Screening for and assessment of gambling concerns

Ask all new patients routinely and others (adolescents and adults) opportunistically and periodically about gambling, as part of a general screen for disorders of substance use and addictive behaviours; these disorders are common (and often co-exist) and people are reluctant to disclose them, often due to fear of stigma. Screening and assessment of substance use and addictive behaviours outlines history-taking (including use of the ASSIST-Lite tool), examination, and investigations that should be considered in a broad review of substance use and addictive behavioursNational Aboriginal Community Controlled Health Organisation (NACCHO), 2018The Royal Australian and New Zealand College of Psychiatrists (RANZCP), 2017.

Consider enquiring about gambling when people present with features that may be gambling harms.

If a patient discloses that they gamble, a 2-item screening questionnaire can assess for hazardous gambling and gambling disorder; see Definitions of gambling behaviour for terminology.

In adults, an appropriate example is based on the Brief Problem Gambling Screen (2-item version)Dowling, 2019, which asks:

  1. In the past 12 months, would you say you have been preoccupied with gambling or had a strong urge to gamble?
  2. In the past 12 months, have you often gambled longer, with more money or more frequently than you intended to?

In young people aged 12 to 25 years, a validated questionnaire is the Lie/Bet questionnaireDowling, 2019, which asks:

  1. Have you ever had to lie to people important to you about how much you gambled?
  2. Have you ever felt the need to bet more and more money?

If the adult or the young person answers ‘yes’ to at least 1 question in the 2-item screening questionnaire, see Screening and assessment for advice on further evaluation of the impact of gambling, any concurrent substance use and the extent of comorbidities. Brief interventions, which employ motivational interviewing, can also be used to assess severity of gambling concerns as well as exploring motivation to change behaviour.

For a patient who might be affected by someone else’s gambling, it is reasonable to adapt the 2-item screening questionnaires above (eg replacing ‘you’ with ‘your significant other’) before exploring their knowledge of the extent of the gambling and its impacts.