An analysis of Iowa gambling treatment completion and an exploration of disclosure among problem gamblers: an ecological approach

While a growing body of evidence suggests health-related behaviors, such as problem and pathological gambling, are affected by multiple levels of influence, gambling studies using an ecological approach have not been documented. This dissertation work, that contains three studies, contributes to fill such research gap by examining gamblers' behaviors in formal treatment programs using an ecological approach. In study 1, the influences of the environmental and individual level factors on the treatment completion is examined. Previous studies have shown that treatment completion has a positive impact on the recovery path from gambling problems. In study 2 and study 3, interpersonal communication between gamblers and their social support networks is explored. More specifically, these two studies focus on understanding of the disclosure of gambling problems using the Integrated Model of Health Disclosure Decision-making. These two studies are significant because this may be the first attempt in gambling studies to explore disclosure of gambling problems. Disclosure may be a necessary step to ameliorate the negative consequences of gambling by creating or reinforcing gamblers' social support network. Each of these studies uses a distinctive dataset and methodology.

Study 1 uses the Iowa Gambling Treatment Outcome system data from 2005 to 2011 from the Iowa Department of Public Health. Study 2 uses the 2011 Iowa Gambling Attitude and Experiences survey data, which included questions designed specifically for gambling disclosure. Study 3 is based on qualitative data (interviews) collected from gamblers who disclosed their gambling problems within their social support network. Results from study 1 based on a generalized linear mixed model suggest that self-reported past behavior of either reducing or quitting gambling behavior has a significant effect on treatment plan completion. Also, gamblers admitted to large treatment agencies that served mostly in urban areas are less likely to complete the treatment plan compared to gamblers admitted in any other type of agencies in urban or rural areas. In study 2, path analysis was performed to examine the disclosure of gambling problems within gamblers' social support network. Severity of gambling was the only significant predictor of disclosure. Study 3 found that the factors that affected disclosure are confrontation, gambling losses, stigma, trust, non-judgmental receivers, and close and long relationship. Outcomes expectations and past experience were also important in disclosure. Disclosures did not have substantial consequences for the size and strength of ties in their social support group, suggesting disclosures did not harm or strengthen relationships. Study 2 and study 3 both suggest that as gambling addiction become more severe, signs of gambling problems could be more visible to the members of social support groups. This may lead to disclosure of gambling problems through confrontations initiated by a friend or family member.