Nearly three-quarters of patients with gambling disorder achieved clinically meaningful symptom improvement through Birches Health, a new study finds.
The peer-reviewed outcomes study was recently published in the Journal of Medical Internet Research. It was a retrospective analysis of 1,305 adults treated by Birches between mid-2024 and mid-2026.
Birches, a virtual provider for digital addictions, says the study is the largest real-world dataset on virtual gambling disorder treatment in the U.S.
“There’s been incredible both academic and outcomes data research done on gambling disorder over the past 20 years,” Elliott Rapaport, founder and CEO of Birches, told Fierce Healthcare in an advanced interview. “That being said, it is such a new and emerging field that I think compared to substance use disorder in particular, it is a minuscule percentage.”
Millions of Americans are affected by problem gambling or gambling disorder, yet some estimates suggest fewer than 10% get treatment. The condition carries a high risk of suicidality and is often comorbid with depression, anxiety and substance use disorders. Yet stigma and lack of treatment options make it difficult to get care.
The study was conducted by a Birches employee and researchers affiliated with Fit Minded, a behavioral sciences consultancy that "received compensation for services rendered as the embedded scientific team for Birches Health independent of the conduct or outcomes of this research," according to the study's published disclosures.
It found that nearly 72% of patients achieved a clinically meaningful reduction in symptom severity on the Gambling Symptom Assessment Scale (G-SAS). The average time to improvement was 14 days. Clinically meaningful improvement was defined as a reduction of four or more points, and Birches' patients saw an 8.3-point drop on average over 12 weeks of treatment.
Over half of participants had at least one other psychiatric diagnosis. Over a quarter of patients had anxiety disorders; a fifth had depressive disorders; and 10% had trauma-related disorders; 7% had substance use disorders; and 5% had ADHD. The study found treatment produced meaningful improvement across patients, including those with co-occurring conditions.
Higher baseline depressive symptom severity was associated with faster improvement in gambling symptoms. “We were seeing some parallel improvements,” Cynthia Grant, Ph.D., VP of clinical at Birches and co-author of the study, told Fierce Healthcare.
The data is relevant to payers, employers and health systems, Rapaport noted, who don’t realize the extent “of what we believe is a public health epidemic that is rapidly advancing across the U.S.” The goal of the study was, in part, to “show that despite the scale of the problem of gambling disorder in the U.S., specialized care does exist [and works].”
While the study itself focused primarily on patients who only received individual psychotherapy, Birches has expanded its clinical model since then. Treatment options now include one-on-one therapy, plus group therapy, peer support and financial wellness counseling. These are all voluntary. The reason for expanding the offerings is driven by internal analyses that show patients are more engaged in care when they participate in groups and work with a peer, per Grant.
Rapaport believes it’s important to “not solely be seen as a company which only treats people who have had their crisis moment.” The earlier someone gets into treatment, the better. “You don’t need to consider yourself addicted to gambling to come to Birches Health,” Rapaport noted.
In order to get reimbursed, patients typically need to meet the criteria for a gambling disorder diagnosis, per Grant. Most Birches patients fit the bill. However, if a patient exhibits problem gambling symptoms—without meeting the criteria for an addiction diagnosis—and has a separate diagnosis like depression, Birches can still treat them.
Birches, which has treated over 5,000 patients to date, operates in all 50 states and is covered by major plans, including UnitedHealthcare, Cigna, Aetna, TRICARE and Blue Cross Blue Shield. It works with Medicaid in some states. It also has partnerships with several state departments of health to support uninsured populations. Some of its contracts are value-based. Expanding Medicaid and into Medicare will be key focuses next year, per Rapaport.
In most cases, peer support is not reimbursed by commercial payers. “Some of those alternative payment arrangements give us the opportunity to expand that service,” Grant said. Even when it isn’t reimbursed, Birches still offers peer support. The company pays its peer support specialists and does not charge patients. The reason is simple, per Grant: “There’s heaps and heaps of research [on] how effective it is when an individual engages with a peer.”
Birches participates in measurement-based care, deploying the PHQ9, GAD7, G-SAS and a work productivity and activity impairment questionnaire monthly. The data is important not only for payer partners but also for providers and patients themselves, who can access their monthly data and track their progress. Providers also discuss their progress in sessions, per Grant.
A lot of existing research on gambling disorder is affiliated with universities and therefore relies on datasets of college students, per Grant. Unless a university offers treatment for gambling disorder, a given study can only consider prevalence and not clinical outcomes. College students are also a specific, limited population. Given the diversity of Birches’ patients, “for us, the real-world part is that these are people…across America,” Grant said. Additional research on gambling disorder and other behavioral and process addictions is in development at Birches.