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      The General Population’s View on Where to Seek Treatment for Gambling Disorder – a General Population Survey

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          Abstract

          Background

          More remains to be understood about attitudes towards treatment for gambling disorder and where to seek treatment. Given the low degree of treatment seeking behaviour in this condition, it may be of interest to study people’s perception about where to seek help in case of problem gambling. From a study originally aiming to address health correlates of problem gambling, the present sub-study aimed to examine the general population’s attitudes towards where to advise a person with problem gambling to seek treatment, and correlates of recommending a formal professional treatment modality.

          Methods

          A cross-sectional general population web survey in Sweden (N=2,038, 55% women, 6% lifetime problem gamblers) was conducted. Preferred advice for gambling-related treatment seeking was defined with a question asking about where one would hypothetically advise a friend to seek help for gambling addiction. Advice for professional vs peer support help was compared with respect to individual characteristics, in problem gamblers and non-problem gamblers.

          Results

          Fifty percent preferred to recommend peer support help for gambling, whereas among professional treatment options, the largest share preferred primary care (22%) or psychiatry/addiction psychiatry (18%), while few suggested occupational health-care (6%) or social services (3%). Opting for a professional treatment modality for problem gambling was unrelated to one’s own problem gambling, whereas those recommending professional treatment were younger and more likely to report psychological distress. In problem gamblers specifically, history of indebtedness was associated with recommending professional treatment.

          Conclusion

          Many people may not perceive gambling disorder to require professional treatment, and may recommend peer support outside of formal treatment systems. Younger individuals, as well as those with a personal history of psychological treatment needs, may be more prone to recommending formal treatment. The findings may have implications for treatment trajectories and may facilitate overcoming perceived treatment barriers.

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          Most cited references33

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          Natural recovery and treatment-seeking in pathological gambling: results of two U.S. national surveys.

          W Slutske (2006)
          Pathological gambling is described in DSM-IV as a chronic and persisting disorder, but recent community-based longitudinal studies that have highlighted the transitory nature of gambling-related problems have called into question whether this is an accurate characterization. This emerging evidence of high rates of recovery coupled with low rates of treatment-seeking for pathological gambling suggests that natural recovery might be common. The purpose of the present study was to document the rates of recovery, treatment-seeking, and natural recovery among individuals with DSM-IV pathological gambling disorder in two large and representative U.S. national surveys. Prevalences of recovery, treatment-seeking, and natural recovery were estimated among individuals from the Gambling Impact and Behavior Study (N=2,417) and the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093) who reported a lifetime history of DSM-IV pathological gambling disorder (N=21 and N=185, respectively). Among individuals with a lifetime history of DSM-IV pathological gambling, 36%-39% did not experience any gambling-related problems in the past year, even though only 7%-12% had ever sought either formal treatment or attended meetings of Gamblers Anonymous. About one-third of the individuals with pathological gambling disorder in these two nationally representative U.S. samples were characterized by natural recovery. Pathological gambling may not always follow a chronic and persisting course. A substantial portion of individuals with a history of pathological gambling eventually recover, most without formal treatment. The results of large epidemiological surveys of pathological gambling may eventually overturn the established wisdom about pathological gambling disorder.
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            Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys.

            This paper reviews evidence pertaining to the prevalence of common comorbid disorders, including alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder, in population-representative samples of problem and pathological gamblers. A systematic search was conducted for peer-reviewed and unpublished articles reported between 1 January 1998 and 20 September 2010. Only studies which examined the prevalence of comorbid conditions in problem and/or pathological gamblers from a general population sample using randomized sampling methods and standardized measurement tools were included. Meta-analysis techniques were then performed to synthesize the included studies and estimate the weighted mean effect size and heterogeneity across studies. Eleven eligible studies were identified from the literature. Results from across the studies indicated that problem and pathological gamblers had high rates of other comorbid disorders. The highest mean prevalence was for nicotine dependence (60.1%), followed by a substance use disorder (57.5%), any type of mood disorder (37.9%) and any type of anxiety disorder (37.4%). However, there was evidence of moderate heterogeneity across studies, suggesting that rate estimates do not necessarily converge around a single population figure, and that weighted means should be interpreted with caution. Problem and pathological gamblers experience high levels of other comorbid mental health disorders and screening for comorbid disorders upon entering treatment for gambling problems is recommended. Further research is required to explore the underlying causes of variability observed in the prevalence estimates. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.
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              Barriers to seeking help for gambling problems: a review of the empirical literature.

              This literature review summarizes recent empirical research on obstacles preventing problem gamblers from seeking treatment for their gambling problems. Relevant databases and bibliographies were searched for English-language papers and reports published since 1998. The only methodological requirement was that gamblers themselves be asked about reasons for not seeking help. Nineteen studies conducted in five countries were identified. All except one targeted adults. Despite differences in methodology, many of the same barriers to treatment were identified. Most commonly reported barriers were: wish to handle problem by oneself; shame/embarrassment/stigma; unwillingness to admit problem; and issues with treatment itself. The authors of the review argue that unwillingness to admit to the problem may be even more prevalent than is typically indicated by the results of barriers studies. Other frequently reported barriers included lack of knowledge about treatment options and practical issues around attending treatment. More research is needed on barriers to treatment-seeking experienced by subgroups of gamblers defined by culture, ethnicity, gender, age. Open-ended questioning methods can help provide insights into what barrier categories mean to different groups and individuals. Input directly from gamblers can be combined with information from other kinds of studies to devise better ways of reaching problem gamblers, especially those in underserviced populations.
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                Author and article information

                Journal
                Psychol Res Behav Manag
                Psychol Res Behav Manag
                PRBM
                prbm
                Psychology Research and Behavior Management
                Dove
                1179-1578
                19 December 2019
                2019
                : 12
                : 1137-1146
                Affiliations
                [1 ]Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University , Lund, Sweden
                [2 ]McGill Group for Suicide Studies, McGill University , Montreal, QC, Canada
                Author notes
                Correspondence: Anders Håkansson Lund University, Malmö Addiction Center , Södra Förstadsgatan 35, Plan 4, MalmöS-205 02, SwedenTel +46 703 135677 Email anders_c.hakansson@med.lu.se
                Author information
                http://orcid.org/0000-0002-5800-8975
                http://orcid.org/0000-0002-2958-2978
                Article
                226982
                10.2147/PRBM.S226982
                6927584
                31908551
                91c12c28-40fd-4668-801a-b06fe1093449
                © 2019 Håkansson and Ford.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 15 August 2019
                : 25 October 2019
                Page count
                Tables: 3, References: 37, Pages: 10
                Categories
                Original Research

                Clinical Psychology & Psychiatry
                gambling disorder,problem gambling,treatment seeking,barriers,attitudes

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