How to identify a patient’s gambling issues
Being able to identify gambling-related issues for your patients is essential. Proven screening tools can help the process along.
In a general practice setting, issues relating to gambling may be masked, especially if a patient seeks support for other issues. People experiencing gambling harm may present with problems associated with financial hardship, relationship breakdown and domestic violence , mental health including stress and health issues related to stress, depression or addiction.
Screening patients for gambling issues may help you start the conversation on bigger issues.
Why routine screening is a smart thing to do
Gambling may be masked by other major concerns – like substance abuse – so it can be difficult to identify gambling harm until significant damage is done. We recommend that you routinely screen patients for gambling and gambling harm as part of a lifestyle assessment.
How you can screen for gambling issues and make a difference
You are in a position to identify patients who may be experiencing gambling harm, provide psychoeducation, support their efforts to change and connect them to gambling support services.
You can ask people about gambling :
- In lifestyle assessments
- When discussing stressors
- As part of a mental health assessment
- When the patient or client presents with problems associated with:
- Financial distress or pressure
- Poor self-care
- Intimate partner conflict
- Dopamine agonist medication (rare adverse effect)
Here are some of the screening tools available to you.
Problem Gambling Severity Index (PGSI)
The PGSI is a tool commonly used in gambling treatment and research. It helps to identify people at risk of gambling harm.
Your client can fill out the PGSI online. The higher their score, the more likely it is that their gambling is a problem.
Brief Biosocial Gambling Screen (BBGS)
The BBGS is a shorter, simpler screening tool you can use with clients to determine if they should have a more comprehensive screen. If your client answers yes to any of these 3 questions, they may be at risk of developing a gambling problem:
- During the past 12 months, have you become restless, irritable or anxious when trying to stop/cut down on gambling?
- During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
- During the past 12 months, did you have such financial trouble that you had to get help with living expenses from family, friends, or welfare?
Gebauer, L., LaBrie, R. A. and Shaffer, H. J. (2010). Optimizing DSM IV classification accuracy: a brief bio-social screen for detecting current gambling disorders among gamblers in the general household population. Canadian Journal of Psychiatry, Vol. 55(2): 82-90.
G 8 – Online Screening Tool
The G 8 – Online Screen tool is an 8-question screening tool that your client can complete online.
The Lie/Bet Questionnaire is a short two question screening tool selected from DSM-IV. It is useful in determining if a longer screening tool or further assessment is appropriate.
- Have you ever bet more than you intended to?
- Have you lied to others to conceal the extent of your gambling?
What and how to ask?
When raising the topic of gambling with a client, you should:
- Anticipate reluctance
- Avoid statements such as “Do you have a problem with gambling?”
- Introduce gambling screening routinely
- Use an opening statement such as “A lot of people like to gamble. What about you?”
- Ask about recreational activities: “What do you do for fun?”
- Ask permission when you raise the issue of money:
“Would it be OK if I asked you how much money you might spend on gambling?”