Nearly three-quarters of people with gambling disorders achieve clinically meaningful improvement through Birches Health, a new study finds.
This peer-reviewed outcome study was recently published in the Journal of Medical Internet Research. This was a retrospective analysis of 1,305 adults treated with Virtis from mid-2024 to 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 United States.
“Over the past 20 years, there has been an incredible amount of research done on gambling disorders, both academic and outcome data,” Elliot Rappaport, founder and CEO of Birches, told Fierce Healthcare in a progressive interview. “Having said that, I think the percentage is very small, especially when compared to substance use disorders, because this is such a new and emerging field.”
Millions of Americans suffer from gambling addiction or addiction, yet some estimates suggest that less than 10% receive treatment. This condition has a high risk of suicide and is often accompanied by depression, anxiety, and substance use disorders. But stigma and a lack of treatment options make it difficult to access care.
According to the research’s published disclosure, the study was conducted by Birches employees and researchers affiliated with behavioral science consultancy Fit Mind, which “received compensation for services rendered as part of Birches Health’s embedded science team, independent of the conduct or results of this study.”
Results showed that almost 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 is defined as a decrease of 4 points or more, and Birches patients saw an average decrease of 8.3 points over 12 weeks of treatment.
More than half of the participants had at least one other psychiatric diagnosis. More than a quarter of patients had an anxiety disorder. The fifth person had a depressive disorder. 10% had trauma-related disorders. 7% had a substance use disorder. and 5% had ADHD. The study found that the treatment led to meaningful improvements across patients, including those with co-morbid conditions.
Greater baseline depressive symptom severity was associated with faster improvement in gambling symptoms. “We saw some parallel improvements,” Dr. Cynthia Grant, vice president of clinical affairs at Birches and co-author of the study, told Fierce Healthcare.
Rappaport noted that this data is relevant to payers, employers and health systems who do not understand the extent of “what we believe is a rapidly developing public health epidemic across the United States.” Part of the study’s goal was to “demonstrate that despite the scale of the gambling disorder problem in the United States, specialized care does exist (and is working).”
Although the study itself primarily focused on patients who received only individual psychotherapy, Birches has since expanded the clinical model. Current treatment options include one-on-one treatment, as well as group therapy, peer support, and financial health counseling. These are all voluntary. Grant said the reason for expanding its offerings is due to internal analysis that showed patients are more engaged in treatment when they participate in groups and collaborate with peers.
Rappaport believes it’s important to “avoid being seen as a company that only deals with people in crisis.” The sooner you receive treatment, the better. “You don’t have to think you have a gambling problem to come to Birches Health,” Rappaport said.
To receive reimbursement, patients typically must meet diagnostic criteria for gambling disorder, according to the grant. Most birch patients fit this condition. However, Dr. Birches can treat patients even if they do not meet the criteria for a gambling problem, exhibit symptoms of problem gambling, and have another diagnosis, such as depression.
Birches, which has treated more than 5,000 patients, operates in all 50 states and is covered by major plans including UnitedHealthcare, Cigna, Aetna, TRICARE and Blue Cross Blue Shield. Some states work with Medicaid. We also partner with several state health departments to support the uninsured. Some contracts are value-based. Expanding Medicaid and entering Medicare will be a major focus next year, Rappaport said.
In most cases, peer support is not reimbursed by commercial payers. “Some of these alternative payment arrangements give us an opportunity to expand that service,” Grant said. Even if you are not reimbursed, Birches will continue to provide peer support. The company pays peer support professionals and does not charge patients. The reason, Grant says, is simple: “There’s a lot of research on how effective it is for individuals to engage with their peers.”
Birches participates in measurement-based care and administers monthly PHQ9, GAD7, G-SAS, and work productivity and disability questionnaires. This data is important not only to payment partners, but also to healthcare providers and patients themselves, who can access monthly data to track progress. Providers also discuss progress in sessions, according to Grant.
Grant says much of the existing research on gambling disorders is related to college and therefore relies on datasets of college students. Unless a university offers treatment for gambling disorders, certain studies can only consider prevalence and not clinical outcomes. University students are also a specific and limited group. Given the diversity of Birches’ patients, “the real-world part for us is that these patients are… people from all over the United States,” Grant said. Birches is developing additional research into gambling disorders and other behavioral and process addictions.
