|
| |
South Oaks Gambling Screen
Print the following page.
Then 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."
|
Not at all
|
Less than once a week
|
Once a week or more
|
|
|
____
|
____
|
____
|
a.
played cards for money |
|
____
|
____
|
____
|
b.
bet on horses, dogs or other animals (in off-track betting, at the
track or with a bookie) |
|
____
|
____
|
____
|
c.
bet on sports (parley cards, with a bookie,, or at jai alai) |
|
____
|
____
|
____
|
d.
played dice games (including craps, over and under, or other dice
games) for money |
|
____
|
____
|
____
|
e.
went to casino (legal or otherwise) |
|
____
|
____
|
____
|
f.
played the numbers or bet on lotteries |
|
____
|
____
|
____
|
g.
played bingo |
|
____
|
____
|
____
|
h.
played the stock and/or commodities market |
|
____
|
____
|
____
|
i.
played slot machines, poker machines or other gambling machines |
|
____
|
____
|
____
|
j.
bowled, shot pool, played golf or played some other game of skill for
money |
2. What is the largest amount of money you have ever gambled with any one day?
___ never have gambled
___ more than $100 up to $1000
___ $10 or less
___ more than $1000 up to $10,000
___ more than $10 up to $100
___ more than $10,000
3. Do (did) your parents have a gambling problem?
___ both my father and mother gamble (or gambled) too much
___ my father gambles (or gambled) too much
___ my mother gambles (or gambled) too much
___ neither gambles (or gambled) too much
4. When you gamble, how often do you go back another day to win back
money you lost?
___ never
___ some of the time (less than half the time) I lost
___ most of the time I lost
___ every time I lost
5. Have you ever claimed to be winning money gambling but weren’t
really? In fact, you lost?
___ never (or never gamble)
___ yes, less than half the time I lost
___ yes, most of the time
6. Do you feel you have ever had a problem with gambling?
___ no
___ yes, in the past, but not now
___ yes
|
Yes
|
No
|
| 7.
Did you ever gamble more than you intended? |
____
|
____
|
| 8.
Have people criticized your gambling? |
____
|
____
|
| 9.
Have you ever felt guilty about the way you gamble or what happens
when you gamble? |
____
|
____
|
| 10.
Have you ever felt like you would like to stop gambling but didn’t
think you could? |
____
|
____
|
| 11.
Have you ever hidden betting slips, lottery tickets, gambling money,
or other signs of gambling from your spouse, children, or other
important people in you life? |
____
|
____
|
| 12.
Have you ever argued with people you like over how you handle money? |
____
|
____
|
| 13.
(If you answered "yes" to question 12): Have money arguments
ever centered on your gambling? |
____
|
____
|
| 14.
Have you ever borrowed from someone and not paid them back as a result
of your gambling? |
____
|
____
|
| 15.
Have you ever lost time from work (or school) due to gambling? |
____
|
____
|
| 16.
If you borrowed money to gamble or to pay gambling debts, where did
you borrow from? (Check "yes" or "no" for each) |
____
|
____
|
a. from household money
|
____
|
____
|
b. from your spouse
|
____
|
____
|
c. from other relatives or in-laws
|
____
|
____
|
d. from banks, loan companies or credit unions
|
____
|
____
|
e. from credit cards
|
____
|
____
|
f. from loan sharks (Shylocks)
|
____
|
____
|
g. your cashed in stocks, bonds or other securities
|
____
|
____
|
h. you sold personal or family property
|
____
|
____
|
i. you borrowed on your checking account (passed bad
checks)
|
____
|
____
|
j. you have (had) a credit line with a bookie
|
____
|
____
|
k. you have (had) a credit line with a casino
|
____
|
____
|
To score the results
click here.
|
