Mechanisms and durability of residential treatment for co-occurring gambling and substance use disorders: a mixed-methods eight-year follow-up study.

INTRODUCTION

Gambling disorder is associated with substantial psychosocial harm, yet long-term outcome data for residential treatment programs remain limited.

METHODS

This mixed-methods study examined outcomes among 36 former residential treatment clients assessed between six months and eight years following discharge from a program treating co-occurring gambling and substance use disorders. Structured interviews evaluated gambling behavior, psychiatric symptoms, substance use, and functional outcomes, supplemented by qualitative thematic analysis.

RESULTS

Sixty-one percent reported gambling following discharge; however, participants demonstrated significant improvements in gambling craving strength, life satisfaction, gambling-related interference, and alcohol use. Employment increased from 25.0% to 66.7%. Treatment non-completion was associated with earlier return to gambling and higher odds of post-discharge gambling. Qualitative analysis identified environmental restructuring, urge-management skill development, structured routines, and post-discharge support as key recovery mechanisms.

DISCUSSION: Residential treatment may support durable improvements in functioning and gambling-related distress among individuals with severe gambling disorder, although causal conclusions are limited by the observational design.