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South Oaks Gambling Screen

Lesieur and Blume, 1987


Please indicate which of the following types of gambling you have done in your lifetime. For each type, mark one answer:
“not at all”, “less than once a week”, Or “once a week or more”.

NOTE: The check boxes and radio buttons are for your convenience.. we are not collecting information.

1   not at all less than once a week once a week or more
a. Play cards for money
b. Bet on horses, dogs, or other animals
(at OTB, the track, or with a bookie)
c. Bet on sports (parlay cards, with bookies, or at Jai Alai Court)
d. Played dice games (including craps, over and under, or other dice games) for money or drinks, etc.
e. Gambled in a casino (legal or otherwise)
f. Played bingo for money.
g. Played the stock, options and or commodities market
h. Played slot machines, poker machines or other games of skill for money
i. Pull tabs or “paper” games other than the lotteries
j.

Some other form of gambling not listed above
 
2 What is the largest amount you have ever gambled with on any one day?

Never gambled

 More than $100 up to $1000
$1 or less

More than $1000 up to $10,000
More than $1 up to $10 More than $10,000
More than $10 up to $100    
3 Check which of the following people in your life has (or had) a gambling problem.

Father

 Brother-in-Law
Mother

Spouse/Partner
Child(ren) Relative
GrandParent A friend or someone else important in my life
 
4 When you gamble, how often do you go back another day to win back the money you lost?

Never

 Some of the time (less than half of the time I lost)
Most of the time I lost

Every time I lost
 
5 Have you ever claimed to be winning money but weren’t really? In fact you lost?

Never

 Yes, most of the time
Yes, less than half of the time I lost  

 
6 Do you feel you have ever had a problem with betting money or gambling?

No

 Yes
 
7 Do you ever gamble more than you intended to?

No

 Yes
 
8 Have people criticized your betting or told you that you have a gambling problem, regardless of whether or not you thought it was true?

No

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

No

 Yes
 
10 Have you ever felt like you would like to stop betting money or gambling but didn’t think you could?

No

 Yes
 
11 Have you ever hidden betting slips, lottery tickets, gambling money, I.O.U’s or other signs of betting or gambling from your spouse, children, or other important people in your life?

No

 Yes
 
12 Have you ever argued with people you live with over how you handle your money?

No

 Yes
 
13 (If you answered yes to question 12); Have money arguments ever centered on your gambling.

No

 Yes
 
14 Have you ever borrowed from someone and not paid them back as a result of your gambling?

No

 Yes
 
15 Have you ever lost time from work/school due to betting money or gambling?

No

 Yes
 
16  If you borrowed money to gamble/to pay gambling debts, who or where did you borrow from?
a. From household money

Yes

 No
b. From your spouse

Yes

 No
c. From other relatives/in laws

Yes

 No
d. From banks, loan companies, or credit unions

Yes

 No
e. From credit cards

Yes

 No
f. From loan sharks

Yes

 No
g. You cashed in stocks, bonds, or other securities
Yes No
h. You sold personal or family property
Yes No
i. You “borrowed” on your checking account (passed bad checks)
Yes No
j. You have (had) a credit line with a bookie
Yes No
k. You have (had) a credit line with a casino
Yes No
 
 

Score Sheet:

Questions 1, 2 and 3 are not counted.   One point for each below:
Q 4 - Almost all the time I lose, or Every time I lose. Q 5 – Yes less than half the time I lose, or Yes, most of the time.
Q6 –  Yes in the past but not now, or Yes. Q7 –  Yes
Q8 –  Yes Q9 –  Yes
Q10 – Yes Q11 – Yes
 Q12 – Not Counted Q13 – Yes
Q14 – Yes Q15 – Yes
Q16-a – Yes Q16-b – Yes
Q16-c – Yes Q16-d – Yes
Q16-e – Yes Q16-f – Yes
Q16-g – Yes Q16-h – Yes
Q16-i – Yes Questions 16-j and 16-k not counted.

 

Total = ________    (20 questions are counted)

0-2 = No problem

3-4 = Problem gambler

5 or more = Probable pathological gambler