6. Follow-up Study

Care and treatment system for subjects with
pathological gambling in Germany
Bettina Grüne1, Pawel Sleczka1, Barbara Braun1,
Gerhard Bühringer1,2 & Ludwig Kraus1,3
1) IFT Institut für Therapieforschung, Munich
2) Institute of Clinical Psychology and Psychotherapy,
Technische Universität Dresden
3) Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm
3rd Int. Conference on Pathological Gambling and Behavioural Addictions
Warsaw, November, 24th – 25th 2015
Institut für
Therapieforschung
München
Overview
1.
Care and treatment system
2.
Care and treatment utilisation
3.
Patients’ characteristics
4.
Treatment process and outcome
5.
Issues & Challenges
6.
Follow-up Study
7.
Summary/Discussion
Institut für
Therapieforschung
München
2
Institut für
Therapieforschung
München
1. Care and treatment system
OUTPATIENT
General Practioner
Primary
care
Secondary
care
Tertiary
care
INPATIENT
General hospitals
General psychosocial services
family - education - work
living - crisis - justice
Outpatient treatment/
psychotherapy
Psychiatric hospitals
Psychosomatic hospitals
Addiction counselling services
Addiction treatment services
Addiction treatment services
and complementary services
Bühringer et al. 2009
3
Institut für
Therapieforschung
München
1. Care and treatment system
Addiction Care System 2013
Outpatient
Inpatient
(1) Facilities (total)
1,402
464
(2) Facilities (sample)
822
200
(3) Ownership
Charity
Public
Commercial
88%
9%
4%
57%
13%
30%
(4) Staff
social worker, psychologists, physicians
(5) Cases/year
334,000
47,000
(6) Diagnoses
Alcohol
Opioids
Cannabis
Gambling
Others
53%
16%
14%
6%
11%
73%
7%
6%
3%
11%
German substance abuse treatment statistic (DSHS, Brand et al. 2014)
4
2. Care and treatment utilisation
Institut für
Therapieforschung
München
2.1 Help seeking
● 80% of subjects with pathological gambling do not have any contact to
health care system in lifetime (Bischof et al. 2012)
● 11% seek intense help (more than 3 contacts) (Bischof et al. 2012)
● 5 - 14% seek help in outpatient addiction care facilities (own estimation)
5
2. Care and treatment utilization
Institut für
Therapieforschung
München
2.2 Trends: PG in addiction care over time
8.0
7.0
6.0
5.0
%
4.0
outpatient
inpatient
3.0
2.0
1.0
0.0
German substance abuse treatment statistic (DSHS)
6
Institut für
Therapieforschung
München
3. Patients’ characteristics
3.1 DSHS: Gender distribution
Outpatient
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
88
Inpatient
90
75
74
26
12
Men
26
10
Women
PG
Men
Women
All
Künzel et al. 2015
7
Institut für
Therapieforschung
München
3. Patients’ characteristics
years
3.2 DSHS: Mean age in years
50
45
40
35
30
25
20
15
10
5
0
35
37
Total
Outpatient
41 43
34
36
Men
Women
Inpatient
38
42
Total
PG
41
37
Men
40
43
Women
All
Künzel et al. 2015
8
Institut für
Therapieforschung
München
4. Treatment process & outcome
4.1 DSHS: Treatment duration in weeks
Outpatient
Inpatient
40
34
35
weeks
30
25
24
36
33
26
24
20
15
10
11
10
Total
Men
12
12
Total
Men
11
12
5
0
Women
PG
Women
All
Künzel et al. 2015
9
Institut für
Therapieforschung
München
4. Treatment process & outcome
4.2 DSHS: Regular treatment termination
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Total
Inpatient
81
81
83
82
53
Outpatient
53
Men
63
62
Total
Men
55
Women
PG
82
80
65
Women
All
Künzel et al. 2015
10
4. Treatment process & outcome
Institut für
Therapieforschung
München
4.3 Study in 36 outpatient treatment centres
● Sample selection
All patients from April 2009 to August 2010
Inclusion criteria: gambling problems, 18 years and older, sufficient German
language skills
● Sample characteristics
93% fulfil DSM-IV criteria for PG
51% high severity of psychological strain
47% moderate/ severe depressive symptoms
● Insufficient use of outpatient treatment
50% less than 6 treatment contacts
70% drop out
→ Low subjective need and willingness for treatment
→ PG seek treatment because of acute crises rather than growing insight
Braun et al. 2013
11
Institut für
Therapieforschung
München
4. Treatment process & outcome
4.4 Psychological problems and symptoms (SCL-90)
Outpatient sample
Inpatient sample
Norm sample
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
Braun et al. 2013, Premper & Schulz et al. 2008
12
5. Issues & Challenges
●
●
●
●
Institut für
Therapieforschung
München
Increase in no. of patients with PG especially in outpatient treatment
High drop-out rates in outpatient care
Short treatment periods in outpatient care
Patients in outpatient care are similarly affected as in inpatient care
!! Broad range of counselling issues & very general guidelines in outpatient
treatment → large variation of treatment concepts
→ Knowledge of factors associated with (long-term) outcome is necessary
for improving outpatient treatment.
13
6. Follow-up Study
Institut für
Therapieforschung
München
Outpatient care of patients with gambling problems
14
6. Follow-up study: aims
Institut für
Therapieforschung
München
(1) To describe and investigate treatment process and outcome
-
Patient and disorder characteristics
Therapy and staff related characteristics
(2) To investigate factors associated with treatment process and outcome
-
Patient-related, treatment-related and therapist-related
(3) To develop best practice recommendations
15
Institut für
Therapieforschung
München
6. Follow-up study: methodology
Design
t1
t0
Recruitment
Baselinequestionnaire
+ phone
interview
6M
First
Follow-up
t2
6M
Second
Follow-up
Therapists‘
questionnaire
Treatment documentation (therapists)
16
Institut für
Therapieforschung
München
6. Follow-up Study: preliminary results
Gambling prevalence
Gambling last 12 months, % (n)
n=78
Gaming machines
75.6 (59)
Slot machines (casino)
28.2 (22)
Table games (casino)
16.7 (13)
Scratch tickets
37.8 (29)
Lotto tickets
25.9 (28)
TV lottery
7.7 (6)
Sports betting office
25.6 (20)
Sport betting internet
19.2 (15)
Internet poker/card games
16.7 (13)
Internet casino
28.2 (22)
17
Institut für
Therapieforschung
München
6. Follow-up Study: preliminary results
Gambling preference last 12 months, % (n)
Most liked
to play
Gaming machines
Most time
spent
Most money
spent
65.4 (51)
66.7 (52)
59.0 (46)
Slot machines (casino)
1.3 (1)
1.3 (1)
1.3 (1)
Table games (casino)
3.9 (3)
1.3 (1)
2.6 (2)
Lotto tickets
1.3 (1)
2.6 (2)
1.3 (1)
Sports betting office
5.1 (4)
3.9 (3)
9.0 (7)
Sports betting internet
9.0 (7)
11.5 (9)
9.0 (7)
Internet poker/card games
1.3 (1)
-
1.3 (1)
Internet casino games
6.4 (5)
6.4 (5)
10.3 (8)
18
6. Follow-up Study: preliminary results
Institut für
Therapieforschung
München
Gambling disorder
DSM-5 criteria fulfilled
% (n)
1-3 criteria
2.6 (2)
4-5 criteria
1.3 (1)
6-7 criteria
33.3 (26)
8-9 criteria
62.8 (49)
GD
>= 4 criteria
Mild:
4 - 5 criteria
Moderate:
6 - 7 criteria
Severe:
8 - 9 criteria
19
Institut für
Therapieforschung
München
6. Follow-up Study: preliminary results
Psychosocial consequences/problems, % (n)
None
5.1 (4)
Separation spouse/partner
21.8 (17)
Loss of friends
37.2 (29)
Social withdrawal/ loneliness
56.4 (44)
Criminal proceedings
16.7 (13)
Job loss
15.4 (12)
Physical/psychosomatic complaints
48.7 (38)
Feeling of guilt/ depression
68.0 (53)
Suicide attempt
Financial issues, debts
10.3 (8)
78.2 (61)
20
Institut für
Therapieforschung
München
6. Follow-up Study: preliminary results
Most severe psychosocial consequence/problem, % (n)
Separation spouse/partner
9.0 (7)
Loss of friends
5.1 (4)
Social withdrawal/ loneliness
6.4 (5)
Criminal proceedings
2.6 (2)
Job loss
2.6 (2)
Physical/psychosomatic complaints
5.1 (4)
Feeling of guilt/ depression
Suicide attempt
Financial issues, debts
15.4 (12)
1.3 (1)
34.6 (27)
21
7. Summary/Discussion
Institut für
Therapieforschung
München
● Need to intensify early intervention and prevention measures in
outpatient care → subclinical pathological gamblers
● Need for research on self change
● Severely burdened patients in outpatient and inpatient care and
treatment
Question of the chicken and the egg remains
● Activities on gaming machines most prevalent
● Sport betting (on- and offline) & Internet casino games → growing
problem → need for regulation
22
Institut für
Therapieforschung
München
Thank you for your attention
Contact: [email protected]
23