| Problem Gambling Self Screen |
| Yes | No | |
|
|
||
| 2. Has gambling ever made your home life unhappy? | Yes | No |
|
|
||
| 3. Have you ever felt remorse after gambling? | Yes | No |
|
|
||
| 4.Did gambling affect your reputation? | Yes | No |
|
|
||
| 5. Have you ever gambled to get money to pay debts or solve other financial difficulties? | Yes | No |
|
|
||
| 6. Has gambling diminished your ambition or ability to do your job? | Yes | No |
|
|
||
| 7. After losing, did you feel you must return as soon as possible and win back your losses? | Yes | No |
|
|
||
| 8. After a win, did you have a strong urge to return and win more? | Yes | No |
|
|
||
| 9. Do you often gamble until your last dollar is gone? | Yes | No |
|
|
||
| 10. Do you ever borrow to finance gambling? | Yes | No |
|
|
||
| 11. Have you ever sold anything to finance gambling? | Yes | No |
|
|
||
| 12. Are you reluctant to use "gambling money" for normal expenditures? | Yes | No |
|
|
||
| 13. Does gambling make you careless about the welfare of yourself and your family? | Yes | No |
|
|
||
| 14. Did you ever gamble longer than you had planned? | Yes | No |
|
|
||
| 15. Have you ever gambled to escape worry or trouble? | Yes | No |
|
|
||
| 16. Have you ever committed, or considered committing, an illegal act to finance gambling? | Yes | No |
|
|
||
| 17. Do you have trouble sleeping because of gambling? | Yes | No |
|
|
||
| 18. Do arguments, disappointments or frustrations create within you an urge to gamble? | Yes | No |
|
|
||
| 19. Do you have an urge to celebrate any good fortune by a few hours of gambling? | Yes | No |
|
|
||
| 20. Have you ever considered self destruction as a result of your gambling? | Yes | No |