Abstract
Given the limited evidence on care received over time by patients with gambling disorder (GD), this study examined care trajectories and their associations with patients’ conditions, gambling characteristics, and quality of care. Data from 14 Quebec addiction treatment centers were collected for 907 patients with at least 3 years of GD, then linked to provincial administrative databases (1979–2022). Group‑based multi‑trajectory modeling identified 3‑year care trajectories (2009–2022) for GD, mental disorders (MDs), substance‑related disorders (SRDs), and physical health problems, considering most patients had co‑occurring disorders. Multiple multinomial logistic regression assessed covariates. Of the five trajectories identified, only Trajectories 3 and 5 received substantial GD treatment throughout the 3‑year period—less than one-third of the cohort. Trajectory 3 had the most GD treatment and the lowest dropout rates, though about half still discontinued care. These patients were older (similar to Trajectories 2 and 4) and had comparatively better conditions (similar to Trajectory 1), although most had co‑occurring disorders and made minimal use of services that could address these issues. MD‑SRD service use was especially low in Trajectories 1–3 (70% of the cohort), although most of these patients had those disorders. Conversely, Trajectory 4 patients showed low GD treatment but high use of other services, while gambling characteristics were not associated with any trajectory. Patients with the worst conditions received the most overall care (Trajectories 4–5), including acute care. GD and MD‑SRD care could be substantially improved to better address the cohort’s substantial unmet needs, including screening, motivational interventions, and referral to treatment, especially for patients in Trajectories 1, 2, and 4.
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In accordance with the applicable ethics regulations in the province of Quebec, the principal investigator is responsible for keeping data confidential.
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We gratefully acknowledge the support of the Fonds de recherche du Québec - Société et culture, and all our extended research team, including our partners.
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This study was funded by the Fonds de recherche du Québec - Société et culture (no 338854). The sponsors had no further role in the study design or collection, analysis, and interpretation of data, in writing the report or in the decision to submit this paper for publication;
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MJF received the study funding. MJF designed the analytic plan for the article. ZC produced the quantitative analyses and tables. GG, ZC and MJF wrote the article. MB and SK reviewed the article prior to submission. All authors thus contributed to this article and approved the submitted version.
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Fleury, MJ., Cao, Z., Grenier, G. et al. Three Years of Care Trajectories Among Patients with Gambling Disorder. Adm Policy Ment Health (2026). https://doi.org/10.1007/s10488-026-01533-7
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DOI: https://doi.org/10.1007/s10488-026-01533-7