The Effect of internalized stigma, perceived social support, depression and anxiety levels on treatment motivation in gambling disorder patients

Abstract

Treatment motivation is very important for the prognosis of gambling disorder (GD) patients. Decreased treatment motivation is reported to be one of the most common reasons for poor treatment compliance and relapse after treatment. This study aims to determine whether internalised stigma, perceived social support, depression, and anxiety have an effect on treatment motivation in patients diagnosed with GD and to examine the effect of sociodemographic data on this relationship. The study was conducted in an alcohol and substance abuse treatment centre on the Asian side of Istanbul. A total of 165 patients between the ages of 18-60 who were diagnosed with GD were included in the study. Sociodemographic and clinical data form, internalised stigma scale in mental illness (ISMI), multidimensional perceived social support scale (MSPSS), Beck depression inventory (BDI), Beck anxiety inventory (BAI) and treatment motivation questionnaire (TMQ) were used to collect data. A moderate positive relationship was found between intrinsic motivation and alienation and (ISMI); between extrinsic motivation and depression, anxiety, and confirmation of stereotypes; between (TMQ) and alienation and (ISMI); and a weak negative relationship was found between (MSPS) and (TMQ). It was concluded that alienation, stereotype endorsement, and perceived discrimination explained 34% of the variance in treatment motivation; alienation and (ISMI) explained 30% of the variance in intrinsic motivation; depression, anxiety, and stereotype endorsement explained 31% of the variance in extrinsic motivation; and stereotype endorsement explained 6% of the variance in interpersonal help-seeking. It was concluded that social support had no effect on treatment motivation.

Keywords

• Gambling
• internalized stigma
• social support
• depression
• anxiety
• motivation

References

1. Raylu N. Oei TPS. Treatment Planning for Problem Gamblers. Australian Clinical Psychologist. 2016;2(1):1-14.
2. Merkouris SS, Thomas SA, Browning CJ, Dowling NA. Predictors of outcomes of psychological treatments for disordered gambling: A systematic review. Clin Psychol Rev. 2016 Aug;48:7-31.
3. Ünübol B, Ünübol H, Bilici R. Kadın bağımlılarda içselleştirilmiş damgalanmanın bağımlılık özelliklerine ve algılanan sosyal desteğe olan etkisinin incelenmesi. Anadolu Psikiyatri Derg. 2019;20(4):377-384.
4. Quigley L. GD and Stigma: Opportunities for Treatment and Prevention. Curr Addict Rep. 2022;9:410–419.
5. Dąbrowska K, Moskalewicz J, Wieczorek Ł. Barriers in Access to the Treatment for People with GDs. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence? J Gambl Stud. 2017 Jun;33(2):487-503.
6. Wieczorek Ł. Stygmatyzacja oso´b uzaleznionych od alkoholu oraz systemu leczenia uzaleznien´ w Warszawie i w społecznos´ci lokalnej [Stigmatisation of alcohol-dependent persons and alcohol treatment systems in Warsaw and the local community]. Alcoholism and Drug Addiction. 2015;28:103-17.
7. Hing N, Russell A, Nuske E, Gainsbury S. The stigma of problem gambling: Causes, characteristics and consequences. Victoria, Australia: Victorian Responsible Gambling Foundation. 2016.
8. Hamidi S, Ebrahimi H, Vahidi M, Areshtanab HN. Internalized Stigma and its Association with Hope, Self-Esteem, Self-Efficacy, and Treatment Adherence among Outpatients with Severe Mental Illness: A Cross-Sectional Survey. Iran J Nurs Midwifery Res. 21. 2023;28(3):345-351.

9. Hing N, Holdsworth L, Tiyce M, Breen H. Stigma and problem gambling: current knowledge and future research directions. International Gambling Studies. 2014;14(1):64-81.
10. Petry NM, Weiss L. Social support is associated with gambling treatment outcomes in pathological gamblers. Am J Addict. 2009;18(5):402-408.
11. Penfold KL, Ogden J. The Role of Social Support and Belonging in Predicting Recovery from Problem Gambling. J Gambl Stud. 2023;(7):1-18. Advance online publication.
12. Hutchison P, Cox S, Frings D. Helping you helps me: Giving and receiving social support in recovery groups for problem gamblers. Group Dynamics: Theory, Research, and Practice, 2018;22(4):187-99.
13. Ledgerwood D, Arfken C. Psychosocial and treatment characteristics of gambling help-line callers. Final Report Submitted to: Michigan Department of Community Health, Wayne State University, 2010; 16-18.
14. Lorains FK, Cowlishaw S, Thomas SA. Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys. Addiction. 2011;106(3):490-98.
15. Fong TW. The vulnerable faces of pathological gambling. Psychiatry (Edgmont). 2005;2(4):34-42.
16. Black DW, Moyer T. Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior. Psychiatr Serv. 1998;49(11):1434-39.
17. Alessi SM, Petry NM. Pathological gambling severity is associated with impulsivity in a delay discounting procedure. Behav Processes. 2003;64(3):345-54.
18. Ledgerwood DM, Petry NM. Gambling and suicidality in treatment-seeking pathological gamblers. J Nerv Mental Dis. 2004;192(10):711-14.
19. Sundqvist K, Rosendahl I. Problem Gambling and Psychiatric Comorbidity-Risk and Temporal Sequencing Among Women and Men: Results from the Swelogs Case-Control Study. J Gambl Stud. 2019;35(3):757-771.
20. Rizeanu S. Pathological Gambling and Depression. Procedia-Social and Behavioral Sciences. 2013;78:501-505.
21. Haw J, Holdsworth L, Nisbet S. Gamblind and Co-morbid disorders. Centre of Gambling and Research Southern Cross University. 2013;1-206.
22. Quigley L, Yakovenko I, Hodgins DC, Dobson KS, El-Guebaly N, Casey DM, et. al. Comorbid Problem Gambling and Major Depression in a Community Sample. J Gambl Stud. 2015;31(4):1135-52.
23. Evans L, Delfabbro P. Motivators for change and barriers to help-seeking in Australian problem gamblers. J Gambl Stud. 2005;21(2):133-155. https://doi.org/10.1007/s10899-005-3029-4
24. Wieczorek Ł, Dąbrowska K. What makes people with GD undergo treatment? Patient and professional perspectives. Nordisk Alcohol Nark. 2018;35(3):196-214.
25. Gomes K, Pascual-Leone A. Primed for change: Facilitating factors in problem gambling treatment. J Gambl Stud. 2009;25(1):1-17.
26. Fan BWS. Factors in determining the development of problem gambling and motivation to quit gambling addiction among offenders. Australian Counselling Journal. 2020;14(2):37-45.
27. Altıntaş M. GD tanısı olan hastalarda anksiyete, depresyon, ruminasyon ve dürtüsellik. Çukurova Medical Journal. 2018;43(3):624-33
28. Blaszczynski A, McConaghy, N. Anxiety and/or Depression in the Pathogenesis of Addictive Gambling. Int J Addict. 1989;24(4):337-50.
29. Milosevic A, Ledgerwood DM. The subtyping of pathological gambling: A comprehensive review. Clin Psychol Rev. 2010;30(8):988-98.
30. Melville KM, Casey LM, Kavanagh DJ. Psychological treatment dropout among pathological gamblers. Clin Psychol Rev. 2007; 27(8):944-58.
31. Leblond J, Ladouceur R, Blaszczynski A. Which pathological gamblers will complete treatment?. Br J Clin Psychol. 2003;42(2):205-9.
32. Brown RI. Dropouts and continuers in Gamblers Anonymous: Life-context and other factors. Journal of Gambling Behavior 1986;2(2):130-140.
33. Echeburúa E, Fernández-Montalvo J, Báez C. Predictors of therapeutic failure in slot-machine pathological gamblers following behavioural treatment. Behavioural and Cognitive Psychotherapy. 2001;29(3):379-83.
34. Milton S, Crino R, Hunt C, Prosser E. The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling. J Gambl Stud. 2002;18(2):207-29.
35. Robson E, Edwards J, Smith G, Colman I. Gambling decisions: an early intervention program for problem gamblers. J Gambl Stud. 2002;18(3):235-255.
36. Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121(1):31-49.
37. Ersoy MA, Varan A. Ruhsal hastalıklarda içselleştirilmiş damgalanma ölçeği, Türkçe formunun güvenirlik ve geçerlik çalışması. Türk Psikiyatri Dergisi. 2007;18(2):163-171.
38. Zimet GD, Dahlem NW, Zimet SG, etc. al. The Multidimensional Scale of Perceived Social Support. J Pers Assess. 1988;52(1):30-41.
39. Eker D, Arkar H, Yaldız H. Çok Boyutlu Algılanan Sosyal Destek Ölçeğinin gözden geçirilmiş formunun faktör yapısı, geçerlik ve güvenirliği. Türk Psikiyatri Dergisi. 2001;12(1): 17-25.
40. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-571.
41. Hisli N. Beck depresyon envanterinin üniversite öğrencileri için geçerliği üzerine bir çalışma. J. Psychol. 1988;6(22):118-26.
42. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-97. https://doi.org/10.1037//0022-006x.56.6.893
43. Ulusoy M, Şahin N, Erkmen H. Turkish version of the Beck anxiety inventory: psychometric properties. J Cogn Psychother. 1998;12:28-35.
44. Ryan RM, Plant RW, O’Malley S. Initial motivations for alcohol treatment: Relations with patient characteristics, treatment involvement, and dropout. Addict Behav. 1995; 20(3):279-97.
45. Evren C, Saatçioğlu Ö, Dalbudak E, et al. Tedavi motivasyonu anketi (TMA) Türkçe versiyonunun alkol bağımlısı hastalarda faktör yapısı, geçerlilik ve güvenilirliği. J Depend. 2006;7:117-122.
46. Peker İ, “The relationship between gambling related cognitions and gambling severity, depression severity and treatment motivation in individuals with problem gambling.” Ege University, Faculty of Medicine, Department of Mental Health and Diseases, İzmir, 2021.
47. Mcmurran M, Theodosi E, and Sellen J. Measuring engagement in therapy and motivation to change in adult prisoners: a brief report. Criminal Behav. Ment. Health. 2006;16: 124-129.
48. Idrees S, Hafeez S, Azam M, Bhatti SH. Patients Perceived Autonomy Support Affecting Treatment Motivation, Depression, Anxiety and Stress in CHD and Diabetes Mellitus. Bulletin of Business and Economics (BBE). 2023;12(4), 219-222.
49. Ijaz S, Kanwal S, Javed I, Rubab A, Itfaq M, Fatima S. Treatment Motivation and Hopelessness among Cardiac Patients. Journal of Health and Rehabilitation Research. 2024; 4. 1425-1430. 10.61919/jhrr.v4i1.679.
50. Setiawan J, Widhiartini, IA, & Aman I. Treatment Motivation in Lung Tuberculosis Patients at Public Health Centres in Denpasar City during COVID-19 Pandemic. International Journal of Research and Review. 2022; 9, 45-50. 10.52403/ijrr.20220107.
51. Mertens VC, Goossens MEJB, Verbunt JA et al. Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized controlled trial. 2013; Trials 14, 90.
52. Webb D, and McMurran M. A comparison of women who continue and discontinue treatment for borderline personality disorder. Personality. 2009; 3: 142-149.
53. Chasson G, Hamilton E, Luxon, A, De LA, Bates S, Jagannathan N. Rendering promise: Enhancing motivation for change in hoarding disorder using virtual reality. Journal of Obsessive-Compulsive and Related Disorders. 2020; 25. 100519. 10.1016/j.jocrd.2020.100519.
54. Wisudawati M, Arista L. Descriptive Study: Self Motivation of Patients Undergoing Routine Hemodialysis with Fluid Restriction. UI Proceedings on Health and Medicine. 2020; 4, 34. 10.7454/uiphm.v4i1.247.
55. Yaqoob N, Sadaf A, and Rubina H. "Urdu Translation and Validation of Beck Suicide Intent Scale Among Patients with Self-Harming Behavior." Pakistan Journal of Psychological Research. 2022; 37.4, 505-514.
56. Elbogen EB, et al. "Effectively implementing psychiatric advance directives to promote self-determination of treatment among people with mental illness." Psychology, Public Policy, and Law. 2007, 13.4, 273.
57. Gunther, B. "Predictors of response to cognitive behavioral therapy guided self-help (GSH-CBT) for generalized anxiety disorder (GAD) in older adults." 2024.
58. Adyani S, Ayu M, and Mella M. "Client Motivation with Medication Compliance in Hypertension Patients." Widya Gantari Indonesian Nursing Journal. 2023, 7.1.
59. Gordana S, Slagona A, Dimitar D. The correlation between, depression, anxiety and treatment motivation in patients with affective disorder. Research on Humanities and Social Sciences. 2016;6(4):128-33.
60. Cahill MA, Adinoff B, Hosig H, Muller K, Pulliam C. Motivation for treatment preceding and following a substance abuse program. Addict Behav. 2003;28(1):67-79.
61. Blume AW, Schmaling KB, Marlat GA. Motivating drinking behavior change depressive symptoms may not be noxious. Addict Behav. 2001;26(2):267-72.
62. Blume AW, Schmaling KB, Marlatt GA. (2005). Memory, executive cognitive function, and readiness to change drinking behavior. Addict Behav. 2005;30(2):301-14.
63. Akdağ EM, Kotan VO, Kose S, Tıkır B, Aydemir MÇ, Okay İT et. al. The relationship between internalized stigma and treatment motivation, perceived social support, depression and anxiety levels in opioid use disorder. Psychiatry and Clinical Psychopharmacology. 2018;28(4):394-401.
64. Mohamed S, Hassan S, Abdelmonem R. Relationship between Self-Efficacy, Social Support and Treatment Motivation among Addict Patients. Minia Scientific Nursing Journal. 2022;12(1):106-13.
65. Tanrıverdi D, Çuhadar D, Durmaz H, Kaplan V, Özkan S. Treatment motivation and social support levels among individuals with substance use disorders and influencing factors, Journal of Substance Use. 2020;25(3):264-70.
66. Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice. 1982;19(3):276-288.
67. Share D, McCrady B, Epstein E. Stage of change and decisional balance for women seeking alcohol treatment. Addict Behav. 2004;29(3):525-35.
68. Lichtenstein E, Lando HA, Nothwehr F. Readiness to quit as a predictor of smoking changes in the Minnesota Heart Health Program. Health Psychol. 1994;13(5):393-396.
69. DiClemente CC, Prochaska JO. Toward a comprehensive, transtheoretical model of change: Stages of change and addictive behaviors. Treating addictive behaviors. 2nd ed. Plenum Press.
70. DiClemente CC. Motivation for change: Implications for substance abuse treatment. Psychological Science. 1999;10(3):209-213.
71. Kushnir V, Godinho A, Hodgins DC, Hendershot CS, Cunningham JA. Motivation to quit or reduce gambling: Associations between Self-Determination Theory and the Transtheoretical Model of Change. J Addict Dis. 2016;35(1):58–65.
72. Unubol B, Akulker G, Bilici R, Arpacioglu S. Examination of Quality of Life among Patients with Alcohol or Substance Use Disorder in Outpatient Rehabilitation Center. Bağımlılık Dergisi, 2024; 25(4):410-420.