · doi:10.1207/s15327752jpa6203_4 · Cited by 28 · see citing works
Dropouts in clinical research: Do results reported reflect clinical reality?
Ladouceur, R., Gosselin, P., Laberge, M., & Blaszczynski, A. P. (2001) · Behavior Therapy · Cited by 24 · see citing works
Öjehagen, A., Skjaerris, A., & Berglund, M. (1988) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.1988.tb00131.x · Cited by 23 · see citing works
Smith, S. A., Thomas, S. A., & Jackson, A. C. (2004) · Journal of Social Work Practice · doi:10.1080/0265053042000180581 · Cited by 22 · see citing works
Predictors of treatment outcome for alcoholics treated by individualized behavior therapy
Maisto, S. A., Sobell, M. B., & Sobell, L. C. (1980) · Addictive Behaviors · doi:10.1016/0306-4603(80)90048-9 · Cited by 17 · see citing works
Attrition from Alcohol and Drug Outpatient Treatment
Doumas, D. M., Blasey, C. M., & Thacker, C. L. (2005) · Alcoholism Treatment Quarterly · doi:10.1300/j020v23n04_04 · Cited by 14 · see citing works
Factors that Predict Treatment Outcomes in a Community Treatment Agency for Problem Gamblers
Raylu, N., & Oei, T. (2007) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-007-9056-x · Cited by 14 · see citing works
A 6‐Year Follow‐Up of Alcoholics After Long‐Term Outpatient Treatment
Öjehagen, A., Berglund, M., & Moberg, A. (1994) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.1994.tb00937.x · Cited by 13 · see citing works
Jackson, A. C., Dowling, N. A., Thomas, S. A., & Holt, T. A. (2008) · Addiction Research & Theory · doi:10.1080/16066350802008793 · Cited by 9 · see citing works
Self-citationR. Crisp, B., A. Thomas, S., C. Jackson, A., & Thomason, N. (2001) · Australian Journal of Primary Health · doi:10.1071/py01031 · Cited by 7 · cited 5× · see citing works
“Finally, several studies have investigated a range of characteristics on outcomes in clients presenting to Australian problem gambling outpatient counselling services (Crisp et al. 2001; Jackson et al. 2002; Smith et al. 2004; Raylu and Oei 2007).”
BackgroundInfluentialMiller, S. I. (1999) · American Journal on Addictions · doi:10.1080/105504999305785 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators.
Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000044 · Cited by 551 · see citing works
Dowling, N. A., Merkouris, S. S., Greenwood, C. J., Oldenhof, E., Toumbourou, J. W., & Youssef, G. J. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.10.008 · Cited by 439 · see citing works
Self-citationA scoping review of co-morbidity in individuals with disordered gambling
Yakovenko, I., & Hodgins, D. (2018) · International Gambling Studies · doi:10.1080/14459795.2017.1364400 · Cited by 103 · see citing works
Predictors of outcomes of psychological treatments for disordered gambling: A systematic review
Merkouris, S. S., Thomas, S. A., Browning, C. J., & Dowling, N. A. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.06.004 · Cited by 96 · see citing works
“(2008) + 1 100% Treatment goal Dowling et al. (2009)/Dowling (2009) x x x x 1 0%”
InfluentialSelf-citationProblem gambling subtypes based on psychological distress, alcohol abuse and impulsivity
Suomi, A., Dowling, N. A., & Jackson, A. C. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.07.023 · Cited by 81 · see citing works
Self-citationInternet-based treatment of pathological gambling with a three-year follow-up
Carlbring, P., Degerman, N., Jonsson, J., & Andersson, G. (2012) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2012.689323 · Cited by 78 · see citing works
Dowling, N. A., Merkouris, S. S., & Lorains, F. K. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.02.012 · Cited by 73 · see citing works
Self-citationDowling, N. A., Smith, D. I., & Thomas, T. (2009) · Journal of Gambling Studies · doi:10.1007/s10899-009-9116-1 · Cited by 51 · see citing works
Self-citationMechanisms of Action in the Relationship between Mindfulness and Problem Gambling Behaviour
de Lisle, S. M., Dowling, N. A., & Allen, J. S. (2014) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-014-9475-4 · Cited by 36 · see citing works
Self-citationWilde, B. D., Goudriaan, A. E., Sabbe, B., Hulstijn, W., & Dom, G. (2013) · Journal of Behavioral Addictions · doi:10.1556/jba.2.2013.1.4 · Cited by 29 · see citing works
Holdsworth, L., Nuske, E., & Breen, H. (2013) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-012-9415-0 · Cited by 27 · see citing works
Guo, S., Manning, V., Thane, K. K. W., Ng, A., Abdin, E., & Wong, K. (2014) · Journal of Gambling Studies · doi:10.1007/s10899-012-9328-7 · Cited by 26 · see citing works
Client engagement characteristics associated with problem gambling treatment outcomes
Dowling, N. A., & Cosic, S. (2011) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-010-9298-x · Cited by 23 · see citing works
Self-citationThe Cognitive‐Behavioral Treatment of Female Problem Gambling
Dowling, N. (2013) · doi:10.1002/9781118316078.ch10 · Cited by 26 · see citing works
Self-citationEfficacy of a self-help treatment for at-risk and pathological gamblers
Boudreault, C., Giroux, I., Jacques, C., Goulet, A., Simoneau, H., & Ladouceur, R. (2018) · Journal of Gambling Studies · doi:10.1007/s10899-017-9717-z · Cited by 19 · see citing works
Definitions and assessments of recovery from gambling disorder: A scoping review
Mansueto, A., Challet‐Bouju, G., Hardouin, J.-B., & Grall‐Bronnec, M. (2024) · Journal of Behavioral Addictions · doi:10.1556/2006.2024.00008 · Cited by 17 · see citing works
Pfund, R., Peter, S. C., Whelan, J., & Meyers, A. (2018) · Journal of Gambling Studies · doi:10.1007/s10899-017-9733-z · Cited by 14 · see citing works
Nilsson, A., Simonsson, O., & Hellner, C. (2021) · Current Psychology · doi:10.1007/s12144-021-02368-1 · Cited by 12 · see citing works
Understanding dropout during psychological treatment for gambling: A scoping review
Hawker, C. O., Dias, S., Dowling, N. A., Thomas, A. C., Thornley, B. J., Campbell, S. L., Quigley, K. L., & Merkouris, S. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102653 · Cited by 7 · see citing works
Self-citationTolchard, B., & Battersby, M. (2013) · Journal of Addiction Research & Therapy · doi:10.4172/2155-6105.1000165 · Cited by 8 · see citing works
Dropout or Early Treatment Response Among Gamblers with Depressive Symptoms
Campos, M. D., Williams, R. C., Joshi, V., Hall, E. A. H., Reid, R. C., Rosenthal, R. J., & Fong, T. W. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-021-00586-z · Cited by 5 · see citing works
Pathological Gambling. Treatment and Personality Factors
Myrseth, H. (2011) · NORA - Norwegian Open Research Archives · Cited by 4 · see citing works
Hawker, C., Dowling, N., Thornley, B., Campbell, S., Quigley, K., Thomas, A. C., Dias, S., & Merkouris, S. (2025) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-025-01557-4 · Cited by 4 · see citing works
Self-citationA Cognitive Behavioural Therapy Programme for Problem Gambling: Therapist Manual
Dowling, N. A. (2011) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2010.00284_4.x · Cited by 2 · see citing works
Self-citationSoberay, A. (2015) · Digital Commons - DU (University of Denver) · Cited by 1 · see citing works
Dowling, N., Merkouris, S., Greenwood, C. J., Oldenhof, E., Toumbourou, J. W., & Youssef, G. J. (2015)
Self-citation
- Authors
- Dowling, N.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Dowling, Nicki
- ORCID
- Dowling, Nicki
- Venue
- Addiction Research & Theory
- Publisher
- Informa UK Limited
- Published
- 2009-01
- Volume
- 17
- Issue
- 2
- Pages
- 205-219
- ISSN
- 1058-6989 (ISSN-L)
- 1606-6359
- 1476-7392
- OpenAlex
- W1979729541
- Cited by
- 26
- References
- 54
- Citations by year
- 2025: 2 · 2024: 1 · 2022: 1 · 2021: 1 · 2017: 3 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 4 · 2012: 2
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addiction Research & Theory (publishedVersion)
- 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, female gamblers, treatment discontinuation, cognitive behavioral therapy, gambling severity, relapse prevention, treatment outcomes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
