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NRGP

National Gambling Board

South African Responsible Gambling Foundation

Problem Gambling - Screening Instruments

  • Introduction
  • Screening overview
  • GA
  • SOGS
  • CPGI
  • Vulnerability factors

2.1) Introduction

The generally accepted view internationally, is that just as a physical disorder can be diagnosed by a patient exhibiting certain symptoms in varying degrees of severity, so too with psychological disorders such as pathological gambling.

If we wish to measure the extent of problem and/or pathological gambling in a particular country, we have to use a reliable screening instrument to do this.

>>  Point to Ponder 3

Why would the government of a country want to measure the extent of problem and / or pathological gambling, do you think? Why would the government need reliable figures on all types of problem behaviours such as alcohol and drug abuse?

 

 

>>  Glossary 2

Screening instrument

A method, usually a series of questions, used to quantitatively determine somebody’s emotional, psychological or activity state

Quantitative Numerical or number-based
Pathological  Serious illness

As we mentioned earlier, the DSM IV is widely regarded as providing a highly reliable and accurate definition of what constitutes pathological gambling. Also however bear in mind that this is the extreme version of problem gambling that actually falls into the realm of a classifiable mental illness or disorder. You will remember that the definition is followed by a set of ten criteria, of which five must be fulfilled in order to classify someone as being a pathological gambler.

You can probably see from this that these are severe behavioural disorders. Such a diagnosis would need to be made by a health care practitioner.

>>  Glossary 3

Prevalence: Extent to which something exists
Ostracised: Deliberately socially isolated
Schizophrenic: A person suffering from schizophrenia, a severe mental illness
Leper: Someone suffering from leprosy a severely disfiguring disease
Paedophile: A person whose sexual preference is for children

Governments have always sought to get reliable figures on the extent of certain conditions, such as TB, Small Pox; HIV AIDS in the general population. Similarly studies have been done in many countries to try to establish the prevalence of problem gambling. Earlier we mentioned some statistics, namely that about 5% of the adult population are problem gamblers and about 1% of the adult population of South Africa are pathological gamblers.

In problem gambling research, it is essential that researchers carefully describe the measures they use, how the scoring is done, and what labels will be assigned to respondents on the basis of their scores.

However, we must be aware that labelling can be problematic in that people labelled in a particular way may be socially ostracised or be prejudiced against. There are many examples of health condition labels that have served to isolate and ostracize afflicted people within societies (e.g., leper, addict, alcoholic, schizophrenic, AIDS victim, paedophile), thus adding to the individual’s torment.

For an interesting and detailed look at how labelling affects people, read the following:-
http://en.wikipedia.org/wiki/Labeling_theory

In the studies done in South Africa to establish the extent of problem gambling and pathological gambling, the Gamblers Anonymous (GA) and South Oaks Gambling Screen (SOGS) have been used. It is noteworthy that the research done into the prevalence of gambling (including problem gambling) has been funded by the NRPG (the National Responsible Gaming Programme). The NRPG is funded by the South African gambling industry itself and is the only body of this type in Africa. In terms of research and treatment that it funds, it is highly rated internationally. 

>>  Point to Ponder 4

There is a saying “let the polluter pay” (Polluter here means someone who is causing the social problem – to “pollute” means to harm or spoil). If we apply this, it would mean that the gambling industry (the polluter) would have to pay for research and treatment. This is indeed the case in South Africa where the NRPG pays for research into problem gambling and the treatment of problem gamblers. Do you think we should extend this to other arenas that have the potential to pollute, such as alcohol, tobacco and pornography? Remember that these are legal activities that are heavily taxed.

 

 

2.2.1  Screening Instruments: Overview

We are now going to look at the two Questionnaires used by the NRPG in their early prevalence studies and then an additional screen currently being used in their latest study.

The questionnaires that we will now look at, namely, GA and SOGS and the CGI, take the DSM IV criteria into account.  These are  questionnaires which people who might themselves think they are at risk can answer, or these questionnaires can be administered by practitioners working in the field of problem gambling such as psychologists, counsellors, staff at recovery centres or people doing research into the prevalence of problem gambling.

 

Video Description of pathological gambling  

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Video A look at the increase in youth gambling  

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2.2.2 Gamblers Anonymous

Gamblers Anonymous is a support group which operates in a very similar manner to the better known Alcoholics Anonymous. People attend meetings where they simply identify themselves by their first name and offer one another support. Such people characteristically introduce themselves at these meetings with the phrase:-

My name is Joe and I am an alcoholic” or: “My name is Jane and I am a gambling addict”. People attending these meetings which are typically held in community halls are encouraged to share their experiences and offer one another support. It has been shown to be a highly effective method of treatment for many and we will look at it in more detail in the next topic.

Alcoholics Anonymous had developed a set of questions that people could answer in order to gauge whether or not they were problem drinkers and/or alcoholics. When it became apparent that problem gambling had similar characteristics to alcohol addiction, this questionnaire was developed.

Gamblers Anonymous offers the following questions to anyone who may have a gambling problem. These questions are provided to help the individual decide if he or she is a compulsive gambler and wants to stop gambling.

  1. Did you ever lose time from work or school due to gambling?
  2. Has gambling ever made your home life unhappy?
  3. Did gambling affect your reputation?
  4. Have you ever felt remorse after gambling?
  5. Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?
  6. Did gambling cause a decrease in your ambition or efficiency?
  7. After losing did you feel you must return as soon as possible and win back your losses?
  8. After a win did you have a strong urge to return and win more?
  9. Did you often gamble until your last rand was gone?
  10. Did you ever borrow to finance your gambling?
  11. Have you ever sold anything to finance gambling?
  12. Were you reluctant to use "gambling money" for normal expenditures?
  13. Did gambling make you careless of the welfare of yourself or your family?
  14. Did you ever gamble longer than you had planned?
  15. Have you ever gambled to escape worry, trouble, boredom or loneliness?
  16. Have you ever committed, or considered committing, an illegal act to finance gambling?
  17. Did gambling cause you to have difficulty in sleeping?
  18. Do arguments, disappointments or frustrations create within you an urge to gamble?
  19. Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
  20. Have you ever considered self destruction or suicide as a result of your gambling?

Most compulsive gamblers will answer yes to at least seven of these questions.
(taken from the GA website)

For more information on Gamblers Anonymous go to:
http://www.gamblersanonymous.org/

 

>>  Point to Ponder 5

Do you think people would answer these questions more truthfully if they administered the test to themselves or if someone else asked them? Think of reasons for your response.

 

 

Experts in the field, such as the academic Peter Collins, from Salford University, pose an interesting question as to whether all these items are equal. For example, many people may feel remorse after losing money gambling (or a heavy night out drinking) but would never, under any circumstances (except extreme compulsion) steal to pay for their past-time – both items however are equally weighted.

 Likewise poor people may well borrow money for any form of entertainment – this would never be an issue for an extremely wealthy person who could afford to finance any addiction, such as drug use or gambling. This raises the question as to whether many of these items are in fact relative, responses will vary depending on social and financial reasons and ethics, so may not be critical in determining the level of compulsion.

For an interesting and very detailed look at “objectivity” in psychological testing go to:-

http://www.guidetopsychology.com/testing.htm

2.2.3 Southern Oaks Gambling Screen

Now we will look at the SOGS questionnaire as used by the NRPG in their 2001 and 2002 studies, combined with the GA Questionnaire.

SOGS:

1.       Do you spend more time or money gambling than you intended?
2.       Have people criticised your gambling?
3.       Have you felt guilty about the way you gamble or what happens when you gamble?
4.       Have you felt like you would like to stop gambling but didn’t think you could?
5.       Have you hidden betting slips, lottery tickets, gambling money or other signs of gambling from your spouse or partner, your children or other important people in your life?
6.       Have you argued with people you live with over how you handle money? IF YES:  have these arguments centred on your gambling?
7.       Have you missed time from work, school or college due to gambling?
8.       Have you borrowed from someone and not paid them back as a result of your gambling?
9.       Have you borrowed from household money to finance gambling?
10.     Have you borrowed money from your spouse or partner to finance gambling?
11.     Have you borrowed money from other relatives or in-laws to finance gambling?
12.     Have you borrowed money from your banks, building societies, loan companies or credit companies for gambling or to pay gambling debts?
13.     Have you made cash withdrawals on credit cards to get money for gambling or to pay gambling debts?
14.     Have you received loans from ‘loan sharks’ to gamble or to pay gambling debts?
15.     Have you cashed in stocks, bonds or other securities to finance gambling?
16.     Have you sold personal or family property to gamble or to pay gambling debts?
17.     Have you borrowed money from your bank or building society account by writing cheques that bounced to get money for gambling or to pay gambling debts?
18.     Do you feel you have a problem with betting money or gambling?
19.     When you gamble, how often do you go back another day to win back money you lost?
20.     Have you claimed to be winning money from gambling when in fact you lost?

Barr G, Collins P, (2001) op.cit.

Interpreting the score:

0 Positives:  No problem with gambling
1-4 Positives: Some problems with gambling
5 or more Positives: Probable Pathological Gambler

http://www.stopgamblingnow.com/sogs_scoring.htm

See also:-

http://www.jeu-aidereference.qc.ca/www/gambling_addiction_test_en.asp?cmpt=2

2.2.4 Canadian Problem Gambling Index (CPGI)

It was felt by the South African researchers that the emphasis on questions relating to debt in SOGS may not have been totally appropriate for all cultural groups in South Africa, so the SOGS was dropped from the third survey and only the GA Twenty Questions was used. In the most recent survey, done in 2008, the GA Questionnaire and the Canadian Problem Gambling Index (Short Form) (CPGI) was used. Let us have a look at this questionnaire which was developed by researchers to include more questions relating to the social context in which the gambler operates.

CPGI – Short Form

Thinking about the last 12 months…

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

Never=0 Sometimes=1 Most of the time=2 Almost always=3

2.   Still thinking about the last 12 month, have you needed to gamble with larger amounts of money to get the same feeling of excitement?

Never=0 Sometimes=1 Most of the time=2 Almost always=3

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

Never=0 Sometimes=1 Most of the time=2 Almost always=3

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

Never=0 Sometimes=1 Most of the time=2 Almost always=3

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

Never=0 Sometimes=1 Most of the time=2 Almost always=3

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

Never=0 Sometimes=1 Most of the time=2 Almost always=3

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

Never=0 Sometimes=1 Most of the time=2 Almost always=3

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

Never=0 Sometimes=1 Most of the time=2 Almost always=3

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

Never=0 Sometimes=1 Most of the time=2 Almost always=3

Below are the scoring instructions:-

Scoring Instructions for the CPGI

Total your score. The higher your score the greater the risk that your gambling is a problem.

Score the following for each response:  

never = 0

sometimes = 1

most of the time = 2

almost always = 3

Scores for the nine items are summed, and the results are interpreted as follows:

0 = Non-problem gambling.

1 - 2 = Low level of problems with few or no identified negative consequences.

3 - 7 = Moderate level of problems leading to some negative consequences.

8 or more = Problem gambling with negative consequences and a possible loss of control.

 

These were the tests or instruments used by the NRPG to assess the extent of problem gambling in South Africa.

2.2.5 Vulnerability Factors

In addition to the CGI scores, the developers of the instrument also suggest that one considers the following certain factors which would make a person more vulnerable and prone to the risk of developing a gambling problem.

Some vulnerability factors:

  • Mistaken beliefs about the odds of winning at gambling

  • A ‘big win’ early in the person’s gambling history

  • A history of drug, alcohol, gambling or overspending problems

  • A family history of drug, alcohol, gambling or overspending problems

  • A history of mental health problems, particularly depression, stress or trauma

  • Loneliness, chronic boredom or lack of leisure activities

  • A habit of using gambling or substances to cope with negative feelings or events

  • A tendency toward impulsive behaviour

  • Financial problems

 

These vulnerability factors would be established by interviewing people who have either identified themselves as being at risk for problem gambling or who have been identified by friends or families as being at risk.

For a small group Activity based on the knowledge gained on the topic so far, let us look at what sort of questions you would ask a person to try to establish their level of vulnerability to potentional Problem Gambling:

>>  Small Group Activity

Activity 2: Creating a Questionnaire (2)

Pairs

By now you have been exposed to and studied three questionnaires in some depth. Look back at your responses to Activity 1. What do you think of your final effort questionnaire in the light of what you know now? Discuss this with your partner.

Now look at the list of vulnerability factors, determined as being significant by the developers of the CGI. Using insights gained thus far in this Topic, work with your partner to devise a nine item Questionnaire that will screen for Vulnerability to Problem Gambling.

You also need to create a scoring method. When you have finished, draw up your questionnaire in a format that is similar to the ones you have read about, for example a table.

Now compare this Questionnaire with your group’s earlier effort. Can you notice any difference? Do you think you now have more insight into how questionnaires are structured? Discuss some reasons for your responses.