Conducting routine problem-gambling screenings and assessments with individuals who access healthcare and support services can help you identify problems early and provide intervention and referrals when needed (Dowling et al., 2017).
This page explores the evidence on screening and assessment for problem gambling and explains the recommended approaches you can use in your clinical practice. This information for mental health and addiction service providers is based on a literature review conducted by an expert in the field.
Screening vs. assessment
Although screening and assessment for problem gambling are two distinct activities, these terms are often used interchangeably (APAPO, 2014). Screening helps you determine whether your client has a problem and whether they will need a full assessment (Matua Raki, 2016; Sandberg et al., 2013). Routine screening is brief and narrow in scope and can help you identify problems early (American Psychological Association Practice Organization, 2014; Matua Raki, 2016).
Alternatively, an assessment provides a more comprehensive view of the client’s situation and helps you develop a treatment plan that is tailored to their specific needs and preferences (APAPO, 2014; George & Murali, 2005).
What does the evidence say?
A 2002 study showed that approximately 2 per cent of Ontario adults have a gambling problem (Rush et al., 2002). Another Ontario-based report showed that about 30 per cent of people experiencing a gambling problem have a co-occurring mental health issues, and more than 3 per cent have a co-occurring substance use problem (Williams & Volberg, 2013).
Individuals with gambling problems are more likely than the general population to have a variety of medical concerns and use medical and behavioural health services at a higher rate (Morasco et al., 2006). Therefore, an effective approach for identifying individuals with a gambling problem is to screen them when they initially seek health services in the community (Dowling et al., 2017)
How do I put the evidence into practice?
Guidelines recommend routinely screening clients who seek mental health services as well as those who belong to groups that have high rates of problem gambling (Problem Gambling Research and Treatment Centre, 2011). Guidelines also recommend using a validated age-appropriate tool to screen young people (Edgren et al., 2016; Hodgins et al., 2011).
Make sure your client understands the purpose of the screening and gives consent to answering the questions before conducting a screening or assessment (George & Murali, 2005; Matua Raki, 2016). Use non-threatening and non-judgmental language to explain the benefits and limitations of the screening or assessment, how long it will take to complete, how you will use the results and how you will keep their results confidential (Matua Raki, 2016).
Discuss the results of the screening immediately with your client, as well as any follow-up assessment, treatment or referral the client might need (Matua Raki, 2016). If the screening results are positive, conduct a full assessment, if possible, or refer your client to specialized services (George & Murali, 2005; Matua Raki, 2016).
When reviewing the results, it is important to go beyond the score and engage the client in a nuanced discussion about their specific behaviours and triggers.
An assessment helps you understand your client’s personal, social and cultural context as well as their strengths and treatment needs (George & Murali, 2005; Matua Raki, 2016). It should include the following (George & Murali, 2005):
- full personal and family psychiatric history
- detailed assessment of gambling behaviour
- negative consequences of the gambling behaviour
- reasons for the consultation and expectations
- motivation to change
- mental health and substance use assessment
- suicide risk assessment.
One tool that is useful for conducting assessments for problem gambling is the Inventory of Gambling Situations (IGS). The IGS contains 63 items that examine a client’s gambling frequency over the past year in different situations in an effort to identify triggers for high-risk gambling (Turner et al., 2013). This well-validated tool helps you and your client gather information that will help you develop a treatment and relapse prevention plan (Turner et al., 2013).
Listen to this audio clip for an example of how you might discuss the IGS results with your client.
Listen to this audio clip for an example of how you might discuss the IGS results with your client.
Would you be willing to complete a questionnaire about your gambling behaviour? It will help us understand the impact that your gambling may be having on your life. It will take about 10 minutes to complete and we'll keep your answers strictly confidential. Once you’ve completed it, we’ll take a few minutes to discuss the results.
If the client consents, it is also useful to invite their partner or spouse, a family member or a friend to a session to gather more insight into the client’s gambling behaviour (George & Murali, 2005). Listen to this audio clip for an example of how you might approach this with a client.
With your consent, we could have your family member or someone close to you join us briefly. They can hear about our services and learn about what is available to support them. We know that folks who have family involved in treatment do better in the long run.
A full assessment will help you build rapport with your client, help them see the extent of the problem and enhance their motivation to change (George & Murali, 2005). When discussing their gambling behaviour, be sensitive to any potential shame your client may feel that may cause them to withhold information (George & Murali, 2005). Listen to this audio clip for an example.
For many people, gambling is something that they hide from everyone else in their lives. They feel such shame and stigma. In North American society, we tend to have a difficult time talking about money. We’ll share about our big wins but we hide our losses. Our goal here is to create a safe space to work together on supporting you as you make changes in your life.
Use clear and non-judgmental language both during the assessment and when explaining the results (George & Murali, 2005; Matua Raki, 2016). Include a description of the client’s strengths, the identified problem and the recommended treatment options or referrals (Matua Raki, 2016). Listen to this audio clip for an example.
Your score on the questionnaire indicates that you’ve been experiencing some pretty concerning issues with your family, such as hiding debts and other problems. At the same time, you also indicated in our discussion that you made a decision to quit gambling about 3 weeks ago. That’s a real testament to your strength and determination! You’ve let me know that you’ve done this by not carrying cash and debit/visa cards, getting support from your friend, and keeping busy.
Screening tools for problem gambling
A wide range of screening tools for program gambling are available. Some take only a couple of minutes to complete, while others take up to 20 minutes. Some of the most reliable and commonly used screening tools are listed below.
South Oaks Gambling Screen (SOGS). This 20-item scale is perhaps the most well-known screening tool (Abbott & Volberg, 2006; Hodgins et al., 2011). While the SOGS has been shown to accurately identify clients with problem gambling it was developed using DSM-III criteria and does not reflect the currently used DSM-5 criteria (Hodgins et al., 2011; Toneatto & Miller, 2004; Wickwire et al., 2008). It has also been revised and validated for use with adolescents (Edgren et al., 2016).
NODS-CLiP. This three-item screening tool is a subset of the 17-item National Opinion Research Centre DSM-IV Screen for Gambling Problems (NODS; Hodgins et al., 2011). CLiP refers to the three questions in the tool, which focus on loss of control (C), lying (L) and preoccupation (P) with gambling (Wickwire et al., 2008). The NODS CLiP is effective for identifying clients with moderate to severe gambling problems, but is not recommended for mild cases (Colishaw et al., 2018; Dowling et al., 2017; Toce-Gerstein et al., 2009).
Problem Gambling Severity Index (PGSI). This nine-item screening tool can be self-administered or administered by a clinician (Jackson et al., 2010). It is a brief version of the 31-item Canadian Problem Gambling Index (Abbott & Volberg, 2006). It uses a four-point scale (“never” to “almost always”) to describe and measure gambling behaviour over the previous 12 months (Callan et al., 2015).
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Toolkit. This online toolkit provides information and tools that you can use to help individuals with problem gambling using the Screening, Brief Intervention and Referral to Treatment (SBIRT) process. The toolkit includes a variety of screening tools, a protocol for brief interventions and ideas for how to access problem gambling services.
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American Psychiatric Association (2018, August). What is gambling disorder? Available: https://www.psychiatry.org/patients-families/gam- bling-disorder/what-is-gambling-disorder. Accessed February 26, 2021.
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