Treating Adults With Co-occurring Disorders

Many individuals that suffer from gambling issues also have co-occurring psychiatric disorders and limited or no adequate treatment options to address all disorders at once. These co-occurring disorders include anxiety, depression and substance use disorders. Because of this problem, the Ohio Department of Mental Health and Addiction Services created The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders (Kruse-Diehr et al., 2022), specifically for adults with co-occurring disorders. This manual, aims to fill in the gaps that exist when treating individuals with co-occurring disorders.


The researchers aimed to create and test the efficacy of a gambling disorder (GD) treatment manual, The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders (OhPGTM). The main aims of the study were to assess, treat and measure changes in gambling disorder when using the manual and the treatment methods it recommends. This is important for treatment providers because it provides a uniform process to address all co-occurring disorders that are presenting along with a client’s gambling issues. Additionally, the overarching and long-term goal of this study was to address the negative consequences of GD and ultimately reduce its prevalence in Ohio populations.

What did they do?

The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders (OhPGTM) was developed over a period of five years, drawing from various addiction treatment models including cognitive behavioral treatment, Motivational Interviewing and improvement of life skills. The manual included a 12-week process of modules with each week covering a new topic related to co-occurring disorders and gambling disorder. Participants completed monitoring logs, craving scales, handouts and take home assignments. Each study participant was placed into a group, with each group consisting of between three to 12 participants. Each participant completed a pre-test and post-test assessment to discern the helpfulness of the 12-week process. The scales used to assess the efficacy of the manual included The Gambling Craving Scale (Young & Wohl, 2009); the Problem Gambling Severity Index (Ferris, J., & Wynne, H., 2001), which was used to assess the previous year’s actual GD symptom severity and its effects on both the individual and family members; and The Rosenberg Self-Esteem Scale (Rosenberg, 1965), which was used to assess participant self-esteem.

What did they find?

Over the course of the study, 122 participants completed the program. Participants that completed the course reported a reduction in gambling, but no change in self-esteem or gambling urges. Two-thirds of the sample that completed the program reported a co-occurring mental disorder, and three fourths had a substance use disorder. The researchers concluded that this manual represents a significant improvement in GD treatment for at risk communities. As with many pilot studies, efficacy is not always immediately clear but the authors believe further research can help solidify its usefulness for both treatment providers and the clients that they serve.


The study authors stated that improvements in gambling behaviors cannot be confirmed as a result of the manual itself; participants may have had other factors in their life that affected their gambling actions over the course of the study. The researchers also noted that the study participants were almost predominantly white, which does not provide a representative sample of the population of Ohio.

Further Direction:

The ICRG was lucky enough to talk with Derek Longmeier,Executive Director, Problem Gambling Network of Ohio, who commented on his excitement over this manual:

We’ve found that screening at intake is not the most effective method for identifying those in need of gambling support services and that there is a strong connection between disordered gambling and substance use disorder. We are confident that this program will be a catalyst for identifying and serving individuals with co-occurring disorders. We know that there are many roads to recovery for those with a gambling disorder and we are hopeful that through broad distribution and utilization of the manual throughout Ohio, we can make the process as smooth as possible for both counselors and the clients they serve.


Ferris, J., & Wynne, H. (2001).The Canadian Problem Gambling Index(Final Report; p. 59). Canadian Consortium for Gambling Research.

Kruse-Diehr, A., Shamblen, S., & Courser, M. (2022). Longitudinal assessment of a manualized group treatment program for gambling disorder: The Ohio problem gambling treatment model for adults with co-occurring disorders.Journal of Gambling Studies.

Rosenberg, M. (1965). Rosenberg self-esteem scale.APA PsychTests.

Young, M., & Wohl, M. (2009). The Gambling Craving Scale: Psychometric validation and behavioral outcomes.Psychology of Addictive Behaviors,23(4).

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