David M. Ledgerwood, Ph.D. Department of Psychiatry and Behavioral Neuroscience Wayne State University School of Medici

1. David M. Ledgerwood, Ph.D. Department of Psychiatry and Behavioral Neuroscience Wayne State University School of Medicine PREDICTORS OF TREATMENT ENGAGEMENT OF PROBLEM GAMBLERS CALLING THE STATE OF MICHIGAN GAMBLING HELPLINE

2. Acknowledgements • Wayne State • Cynthia Arfken • Ken Bates • Joi Moore • Ashley Weidemann • Lisa Sulkowsky • Deb Kish • Jessica Butzin • Caren Steinmiller • State of Michigan – Deborah Hollis • NSO • Don Holmes • LaNiece Jones • Helpline Staff

3. Joe Cada, a 21-year old poker professional from Michigan, poses with bundles of cash after winning $8.5 million in prize money at the World Series of Poker tournament at the Rio hotel-casino in Las Vegas, Nevada November 9, 2009. Darvin Moon, a 45-year-old logger from Maryland, came in second place. Photograph by: Steve Marcus, Reuters

5. Role of Helplines • Open 24 hours per day • Provide brief counseling for problem gambling and concurrent problems • Sometimes provide crisis call contact • Provide treatment referral

6. State of Michigan Helpline • Funded by the State of Michigan • Operated by Neighborhood Services Organization • In 2007, 1171 callers were referred for gambling treatment and 894 were referred to Gambler’s Anonymous or Gamanon

7. NSO Gambling Treatment Mission • The mission of the Gambling Treatment Program is to provide comprehensive treatment services to compulsive gamblers and their families. The philosophy of consumer care is based upon consumer participation and decision making. • The Michigan Department of Community Health funds the Gambling Treatment Program. It is a statewide program for compulsive gamblers and their families. Through this program, consumers needing assistance with problem and/or compulsive gambling can receive a referral to a trained treatment provider.

8. Research on Gambling Helplines • Potenza and colleagues – Connecticut State Helpline (several studies) • Characterized problem gamblers calling the state helpline, examining differences based on gender, race/ethnicity, age, presence of suicidal ideation, gambling-related illegal behaivors and other factors

9. Research on Gambling Helplines • Griffiths et al. 1999, characterized callers of a helpline in the UK • Heatter & Patton, 2006, gender differences of callers to a helpline in Canada • Shandley & Moore, 2008, evaluation of an Australian helpline from consumer perspective • Reports completed by states or countries

10. Research on Gambling Helplines • Few, if any studies have examined factors that contribute to whether the helpline caller pursues treatment • No studies examine factors such as treatment motivation and barriers that have the potential to keep individuals from following through

11. Our Study • Wanted to re-contact a portion of the callers to the helpline to answer the following: • What are the socio-economic and legal (i.e., crime) consequences of problem gambling among callers to the State of Michigan problem gambling helpline • How many people calling the gambling helpline sought treatment, and what are the perceived and actual barriers they encountered

12. Our Study • Wanted to re-contact a portion of the callers to the helpline to answer the following: • What are the socio-economic and legal (i.e., crime) consequences of problem gambling among callers to the State of Michigan problem gambling helpline • How many people calling the gambling helpline sought treatment, and what are the perceived and actual barriers they encountered

13. Study Sample • N = 188 problem gamblers • N = 78 men (42%) and N = 110 women (58%) (Helpline data:45 and 55%) • 50% Caucasian, 43% African American (Helpline data: 57% and 36%) • 2% Latino • N = 41% Married • N = 46.2% Employed

14. Our follow-up sample so far… • So far, we have re-contacted 98 participants at least 2 months following the original call • Anticipate eventually contacting 75-80% of the original sample

15. Our follow-up sample so far… • 69% have engaged in treatment • Just under 1/3 did not attend a single session • Very similar to data reported by the helpline • From Oct 08 – Sept 09: 61.5% attended • From Oct 09 – Jan 10: 65.9% attended

16. So, what might be getting in the way of attending treatment? • Demographic factors? • Gambling severity? • Psychiatric/Substance use problems? • Satisfaction their helpline call? • Motivation for treatment? • Barriers to treatment?

17. Demographic Predictors? • Slightly more of the women (72%) than of the men (63%), but not significant • Race and ethnicity were not factors • Marital status and employment were not factors • Education, personal and household income were not factors

18. Problem Gambling Severity • Past research has indicated that problem gamblers with more severe problems are more likely to go to treatment.

19. Co-occurring Psychiatric/Substance Abuse? • Family history of drug, alcohol or gambling problems were not a factor • Depression, anxiety, suicidality were not factors • Personal drug and alcohol problems were not factors • Past problem gambling treatment and past use of GA significantly predicted current treatment

20. What did they think of the helpline call? • Asked 3 Questions, on a scale of 1 to 10 • …how helpful was the counseling you received from the helpline? • …rate the extent to which the counseling you received was enough (i.e., that you didn’t need any more counseling for your gambling problems). • …how likely are you to follow up on the treatment referral you received from the helpline?

21. Motivation • Treatment Readiness – to what extent is the caller “ready” for treatment? • Does the individual believe he/she has a problem? • Are the consequences of the problem sufficient to result in significant changes? • Stages of Change Model (aka Transtheoretical model)

22. Stages of Change Pre-Contemplation - The patient does not consider him/herself to have a problem with drugs and does not want treatment Contemplation - The patient is beginning to feel that drugs/alcohol are becoming a problem, but he/she has not begun to act on this feeling Action – The Patient is actively working toward recovery Maintenance - The patient is fully in recovery and continues to engage in activities that lead to further growth

23. Perceived Treatment Barriers • Availability • Cost • Stigma • Uncertainty • Avoidance

24. Most frequently reported barriers to treatment • Asked participants to answer the following question: • Whether or not you followed up on your treatment referral, what factors made it less likely that you would seek treatment for your gambling problems? (e.g., factors that made it difficult or that turned you off of treatment)

25. Most Prominent Differences • Callers who do not go to treatment: • Don’t believe they have a problem or feel they can handle it on their own. • Don’t want to stop gambling. • Report not being ready for treatment.

26. Most frequently reported reasons for going to treatment • Asked participants to answer the following question: • What factors made it more likely that you would seek treatment for your gambling problems? (e.g., factors that made seeking treatment easier or that made treatment more appealing)

27. What are the implications?

28. What are the implications? • Motivation for changing problem gambling behaviors is very important • Participants mostly knew that they were unlikely to follow through on their referral • Interventions that address motivation (e.g., Motivational Interviewing) can be used to improve the chances a problem gambler will attend treatment • Telephone counselors at the helpline can be trained to do these interviews

29. What are the implications? • Treatment barriers are also very important in understanding treatment non-compliance • Availability, Cost, Stigma and Uncertainty differ between gamblers who do and don’t seek treatment • Interventions can address the ambivalence • In some cases, treatment providers may be a distance away

30. What are the implications? • Those who went to treatment saw treatment as believe that they had a significant gambling problem, saw treatment as a potentially effective alternative, believed therapy to be a supportive/non-judgmental environment, and appreciated the opportunity to discuss their problems with others

31. What are the implications? • These findings are also important for therapists, once the helpline client is seen in therapy • Those who experience less motivation for treatment, or who have more barriers to treatment may be less likely to continue in treatment beyond a few sessions

32. Thank You!