Early Disengagement from Gambling Treatment: Insights from Clients and Practitioners

Early disengagement may undermine the effectiveness of evidence-based gambling treatment, yet limited research has examined why clients disengage and how services can better support retention. This exploratory mixed-methods study investigated reasons for early disengagement, its potential consequences for clients, and practical strategies to improve retention in real-world gambling services. Data were drawn from a two-timepoint client survey (pre-treatment and one-month follow-up), and a practitioner survey and hui (group discussion), capturing complementary perspectives. Participants were 67 clients (Mage=36.7; 59.7% male; 91.0% with mild-to-extreme gambling symptom severity) and 15 practitioners (Mage=48.3; 20.0% male; 66.7% counsellors) from New Zealand gambling specialist services. Across clients and practitioners, common reasons for early disengagement included logistical barriers, low motivation and external support, co-occurring mental health issues, concern about missing gambling, and gambling-related financial stress. Practitioners also highlighted early goal attainment, non-linear engagement, and systemic barriers. At follow-up, early disengagement was generally associated with making less gains in gambling, psychological, and broader addiction outcomes and greater professional help-seeking for non-gambling issues, compared with clients who completed or remained in treatment. Practitioners noted, however, that even brief engagement can build insight and readiness for future help-seeking. Clients and practitioners identified multi-level strategies to strengthen early retention, centred on relational quality (e.g., empathy, motivational style, peer/group support), proactive contact (e.g., welcome calls, reminders), service flexibility (e.g., multiple delivery formats, after-hours options), and workforce capacity (e.g., culturally responsive training). These findings provide a foundation for future research to evaluate the effectiveness and feasibility of treatment retention strategies in routine care.