Screening For Gambling Harms

Gambling harm can be a hidden cause of many of the symptoms and problems encountered regularly in general practice or mental health settings. 

Due to the stigma and shame associated with gambling harms, people are often unlikely to seek help until their gambling reaches a crisis.

Some red flags that may suggest someone is struggling with gambling include the following:

  •  Depression
  •  Anxiety
  •  Suicidal ideation
  •  Relationship problems
  •  Work/study problems
  •  Financial problems
  •  Withdrawn
  •  AOD Issues
  •  Past trauma/grief
  •  Domestic Violence

Using a brief gambling screen as a talking point can help the client discuss their gambling concerns.

A Short & Effective Screen:

“In the past twelve months, have you gambled more than you could afford to lose?”

If the client answers yes, undertake an assessment or refer to our clinical team for a more thorough assessment and treatment plan. 

There are also more detailed screens that could be used as a reference point.

Gambling Disorder DSM 5 Diagnostic Criteria 312.31

Persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period:

  • Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 
  • Is restless or irritable when attempting to cut down or stop gambling
  • Has made repeated unsuccessful efforts to control, cut back, or stop gambling. 
  • Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
  • Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
  • After losing money gambling, often returns another day to get even (“chasing” one’s losses).
  • Lies to conceal the extent of involvement with gambling.
  • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
  • Relies on others to provide money to relieve desperate financial situations caused by gambling.
  • The gambling behaviour is not better explained by a manic episode.

Severity:  Mild: 4–5 criteria met.  Moderate: 6–7 criteria met.  Severe: 8–9 criteria met. 

Problem Gambling Severity Index:

9 Items; scored on a 0-3 point scale; Maximum Score is 27. 

The Problem Gambling Severity Index (PGSI) is a reliable and standardised measure of at-risk behaviour in problem gambling.

The PGSI is a tool based on research on the common signs and consequences of problematic gambling.

You can access this tool from a number of different websites, including Gambling help online.

The index asks the following questions:

1. Have you bet more than you could really afford to lose?

2. Have you needed to gamble with larger amounts to get the same feeling of excitement?

3. When you gambled, did you go back another day to try to win back the money you lost?

4. Have you borrowed money or sold anything to get money to gamble?

5. Have you felt you might have a problem with gambling?

6. Has gambling caused you any health problems, including stress or anxiety?

7. Have people criticised your betting or told you that you had a gambling problem, regardless of whether or not you thought it was true?

8. Has your gambling caused any financial problems for you or your household?

9. Have you felt guilty about the way you gamble or what happens when you gamble?

Low Risk: 1-2 Moderate Risk: 3-7 Problem Gambling: 8+

Client Engagement – Considerations

It is important to use the window of opportunity when the client admits they are struggling with their gambling to encourage them to gain insight into their need for professional help.

If the client becomes distressed during the conversation it is important to normalise and reduce their distress. Therefore it is important not to encourage the client to discuss the enormity of their gambling issues, but just the presenting concerns. In-depth storytelling about gambling harms can increase the client’s distress, which limits their capacity to take on new information and engage in problem-solving skills. 

It is best to reduce the client’s level of distress to a point at which the client can engage in and profit from the help-seeking experience, but without eliminating distress entirely. Clients can then remain mindful of the seriousness of the situation and can think more clearly and realise their need to seek ongoing professional help. Motivational enhancement strategies can assist clients to identify, explore and resolve ambivalence about seeking help, and agreeing to a referral that is consistent with their values and concerns.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th Ed.), Washington D.C.

Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index: Final report. Submitted for the Canadian Centre on Substance Abuse. State of Queensland (Department of Justice and Attorney-General). (2012). Queensland Household Gambling Survey 2011–12. Author. Brisbane. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Author, Washington D.C.

Oakes, J. E., Manning, V., Rodda, S. N., & Lubman, D. I. (2020). A six-step brief intervention to reduce distress and increase treatment readiness in problem gamblers. Australasian Psychiatry, 28(4), 418-422.