Gambling Diagnostic Form

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Persistent and recurrent maladaptive gambling behavior as indicated by Four (or more)
of the following criteria:

IN THE PAST YEAR....

1. Have you often found yourself thinking about gambling (e.g.,reliving past gambling experiences, planning the next time youwill play or thinking of ways to get money to gamble)?

1 point

Yes

Clear selection

2. Have you needed to gamble with more and more money to get the amount of excitement you are looking for?

1 point

Yes

Clear selection

3. Have you become restless or irritable when trying to cut down orstop gambling?

0 points

Yes

Clear selection

4. Have you gambled to escape from problems or when you are feeling depressed, anxious or bad about yourself?

1 point

Yes

Clear selection

5. After losing money gambling, have you returned another day in order to get even?

1 point

Yes

Clear selection

6. Have you lied to your family or others to hide the extent of your gambling?

1 point

Yes

Clear selection

7. Have you made repeated unsuccessful attempts to control, cutback or stop gambling?

1 point

Yes

Clear selection

8. Have you risked or lost a significant relationship, job, educational or career opportunity because of gambling?

1 point

Yes

Clear selection

9. Have you sought help from others to provide the money to relieve a desperate financial situation caused by gambling?

1 point

Yes

Clear selection

**4 or more “yes” answers indicates a diagnosis for Gambling Disorder **Less than 4 indicates a potential problem and/or at risk indicators which may warrant further support, education and treatment services.

If your screening test shows that you have a problem with gambling, then we would advise setting up an appointment with a SAPTA counselor for a more in-depth assessment and possible counseling program.

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