RESEARCH QUESTION
What are the behavioural indicators (e.g., frequency, duration, money spent) associated with gambling-related harm in post-treatment pathological gamblers (PGs)?

PURPOSE
To begin the development of behavioural indicators (e.g., frequency, duration, money spent) that quantify the relationship between post-treatment gambling behaviour and harm.

HYPOTHESIS
None stated.

PARTICIPANTS
One hundred and seventy-eight individuals (52% males; average age = 46 years) who participated in a randomized controlled trial for the treatment of pathological gambling and completed the 12-month follow-up assessment. Participants had a DSM-IV diagnosis of pathological gambling and gambled within two months prior to enrolling in the study. Slot machines were reported as the primary problematic gambling activity (44%), followed by table games (19%), lottery-scratch tickets (12%), betting on animals (8%), and sports betting (7%).  

PROCEDURE
Participants were randomly assigned to one of three treatment conditions: referral to Gamblers Anonymous (GA) alone, referral to GA plus cognitive behavioural treatment (CBT) provided in a workbook format, or referral to GA plus eight sessions of individual CBT. Assessments of gambling behaviours and problems were completed at baseline and at 1, 2, 6, and 12 months post-treatment. Information in this article was reported from baseline and 12-month assessments only and collapsed across all groups.

MAIN OUTCOME MEASURES
The Gambling Timeline Followback (G-TLFB), a retrospective, calendar-based self-report measure of gambling behaviour, was used to assess pathological gambling behaviours including total time and total dollar amount spent gambling. The South Oaks Gambling Screen (SOGS) was used to assess pathological gambling over the lifetime and collateral reports were obtained for the SOGS at the 12-month follow-up evaluation.

KEY RESULTS
Problem-free indicators. Based on pathological gambling (SOGS) scores obtained at the 12-month follow-up assessment, 45 participants were categorized as problem-free gamblers (score = 0) and 122 as symptomatic gamblers (score of 1 or more). With regard to gambling behaviours for the past 6-months (at 12-month follow-up), the problem-free gambling group reported gambling less frequently, spending less time gambling, and spending a smaller proportion of their monthly income gambling compared to the symptomatic gambling group. The behavioural indicator cutoffs for problem-free gamblers found the optimal monthly frequency to be 0.7 times or less per month. The optimal problem-free cutoff for monthly gambling duration was gambling 1.5 hours or less per month and the optimal cutoff for percentage of monthly income spent gambling was less than 2% of monthly income. Examination of behavioural indicators at a range of cut-points. To investigate the continuum of gambling from problem-free to probable pathological, the sample was divided by 12-month pathological gambling (SOGS) scores at each possible SOGS score cut-point between 0 and 5.  The examination of behavioural indicators at these cutoffs showed that monthly gambling frequency ranged from less than 1 episode per month for the problem-free indicator to 1.5 episodes per month for the indicator associated with probable pathological gambling. Monthly duration ranged from no more than 1.5 hours per month for the problem-free indicator to no more than 3.5 hours per month for the indicator associated with probable pathological gambling. Percentage of monthly income spent gambling ranged from less than 2% of monthly income for the problem-free indicator to no more than 7% for the indicator associated with probable pathological gambling. When abstinent gamblers (n = 32) were removed from the sample, the disordered gambling indicators increased twofold in terms of monthly frequency and monthly duration.

LIMITATIONS
The type of gambling activity engaged in during the follow-up assessment period may have been different from the problematic gambling activity engaged in at baseline.  Data was self-report and may be subject to bias.

CONCLUSIONS
This study empirically evaluated post-treatment gambling in relation to harm in a sample of pathological gamblers who presented for treatment. The novel findings regarding behavioural indicators for problem free gambling provide information about when former pathological gamblers’ gambling behaviour may no longer be harmful. The study also represents an initial step in developing guidelines that would offer a potential alternative to abstinence for some pathological gamblers seeking to change their behaviour.