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What does it mean to recover from a Gambling Disorder? Perspectives of
gambling help service users
Dylan Pickering
a
*, Michael J. Spoelma
a
, Anna Dawczyk
b
, Sally M. Gainsbury
a
,
and Alex Blaszczynski
a
a
University of Sydney, Faculty of Science, Brain and Mind Centre, School of Psychology,
Sydney, Australia;
b
Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada.
*Correspondence to Dylan Pickering, Level 2, Brain and Mind Centre (M02F), 94 Mallett Street,
Camperdown, NSW 2050. Email: dylan.pickering@sydney.edu.au; Phone: +61 2 9114 4374.
This is an Accepted Manuscript of an article published by Taylor & Francis in International
Gambling Studies on 28 Apr 2019, available online:
https://doi.org/10.1080/16066359.2019.1601178
Citation: Pickering, D., Spoelma, M. J., Dawczyk, A., Gainsbury, S. M., & Blaszczynski, A.
(2019). What does it mean to recover from a Gambling Disorder? Perspectives of gambling help
service users. Addiction Research & Theory. https://doi.org/10.1080/16066359.2019.1601178
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Abstract
Background: There is no consensus on how to best define recovery in gambling disorder. This
minimizes clinicians’ abilities to apply optimal treatment goals and contributes to inconsistency
in the use of outcome variables to evaluate interventions. Current understanding of recovery is
largely based on professional opinion and theoretical models of gambling disorder. This study
aimed to examine core features of recovery identified by service users with lived experiences.
Methods: Thematic analysis was applied to qualitative data from 32 face-to-face interviews.
Interviewees were at various stages of help-seeking for gambling problems mostly related to
electronic gaming machines via self-exclusion and/or specialized gambling counseling.
Results: Recovery was perceived by the participants as a continuous process that encompasses
periods of improvement and decline. Several key themes of recovery emerged; participants
highlighted the importance of developing insight into the psychological and environmental
processes that contribute to their gambling problem. Insight helped participants feel empowered
to successfully manage their gambling urges and behavior. Recovery extended to building a
meaningful life beyond gambling, which involved engagement in alternative activities and
fostering strong social relationships. It included stabilization of personal finances and achieving
general psychological health and wellbeing.
Conclusions: Findings challenge acute symptom-focused models of recovery by broadening the
definitional boundaries to include sustained improvements across multiple psychosocial
dimensions. Greater emphasis should be given to service user-defined elements of recovery in
treatment and research. The long-term perspective of the recovery process has implications for
extending standard follow-up assessment intervals in gambling treatment studies.
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Keywords: Consumers, service users, recovery, gambling treatment, gambling disorder, problem
gambling
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Introduction
Over the last few decades, the concept of recovery has received increased attention in mental
health research and practice. Influenced by service user advocacy organizations, recovery-
oriented principles have been incorporated into contemporary mental health services policy
across western countries (O’Hagan 2001; Mental Health and Substance Abuse Division 2012;
Australian Health Ministers’ Advisory Council 2013). Accordingly, a proliferation of recovery
peer-reviewed journal articles and conference proceedings have emerged in the academic
literature (Leamy et al. 2011; Slade 2017). Clear distinctions have been made between the
medical and service user (also referred to as ‘consumer’) perspectives of recovery. The former,
based on professional opinion, narrowly defines recovery as the absence of symptoms and return
to a pre-morbid level of functioning (Mountain and Shah 2008). The medical model focuses
primarily on illness symptoms and aligns with acute health care practices with short-term follow-
up (Bellack 2006; White 2007). In contrast, the service user model adopts a broader holistic
perspective of recovery and supports the potential for a socially rich and meaningful life despite
symptom persistence or reoccurrence (Anthony 1993; Gagne et al. 2007). Accordingly, longer-
term recovery management and extended follow-ups are inherent to the service user model
(McLellan et al. 2007; Laudet 2007). Despite the increased focus on recovery, there is no
consensus of how this term should be defined. The absence of clear operational criteria for
recovery undermines the effectiveness of clinical practice and advancement of research. Indices
of recovery must be clearly understood if mental health services are expected to work towards
this goal.
Gambling disorder is characterized by repeated problematic gambling causing significant
personal impairment or distress (American Psychiatric Association [APA] 2013). A gambling
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disorder is associated with a diverse range of consequences, including significant financial
hardship, financial crime, interpersonal conflict, social disengagement, decreased productivity,
psychological distress, and physical health issues (i.e. sleep deprivation) (Langham et al. 2016;
Shannon et al. 2017). Various biopsychosocial processes are implicated in the development and
maintenance of a gambling disorder, evidenced by multiple explanatory models from a number
of related disciplines (Jacobs 1986; Korn and Shaffer 1999; Blaszczynski and Nower 2002;
Sharpe 2002; Potenza 2013). Separate subtypes of gambling disorder have been proposed (e.g.,
behaviorally conditioned, emotionally vulnerable, and antisocial impulsivist; see Blaszczynski
and Nower, 2002), suggesting etiological heterogeneity. Pathways to recovery may differ
depending on individual subtypes of gambling disorder. Non-treatment assisted ‘natural’
recovery has been linked to less severe instances of gambling disorder and individuals lacking
premorbid psychopathology and correspond with a behaviorally conditioned subtype description
(Hodgins and el-Guebaly 2000; Toneatto et al. 2008).
Diffuse conceptualizations of recovery have contributed to significant variability of
reported outcomes in gambling treatment studies (Petry 2005; Smith et al. 2007). In a systematic
review, Pickering et al. (2018) reported 63 different measures used to measure treatment
effectiveness in 34 studies. The measures were categorized as gambling specific (i.e. problem
gambling symptoms and behaviors) and non-gambling specific (i.e. psychopathology, cognitive-
emotional processes, global functioning and wellbeing). Furthermore, although ‘recovery’ was
operationalized by a small proportion of studies reviewed (32.4%), these also varied between
gambling abstinence (Jiménez-Murcia et al. 2007), a specified reduction in gambling intensity or
problem gambling symptoms (Myrseth et al. 2011; McIntosh et al. 2016), or to no longer meet
diagnostic criteria for a gambling disorder (Rossini-Dib et al. 2015). A lack of sufficient follow-
