title: A prospective natural history study of quitting or reducing gambling with or without treatment: protocol.
abstract: BACKGROUND
  Only a small percentage of gamblers ever seek treatment, often due to stigma, embarrassment, or a desire to handle their problems on their own. While the majority of pathological gamblers who achieve remittance do so without accessing formal treatment, factors related to successful resolution have not been thoroughly explored.
  
  
  OBJECTIVE
  Employing a prospective natural history design, the study will therefore undertake an investigation to explore life events, motivating factors, and strategies used by problem gamblers to quit or reduce their gambling without formal treatment.
  
  
  METHODS
  Prospective participants (19 years or older) currently gambling at problematic levels with strong intentions toward quitting gambling will be directed to fill out a Web-based survey. Eligible participants will subsequently complete a survey that will assess: (1) types, frequency, and amount of money spent on gambling, (2) life events experienced in the past 12 months, (3) level of autonomous motivation for change, and (4) use of treatment services. Every 3 months for the duration of one year following the completion of their baseline survey, participants will be sent an email notification requesting them to complete a follow-up survey similar in content to the baseline survey. The four surveys will assess whether participants have experienced changes in their gambling behaviors along with positive or negative life events and motivations for change since the last survey. Individuals who are in the action and maintenance stages of quitting gambling at follow-up will be also asked about their techniques and strategies used to quit or reduce gambling. At 18 months post baseline, participants will be asked to complete a fifth and final follow-up survey that will also assess whether participants have experienced any barriers to change and whether they resolved their gambling to low risk levels.
  
  
  RESULTS
  The study has commenced in May 2013 and is currently in the recruitment stage. The study is scheduled to conclude in 2016.
  
  
  CONCLUSIONS
  As this study will examine the active ingredients in natural recovery from gambling problems, the results will inform ways of promoting change among the large number of problem gamblers who do not seek treatment as well as improve treatment for those who do seek help. The information gained will also be useful in identifying effective self-help strategies for those who face challenges in accessing treatment, may be incorporated in standard treatment, provide brief intervention techniques, as well as inform relapse prevention strategies.
authors.affiliation: Center for Addiction and Mental Health, Toronto, ON, Canada. vlad.kushnir@camh.ca.
authors.forename: Vladyslav
authors.initials: V
authors.lastname: Kushnir
authors.forename: John A
authors.initials: JA
authors.lastname: Cunningham
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgins
keywords: gambling; life events; longitudinal study; motivational factors; natural recovery; prospective natural history study; treatment