Clustering Treatment Outcomes in Women with Gambling Disorder

Springer Science and Business Media LLC - Tập 38 - Trang 1469-1491 - 2021
Milagros Lizbeth Lara-Huallipe1, Roser Granero2,3, Fernando Fernández-Aranda1,3,4,5, Mónica Gómez-Peña1, Laura Moragas1, Amparo del Pino-Gutierrez3,6, Eduardo Valenciano-Mendoza1, Bernat Mora-Maltas1, Isabel Baenas1,3,4, Mikel Etxandi1, José M. Menchón1,4,5,7, Susana Jiménez-Murcia1,3,4,5
1Department of Psychiatry, Hospital Universitari de Bellvitge, L′Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Barcelona, Spain
2Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain
3CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
4Psychiatry and Mental Health Group, Neuroscience Program, Institut d′Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain
5Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona–UB, Barcelona, Spain
6Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, Universitat de Barcelona–UB, Barcelona, Spain
7CIBER Salud Mental (CIBERSam), Instituto Salud Carlos III, Madrid, Spain

Tóm tắt

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.

Tài liệu tham khảo

Aalen, O. O., Borgan, O., & Gjessing, H. K. (2008). Survival and event history analysis: a process point of view. Springer. Abbott, M. W. (2019). Professionally delivered interventions for gambling disorder. Current Opinion in Psychiatry, 32(4), 313–319. https://doi.org/10.1097/YCO.0000000000000516 Alvarez-Moya, E. M., Ochoa, C., Jiménez-Murcia, S., Aymamí, M. N., Gómez-Peña, M., Fernández-Aranda, F., & Menchón, J. M. (2011). Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling. Journal of Psychiatry and Neuroscience : JPN, 36(3), 165–175. https://doi.org/10.1503/jpn.090095 American Psychiatric Association. (2010). Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition-Rev) (4th Rev). American Psychiatric Association. An, H., He, R.-H., Zheng, Y.-R., & Tao, R. (2017). Cognitive-behavioral therapy. Advances in Experimental Medicine and Biology, 1010, 321–329. https://doi.org/10.1007/978-981-10-5562-1_16 Andronicos, M., Beauchamp, G., DiMambro, M., Robert, M., Besson, J., & Séguin, M. (2015). Do male and female gamblers have the same burden of adversity over their life course? International Gambling Studies, 15(2), 224–238. https://doi.org/10.1080/14459795.2015.1024706 Babić, R., Babić, D., Martinac, M., Pavlovic, M., Vasilj, I., Miljko, M., & Vasilj, M. (2018). Addictions without drugs: contemporary addictions or way of life? Psychiatria Danubina, 30(Suppl 6), 371–379. Bischof, A., Meyer, C., Bischof, G., Guertler, D., Kastirke, N., John, U., & Rumpf, H.-J. (2014). Association of sociodemographic, psychopathological and gambling-related factors with treatment utilization for pathological gambling. European Addiction Research, 20(4), 167–173. https://doi.org/10.1159/000356904 Blanco, C., Hanania, J., Petry, N. M., Wall, M. M., Wang, S., Jin, C. J., & Kendler, K. S. (2015). Towards a comprehensive developmental model of pathological gambling. Addiction (abingdon, England), 110(8), 1340–1351. https://doi.org/10.1111/add.12946 Blanco, C., Hasin, D. S., Petry, N., Stinson, F. S., & Grant, B. F. (2006). Sex differences in subclinical and DSM-IV pathological gambling: results from the national epidemiologic survey on alcohol and related conditions. Psychological Medicine, 36(7), 943–953. https://doi.org/10.1017/S0033291706007410 Boughton, R., & Falenchuk, O. (2007). Vulnerability and comorbidity factors of female problem gambling. Journal of Gambling Studies, 23(3), 323–334. https://doi.org/10.1007/s10899-007-9056-6 Braun, B., Ludwig, M., Sleczka, P., Bühringer, G., & Kraus, L. (2014). Gamblers seeking treatment: who does and who doesn’t? Journal of Behavioral Addictions, 3(3), 189–198. https://doi.org/10.1556/JBA.3.2014.3.7 Brunborg, G. S., Hanss, D., Mentzoni, R. A., Molde, H., & Pallesen, S. (2016). Problem gambling and the five-factor model of personality: a large population-based study. Addiction (abingdon, England), 111(8), 1428–1435. https://doi.org/10.1111/add.13388 Calado, F., & Griffiths, M. D. (2016). Problem gambling worldwide: an update and systematic review of empirical research (2000–2015). Journal of Behavioral Addictions, 5(4), 592–613. https://doi.org/10.1556/2006.5.2016.073 Challet-Bouju, G., Bruneau, M., IGNACE Group, C., Victorri-Vigneau, C., & Grall-Bronnec, M. (2017). Cognitive remediation interventions for gambling disorder: a systematic review. Frontiers in Psychology, 8, 1961. https://doi.org/10.3389/fpsyg.2017.01961 Chen, C.-Y., Lin, S.-H., Li, P., Huang, W.-L., & Lin, Y.-H. (2015). The role of the harm avoidance personality in depression and anxiety during the medical internship. Medicine, 94(2), e389. https://doi.org/10.1097/MD.0000000000000389 Cloninger, C. R., Przybeck, T. R., Syrakic, D. M., Wetzel, R. D. (1994). The Temperament and Character Inventory (TCI). A guide to its development and use. Washington University, St. Louis, MO: Center for Psychobiology of Personality Coriale, G., Ceccanti, M., De Filippis, S., Falletta Caravasso, C., & De Persis, S. (2015). Gambling disorder: epidemiology, diagnosis, interpretative models and intervention. Rivista Di Psichiatria, 50(5), 216–227. https://doi.org/10.1708/2040.22162 Cowlishaw, S., & Kessler, D. (2016). Problem Gambling in the UK: implications for health, psychosocial adjustment and health care utilization. European Addiction Research, 22(2), 90–98. https://doi.org/10.1159/000437260 Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database of Systematic Reviews, 11, CD008937. https://doi.org/10.1002/14651858.CD008937.pub2 Crisp, B. R., Thomas, S. A., Jackson, A. C., Smith, S., Borrell, J., Ho, W., & Thomason, N. (2004). Not the same: a comparison of female and male clients seeking treatment from problem gambling counselling services. Journal of Gambling Studies, 20(3), 283–299. https://doi.org/10.1023/B:JOGS.0000040280.64348.d1 Dannon, P. N., Lowengrub, K., Shalgi, B., Sasson, M., Tuson, L., Saphir, Y., & Kotler, M. (2006). Dual psychiatric diagnosis and substance abuse in pathological gamblers: a preliminary gender comparison study. Journal of Addictive Diseases, 25(3), 49–54. https://doi.org/10.1300/J069v25n03_07 Derogatis, L. R. (1997). SCL-90-R. Cuestionario de 90 síntomas. Madrid: TEA Ediciones Di Nicola, M., Tedeschi, D., De Risio, L., Pettorruso, M., Martinotti, G., Ruggeri, F., & Janiri, L. (2015). Co-occurrence of alcohol use disorder and behavioral addictions: relevance of impulsivity and craving. Drug and Alcohol Dependence, 148, 118–125. https://doi.org/10.1016/j.drugalcdep.2014.12.028 Díez, D., Aragay, N., Soms, M., Prat, G., & Casas, M. (2014). Male and female pathological gamblers: bet in a different way and show different mental disorders. The Spanish Journal of Psychology, 17, E101. https://doi.org/10.1017/sjp.2014.88 Dion, J., Cantinotti, M., Ross, A., & Collin-Vézina, D. (2015). Sexual abuse, residential schooling and probable pathological gambling among Indigenous Peoples. Child Abuse & Neglect, 44, 56–65. https://doi.org/10.1016/j.chiabu.2015.03.004 Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: a systematic review and meta-analysis. The Australian and New Zealand Journal of Psychiatry, 49(6), 519–539. https://doi.org/10.1177/0004867415575774 Dunsmuir, P., Smith, D., Fairweather-Schmidt, A. K., Riley, B., & Battersby, M. (2018). Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults. Psychiatry Research, 262, 282–289. https://doi.org/10.1016/j.psychres.2018.02.028 Fattore, L., Melis, M., Fadda, P., & Fratta, W. (2014). Sex differences in addictive disorders. Frontiers in Neuroendocrinology, 35(3), 272–284. https://doi.org/10.1016/j.yfrne.2014.04.003 Finner, H. (1993). On a monotonicity problem in step-down multiple test procedures. Journal of the American Statistical Association, 88, 920–923. https://doi.org/10.1080/01621459.1993.10476358 Fortune, E. E., & Goodie, A. S. (2012). Cognitive distortions as a component and treatment focus of pathological gambling: a review. Psychology of Addictive Behaviors, 26(2), 298–310. https://doi.org/10.1037/a0026422 Gainsbury, S. M., Russell, A., Blaszczynski, A., & Hing, N. (2015). The interaction between gambling activities and modes of access: a comparison of Internet-only, land-based only, and mixed-mode gamblers. Addictive Behaviors, 41, 34–40. https://doi.org/10.1016/j.addbeh.2014.09.023 Gomes, K., & Pascual-Leone, A. (2015). A Resource model of change: client factors that influence problem gambling treatment outcomes. Journal of Gambling Studies, 31(4), 1651–1669. https://doi.org/10.1007/s10899-014-9493-y González de Rivera, J. L., Derogatis, L. R., De las Cuevas, C., Gracia Marco, R., Rodríguez-Pulido, F., Henry-Benítez, M., Monterrey, A. L. (1989). The Spanish version of the SCL-90-R. Normative data in the general population. Towson: Clinical Psychometric Research. Granero, R., Fernández-Aranda, F., Mestre-Bach, G., Steward, T., García-Caro, B., Prever, F., & Jiménez-Murcia, S. (2018). Clustering of treatment-seeking women with gambling disorder. Journal of Behavioral Addictions, 7(3), 770–780. https://doi.org/10.1556/2006.7.2018.93 Granero, R., Jimenez-Murcia, S., Del Pino-Gutierrez, A., Mena-Moreno, T., Mestre-Bach, G., Gomez-Pena, M., & Fernandez-Aranda, F. (2020). Gambling phenotypes in older adults. Journal of Gambling Studies, in Press. https://doi.org/10.1007/s10899-019-09922-4 Granero, R., Penelo, E., Martínez-Giménez, R., Álvarez-Moya, E., Gómez-Peña, M., Aymamí, M. N., & Jiménez-Murcia, S. (2009). Sex differences among treatment-seeking adult pathologic gamblers. Comprehensive Psychiatry, 50(2), 173–180. https://doi.org/10.1016/j.comppsych.2008.07.005 Grant, J. E., Chamberlain, S. R., Schreiber, L. R. N., & Odlaug, B. L. (2012). Gender-related clinical and neurocognitive differences in individuals seeking treatment for pathological gambling. Journal of Psychiatric Research, 46(9), 1206–1211. https://doi.org/10.1016/j.jpsychires.2012.05.013 Grant, J. E., Odlaug, B. L., & Mooney, M. E. (2012). Telescoping phenomenon in pathological gambling: association with gender and comorbidities. The Journal of Nervous and Mental Disease, 200(11), 996–998. https://doi.org/10.1097/NMD.0b013e3182718a4d Gutiérrez-Zotes, J. A., Bayón, C., Montserrat, C., Valero, J., Labad, A., Cloninger, C. R., & Fernández-Aranda, F. (2004). Temperament and character inventory revised (TCI-R) standardization and normative data in a general population sample. Actas Españolas de Psiquiatria, 32(1), 8–15. Håkansson, A., & Ford, M. (2019). The general population’s view on where to seek treatment for gambling disorder–a general population survey. Psychology Research and Behavior Management, 12, 1137–1146. https://doi.org/10.2147/PRBM.S226982 Håkansson, A., Karlsson, A., & Widinghoff, C. (2018). Primary and secondary diagnoses of gambling disorder and psychiatric comorbidity in the swedish health care system-a nationwide register study. Frontiers in Psychiatry, 9, 426. https://doi.org/10.3389/fpsyt.2018.00426 Håkansson, A., & Widinghoff, C. (2020). Gender Differences in problem gamblers in an online gambling setting. Psychology Research and Behavior Management, 13, 681–691. https://doi.org/10.2147/PRBM.S248540 Hartmann, M., & Blaszczynski, A. (2018). The Longitudinal relationships between psychiatric disorders and gambling disorders. International Journal of Mental Health and Addiction, 16(1), 16–44. https://doi.org/10.1007/s11469-016-9705-z Haw, J., & Holdsworth, L. (2016). Gender differences in the temporal sequencing of problem gambling with other disorders. International Journal of Mental Health and Addiction, 14, 687–699. https://doi.org/10.1007/s11469-015-9601-y Hing, N., Russell, A., Tolchard, B., & Nower, L. (2016). Risk factors for gambling problems: an analysis by gender. Journal of Gambling Studies, 32(2), 511–534. https://doi.org/10.1007/s10899-015-9548-8 Hing, N., Russell, A. M. T., Vitartas, P., & Lamont, M. (2016). Demographic, behavioural and normative risk factors for gambling problems amongst sports bettors. Journal of Gambling Studies, 32(2), 625–641. https://doi.org/10.1007/s10899-015-9571-9 Hodgins, D. C., & Guebaly-el, N. (2004). Retrospective and prospective reports of precipitants to relapse in pathological gambling. Journal of Consulting and Clinical Psychology., 72(1), 72–80. https://doi.org/10.1037/0022-006X.72.1.72 Hodgins, D. C., & Holub, A. (2015). Components of impulsivity in gambling disorder. International Journal of Mental Health and Addiction, 13(6), 699–711. https://doi.org/10.1007/s11469-015-9572-z Hollingshead, A. B. (2011). Four factor index of social status. Yale Journal of Sociology, 8, 21–51. Howard, M., & Hoffman, M. (2017). Variable-centered, person-centered, and person-specific approaches: where theory metes the method. Organizational Research Methods, 21(4), 846–876. https://doi.org/10.1177/1094428117744021 Ibáñez, A., Blanco, C., Moreryra, P., & Sáiz-Ruiz, J. (2003). Gender differences in pathological gambling. The Journal of Clinical Psychiatry, 64(3), 295–301. https://doi.org/10.4088/jcp.v64n0311 IBM-Corp. (2016). IBM SPSS Statistics for Windows, version 24.0. Arkmonk, NY: IBM Corp Jiménez-Murcia, S., Álvarez-Moya, E. M., Granero, R., Aymami, M. N., Gómez-Peña, M., Jaurrieta, N., & Vallejo, J. (2007). Cognitive-behavioral group treatment for pathological gambling: analysis of effectiveness and predictors of therapy outcome. Psychotherapy Research, 17(5), 544–552. https://doi.org/10.1080/10503300601158822 Jiménez-Murcia, Susana, Del Pino-Gutiérrez, A., Fernández-Aranda, F., Granero, R., Hakänsson, A., Tárrega, S., & Menchón, J. M. (2016). Treatment outcome in male gambling disorder patients associated with alcohol use. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2016.00465 Jiménez-Murcia, S., Fernández-Aranda, F., Granero, R., & Menchón, J. M. (2014). Gambling in Spain: update on experience, research and policy. Addiction, 109(10), 1595–1601. https://doi.org/10.1111/add.12232 Jiménez-Murcia, S., Fernández-Aranda, F., Mestre-Bach, G., Granero, R., Tárrega, S., Torrubia, R., & Menchón, J. M. (2017). Exploring the Relationship between reward and punishment sensitivity and gambling disorder in a clinical sample: a path modeling analysis. Journal of Gambling Studies, 33(2), 579–597. https://doi.org/10.1007/s10899-016-9631-9 Jiménez-Murcia, S., Granero, R., Fernández-Aranda, F., Arcelus, J., Aymamí, M. N., Gómez-Peña, M., & Menchón, J. M. (2015). Predictors of outcome among pathological gamblers receiving cognitive behavioral group therapy. European Addiction Research, 21(4), 169–178. https://doi.org/10.1159/000369528 Jiménez-Murcia, S., Granero, R., Fernández-Aranda, F., Aymamí, N., Gómez-Peña, M., Mestre-Bach, G., & Menchón, J. M. (2019). Developmental trajectories of gambling severity after cognitive-behavioral therapy. European Psychiatry, 60, 28–40. https://doi.org/10.1016/j.eurpsy.2019.04.001 Jiménez-Murcia, S., Granero, R., Giménez, M., Del Pino-Gutiérrez, A., Mestre-Bach, G., Mena-Moreno, T., & Fernández-Aranda, F. (2020). Contribution of sex on the underlying mechanism of the gambling disorder severity. Scientific Reports, 10(1), 18722. https://doi.org/10.1038/s41598-020-73806-6 Jiménez-Murcia, S., Stinchfield, R., Alvarez-Moya, E., Jaurrieta, N., Bueno, B., Granero, R., & Vallejo, J. (2009). Reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for pathological gambling. Journal of Gambling Studies, 25(1), 93–104. https://doi.org/10.1007/s10899-008-9104-x Jiménez-Murcia, S., Tremblay, J., Stinchfield, R., Granero, R., Fernández-Aranda, F., Mestre-Bach, G., & Menchón, J. M. (2017). The Involvement of a concerned significant other in gambling disorder treatment outcome. Journal of Gambling Studies, 33(3), 937–953. https://doi.org/10.1007/s10899-016-9657-z Karlsson, A., & Håkansson, A. (2018). Gambling disorder, increased mortality, suicidality, and associated comorbidity: a longitudinal nationwide register study. Journal of Behavioral Addictions, 7(4), 1091–1099. https://doi.org/10.1556/2006.7.2018.112 Kelley, K., & Preacher, K. J. (2012). On effect size. Psychological Methods, 17(2), 137–152. https://doi.org/10.1037/a0028086 Langham, E., Thorne, H., Browne, M., Donaldson, P., Rose, J., & Rockloff, M. (2016). Understanding gambling related harm: a proposed definition, conceptual framework, and taxonomy of harms. BMC Public Health, 16(1), 80. https://doi.org/10.1186/s12889-016-2747-0 Laursen, B., & Hoff, E. (2006). Person-centered and variable-centered approaches to longitudinal data. Merrill-Palmer Quarterly, 52, 377–389. https://doi.org/10.1353/mpq.2006.0029 Ledgerwood, D. M., & Arfken, C. L. (2017). Assessing the need for higher levels of care among problem gambling outpatients. Journal of Gambling Studies, 33(4), 1263–1275. https://doi.org/10.1007/s10899-017-9677-3 Ledgerwood, D. M., Dyshniku, F., McCarthy, J. E., Ostojic-Aitkens, D., Forfitt, J., & Rumble, S. C. (2020). Gambling-related cognitive distortions in residential treatment for gambling disorder. Journal of Gambling Studies, 36(2), 669–683. https://doi.org/10.1007/s10899-019-09895-4 Mallorquí-Bagué, N., Mestre-Bach, G., Lozano-Madrid, M., Granero, R., Vintró-Alcaraz, C., Fernández-Aranda, F., & Jiménez-Murcia, S. (2021). Gender and gambling disorder: differences in compulsivity-related neurocognitive domains. Addictive Behaviors, 113, 106683. https://doi.org/10.1016/j.addbeh.2020.106683 Mallorquí-Bagué, N., Vintró-Alcaraz, C., Verdejo-García, A., Granero, R., Fernández-Aranda, F., Magaña, P., & Jiménez-Murcia, S. (2019). Impulsivity and cognitive distortions in different clinical phenotypes of gambling disorder: profiles and longitudinal prediction of treatment outcomes. European Psychiatry. https://doi.org/10.1016/j.eurpsy.2019.06.006 Maniaci, G., La Cascia, C., Picone, F., Lipari, A., Cannizzaro, C., & La Barbera, D. (2017). Predictors of early dropout in treatment for gambling disorder: the role of personality disorders and clinical syndromes. Psychiatry Research, 257, 540–545. https://doi.org/10.1016/j.psychres.2017.08.003 Marchica, L. A., Keough, M. T., Montreuil, T. C., & Derevensky, J. L. (2020). Emotion regulation interacts with gambling motives to predict problem gambling among emerging adults. Addictive Behaviors, 106, 106378. https://doi.org/10.1016/j.addbeh.2020.106378 Marco, L. (2013). Relationship between temperament and anxiety disorders: a systematic review. Mediterranean Journal of Clinical Psychology. https://doi.org/10.6092/2282-1619/2013.1.897 Mathieu, S., Barrault, S., Brunault, P., & Varescon, I. (2020). The role of gambling type on gambling motives, cognitive distortions, and gambling severity in gamblers recruited online. PLoS ONE, 15(10), e0238978. https://doi.org/10.1371/journal.pone.0238978 Merkouris, S. S., Thomas, S. A., Browning, C. J., & Dowling, N. A. (2016). Predictors of outcomes of psychological treatments for disordered gambling: a systematic review. Clinical Psychology Review, 48, 7–31. https://doi.org/10.1016/j.cpr.2016.06.004 Mestre-Bach, G., Granero, R., Steward, T., Fernández-Aranda, F., Baño, M., Aymamí, N., & Jiménez-Murcia, S. (2016). Reward and punishment sensitivity in women with gambling disorder or compulsive buying: Implications in treatment outcome. Journal of Behavioral Addictions, 5(4), 658–665. https://doi.org/10.1556/2006.5.2016.074 Moragas, L., Granero, R., Stinchfield, R., Fernández-Aranda, F., Fröberg, F., Aymamí, N., & Jiménez-Murcia, S. (2015). Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences. BMC Psychiatry, 15(1), 86. https://doi.org/10.1186/s12888-015-0459-0 Muthén, B., & Muthén, L. K. (2000). Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcoholism, Clinical and Experimental Research, 24(6), 882–891. https://doi.org/10.1111/j.1530-0277.2000.tb02070.x Nuske, E. M., Holdsworth, L., & Breen, H. (2016). Significant life events and social connectedness in Australian women’s gambling experiences. NAD Nordic Studies on Alcohol and Drugs, 33(1), 7–26. https://doi.org/10.1515/nsad-2016-0002 Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling, 14(4), 535–569. https://doi.org/10.1080/10705510701575396 Petry, N. M., Ginley, M. K., & Rash, C. J. (2017). A systematic review of treatments for problem gambling. Psychology of Addictive Behaviors, 31(8), 951–961. https://doi.org/10.1037/adb0000290 Pickering, D., Keen, B., Entwistle, G., & Blaszczynski, A. (2018). Measuring treatment outcomes in gambling disorders: a systematic review. Addiction, 113(3), 411–426. https://doi.org/10.1111/add.13968 Pilver, C. E., Libby, D. J., Hoff, R. A., & Potenza, M. N. (2013). Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample. Drug and Alcohol Dependence, 133(1), 204–211. https://doi.org/10.1016/j.drugalcdep.2013.05.002 Pilver, C. E., Libby, D. J., Hoff, R. A., & Potenza, M. N. (2013). Problem gambling severity and the incidence of axis I psychopathology among older adults in the general population. Journal of Psychiatric Research, 47(4), 534–541. https://doi.org/10.1016/j.jpsychires.2012.12.013 Potenza, M. N., Maciejewski, P. K., & Mazure, C. M. (2006). A gender-based examination of past-year recreational gamblers. Journal of Gambling Studies, 22(1), 41–64. https://doi.org/10.1007/s10899-005-9002-4 American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (5th ed). Washington D.C.: Author. Quintero, G. (2016). A biopsychological review of gambling disorder. Neuropsychiatric Disease and Treatment, 13, 51–60. https://doi.org/10.2147/NDT.S118818 Ramos-Grille, I., Gomà-i-Freixanet, M., Aragay, N., Valero, S., & Vallès, V. (2015). Predicting treatment failure in pathological gambling: the role of personality traits. Addictive Behaviors, 43, 54–59. https://doi.org/10.1016/j.addbeh.2014.12.010 Rash, C., Weinstock, J., & Van Patten, R. (2016). A review of gambling disorder and substance use disorders. Substance Abuse and Rehabilitation, 17(7), 3–13. https://doi.org/10.2147/SAR.S83460 Rogier, G., & Velotti, P. (2018). Conceptualizing gambling disorder with the process model of emotion regulation. Journal of Behavioral Addictions, 7(2), 239–251. https://doi.org/10.1556/2006.7.2018.52 Ronzitti, S., Lutri, V., Smith, N., Clerici, M., & Bowden-Jones, H. (2016). Gender differences in treatment-seeking british pathological gamblers. Journal of Behavioral Addictions, 5(2), 231–238. https://doi.org/10.1556/2006.5.2016.032 Ronzitti, S., Soldini, E., Lutri, V., Smith, N., Clerici, M., & Bowden-Jones, H. (2016). Types of gambling and levels of harm: a UK study to assess severity of presentation in a treatment-seeking population. Journal of Behavioral Addictions, 5(3), 439–447. https://doi.org/10.1556/2006.5.2016.068 Ronzitti, S., Soldini, E., Smith, N., Clerici, M., & Bowden-Jones, H. (2017). Gambling disorder: exploring pre-treatment and in-treatment dropout predictors a study. Journal of Gambling Studies, 33(4), 1277–1292. https://doi.org/10.1007/s10899-017-9686-2 Rousseeuw, P. J. (1987). Silhouettes: a graphical aid to the interpretation and validation of cluster analysis. Journal of Computational and Applied Mathematics, 20, 53–65. https://doi.org/10.1016/0377-0427(87)90125-7 Shannon, K., Anjoul, F., & Blaszczynski, A. (2017). Mapping the proportional distribution of gambling-related harms in a clinical and community sample. International Gambling Studies, 17(3), 366–385. https://doi.org/10.1080/14459795.2017.1333131 Singer, J. D., Willett, J. B. (2003). Applied longitudinal data analysis: modeling change and event occurrence. In Journal of the American Statistical Association. New York: Oxford University Press Slutske, W. S., Piasecki, T. M., Deutsch, A. R., Statham, D. J., & Martin, N. G. (2015). Telescoping and gender differences in the time course of disordered gambling: evidence from a general population sample. Addiction (abingdon, England), 110(1), 144–151. https://doi.org/10.1111/add.12717 Smith, D., Battersby, M., & Harvey, P. (2015). Does gender moderate the subjective measurement and structural paths in behavioural and cognitive aspects of gambling disorder in treatment-seeking adults? Addictive Behaviors, 48, 12–18. https://doi.org/10.1016/j.addbeh.2015.04.001 Stinchfield, R. (2003). Reliability, validity, and classification accuracy of a measure of dsm-iv diagnostic criteria for pathological gambling. American Journal of Psychiatry, 160(1), 180–182. https://doi.org/10.1176/appi.ajp.160.1.180 Sundqvist, K., & Rosendahl, I. (2019). Problem gambling and psychiatric comorbidity-risk and temporal sequencing among women and men: results from the swelogs case-control study. Journal of Gambling Studies, 35(3), 757–771. https://doi.org/10.1007/s10899-019-09851-2 Tackett, J. L., Krieger, H., Neighbors, C., Rinker, D., Rodriguez, L., & Edward, G. (2017). Comorbidity of alcohol and gambling problems in emerging adults: a bifactor model conceptualization. Journal of Gambling Studies, 33(1), 131–147. https://doi.org/10.1007/s10899-016-9618-6 Tavares, H., Zilberman, M. L., Beites, F. J., & Gentil, V. (2001). Gender differences in gambling progression. Journal of Gambling Studies, 17(2), 151–159. https://doi.org/10.1023/a:1016620513381 Tolchard, B. (2017). Cognitive-behavior therapy for problem gambling: a critique of current treatments and proposed new unified approach. Journal of Mental Health (abingdon, England), 26(3), 283–290. https://doi.org/10.1080/09638237.2016.1207235 Toneatto, T., & Wang, J. J. (2009). Community treatment for problem gambling: sex differences in outcome and process. Community Mental Health Journal, 45(6), 468–475. https://doi.org/10.1007/s10597-009-9244-1 Tremblay, J., Savard, A. C., Blanchette-Martin, N., Dufour, M., Bertrand, K., Ferland, F., & Saint Jacques, M. (2015). Integrative couple treatment for pathological gambling/ICT-PG: description of the therapeutic process. Canadian Journal of Addiction, 6(2), 54–61. https://doi.org/10.1097/02024458-201509000-00008 Von Eye, A., & Bogat, G. A. (2006). Person-oriented and variable-oriented research: concepts, results, and development. Merrill-Palmer Quarterly, 52, 390–420. https://doi.org/10.1353/mpq.2006.0032 Wenzel, H. G., & Dahl, A. A. (2009). Female pathological gamblers-a critical review of the clinical findings. International Journal of Mental Health and Addiction, 7, 190–202. https://doi.org/10.1007/s11469-008-9174-0 Yakovenko, I., Quigley, L., Hemmelgarn, B. R., Hodgins, D. C., & Ronksley, P. (2015). The efficacy of motivational interviewing for disordered gambling: systematic review and meta-analysis. Addictive Behaviors, 43, 72–82. https://doi.org/10.1016/j.addbeh.2014.12.011