Study Finds Substantial Rate of Natural Recovery Among Pathological Gamblers
In a study published earlier this year, Dr. Wendy Slutske of the University of Missouri-Columbia found evidence suggesting that approximately one-third of pathological gamblers experience "natural recovery" from the disorder, meaning that they get better without seeking or accepting formal treatment. Her study, "Natural Recovery and Treatment-Seeking in Pathological Gambling: Results of Two U.S. National Surveys," was published in the February issue of the American Journal of Psychiatry and will be featured in
a plenary session at the seventh annual NCRG Conference on Gambling and Addiction, scheduled for Nov. 12-14 at the Rio All-Suite Hotel & Casino in Las Vegas.
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes pathological gambling as a chronic and persisting disorder. According to this study, however, recent research has highlighted the transitory nature of gambling-related problems and suggests that natural recovery might be common. Slutske's study sought to further investigate these areas by documenting the rates of recovery, treatment-seeking, and natural recovery among individuals meeting the DSM-IV criteria for pathological gambling in two large and representative U.S. national surveys.
Slutske analyzed data from the Gambling Impact and Behavior Study (GIBS), conducted with a sample of 2,417 adults from 1998 to 1999, and the National Epidemiologic Survey on Alcohol and Related Conditions, conducted from 2001 to 2002 and consisting of in-person interviews with 43,093 adults. To render the surveys' data comparable in her analysis, Slutske used the DSM-IV Screen for Gambling Problems (the screen employed in the GIBS), which assigns a lifetime diagnosis of pathological gambling if an individual experiences five of the DSM-IV symptoms of pathological gambling any time over the course of his or her life. These symptoms do not have to occur simultaneously for the diagnosis of pathological gambling to be assigned.
Slutske found that 36 to 39 percent of the individuals with a lifetime history of pathological gambling did not experience any gambling-related problems in the past year. Only 7 to 12 percent had sought either formal treatment Ñ such as therapy with a professional counselor Ñ or attended meetings of Gamblers Anonymous. She concluded that approximately one-third of these individuals recovered on their own. (It is important to note that these findings come from two independent surveys.) As Dr. Eric Nestler observed in an editorial in the same issue of the American Journal of Psychiatry, Slutske's analysis contradicts the view of pathological gambling as a chronic disorder, an assumption that arose because most prevalence estimates were developed around treatment observations, not from community samples.
Slutske notes several limitations to the study, including the possibility that individuals who are currently without symptoms might be less likely to report previous problems. Another question that requires further research is how long one has to be symptom-free to be considered fully "recovered". Future research on the natural history of the disorder will provide the answers, according to researchers.
Identifying "natural recovery" among disordered gamblers is more than an academic exercise. Understanding the way in which people get well is vital for developing intervention and treatment strategies for those who do need more guidance in their recovery. The implications of Slutske's research and its potential impact on public health policy will make for fascinating discussions at the NCRG Conference on Gambling and Addiction.
