Screening for Problem Gambling

Screening for gambling-related history and symptoms is justified because of the prevalence and potential severity of problem gambling, the potential to improve patient outcomes, and the low cost and risk associated with asking about problem gambling. Early intervention of problem gambling through screening and motivating help-seeking may reduce the harm of problem gambling on individuals and their families.

If patients present with symptoms that could be related to sustained stress, when you assess for behavioral conditions, include questions on gambling. If gambling is a frequent activity, then consider utilizing a simple screening tool - the Lie-Bet Questionnaire. This questionnaire is valid and reliable for ruling out pathological gambling behaviors.

The Lie-Bet Questions
1) Have you ever felt the need to bet more and more money?
2) Have you ever had to lie to people important to you about how much you gambled?

If a patient answers yes to one or both of the questions on the Lie-Bet questionnaire, further assessment is indicated. Conduct a clinical interview using the DSM-IV criteria provided below or provide self assessments such as the South Oaks Gambling Screen (SOGS) (click for more information about assessment instruments). Patients suspected of a gambling problem should be encouraged to seek specialized treatment and provided with a referral for such services.

DSM IV Diagnostic Criteria for Pathological Gambling
A. Persistent and recurrent maladaptive gambling behavior as indicated by 5 (or more) of the following:

(1) Is preoccupied with gambling (e.g.,preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble).

(2) Needs to gamble with increasing amounts of money in order to achieve
the desired excitement.

(3) Has repeated unsuccessful efforts to control, cut back, or stop gambling.

(4) Is restless or irritable when attempting to cut down or stop gambling.

(5) Gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings helplessness, guilt, anxiety, depression).

(6) After losing money gambling, often returns another day to get even (”chasing” after one’s losses).

(7) Lies to family members, therapist, or others to conceal the extent of involvement with gambling.

(8) Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling.

(9) Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.

(10) Relies on others to provide money to relieve a desperate financial situation caused by gambling.

B. The gambling behavior is not better accounted for by a manic episode.

How is Problem Gambling Associated with Patient Health?

Adapted from the The National Council on Problem Gambling Website