1. Sociodemographical and Clinical Features Of Treatment-Seeking Patients With Gambling Disorder
Ahmet Zihni Soyata1, Funda Süleyman2, Duygu Kınay2, Yasemin Sanal3, Lütfi İlhan Yargıç1 1Department Of Psychiatry, Istanbul University, Istanbul
2Department Of Child And Adolescent Psychiatry, Istanbul University, Istanbul
3Department Of Psychology, Adana University Of Science And Technology, Adana
INTRODUCTION
Gambling disorder is the new term for “pathological gambling in the DSM-V.  The disorder is now classified in the “Substance Related and Addictive Disorders” section. Data on neurobiological underpinnings and pharmacology of gambling disorder is scarce(1). Also, it is an emerging mental health concern with easier access and increasing opportunities nowadays. Moreover, treatment seeking is low(2) and clinical data in Turkish population is limited to a single study(3). Therefore, we assessed sociodemographical and clinical variables in a treatment-seeking male population.
METHOD
Charts of forty one patients that admitted to our addiction outpatient unit were reviewed. Manic or psychotic patients were excluded. Relationships between sociodemographical and clinical variables were noted. Spearman test was used to determine correlations. Mann-Whitney U test was used to determine the differences between subgroups.
RESULTS
Seventy percent of the sample was married and 85 % was employed. 48% was graduated from high school. Mean age at admission was 38. Mean compulsive gambling duration before admission was 8 years. Sixty three percent of the patients admitted voluntarily. Fifty eight of the sample had unsuccessful trial histories to quit gambling.  Forty three percent reported a history of selling properties or goods while eighty five percent reported a history of family financial support to pay their debts. The gambling types were as follows: 48% horse races, 48% football bet, 4.9 % stock exchange, 34.1 % card games, 24.4 % dice games, 19.7 %online bet sites.  Frequency of gambling behaviors were as follows: 61% every day, 34% three times a week, 2.4 % once a week, 2.4 % less than four times in a month. Mean follow-up period was 3.9 months.  Regarding comorbidities, fifty one percent had major depressive disorder at admission. Forty three percent had passive suicidal ideation. Twenty two percent of the sample reported active suicidal ideation in the previous year. Ten percent of the sample reported a history of suicide attempts. Five percent of the sample was hospitalized at first admission due to active suicidal ideation and intention.
Twenty seven percent of the sample had reported alcohol, 12 % had cannabis, 7 % had designer drugs , 2.4% had cocaine, 2.4 % had heroine abuse. Nine percent of the sample had paternal alcohol addiction history.  A single patient had a history of crime.
During follow-up 28.9 % of the sample stopped gambling and 10.5 % had reduced gambling frequency. However, due to drop-outs, follow-up information of the 47.4% of the sample was unknown.  Patients that were hospitalized had higher follow-up duration. Patients that admitted voluntarily had higher depression rates, passive suicidal ideation rates and higher follow-up duration.
DISCUSSION
The main finding of this chart review is the high early drop-out rate of the patients with gambling disorder despite treatment seeking behavior.  Another finding was the long interval of compulsive gambling without treatment seeking. Notably, none of the efforts to quit gambling was made during psychiatric follow-up. Stigma and lack of knowledge might play a role to explain these situations. Besides, depression and suicidality seems to be an important factor for treatment seeking. Gambling behaviors should be assessed and targeted specifically in depressive patients.
To conclude, new treatment models are highly needed to increase admission and attendance to treatment and studies that was conducted in general population or risky populations are needed. .
References
1.Disordered gambling: the evolving concept of behavioral addiction. Clark L. Ann N Y Acad Sci ;1327:46-61
2.Braun B, Ludwig M, Sleczka P, Bühringer G, Kraus L. Gamblers seeking treatment: Who does and who doesn't? J Behav Addict ;3:
3. Grant JE.Kim SW.Kuskowsky M. Retrospective review of treatment retention in pathological gambling. Compr Psychiatry ;45:83-7.
Keywords: Gambling disorder, treatment seeking, behavioral addictions