South Oaks Gambling Screen for Self



1. Please indicate which of the following types of gambling your spouse has done in his/her 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. 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 & under, or other dice games) for money or drinks, etc.
e. gambled in a casino (legal or otherwise)
f. played the numbers or bet the lotteries
g. played bingo for money
h. played the stock, options and or commodities markets
i. played slot machines, poker machines or other game of skill for money
j. pull tabs or "paper" games other than lotteries
k. some other form of gambling not listed above

2. What is the largest amount of money your spouse have ever gambled with on any one-day?
Never have gambled
$1 or less
more then $1 up to $10
more than $10 up to $100
more than $100 up to $1000
more than $10,000
more than $1000 up to $10,000
3. Check which of the following people in your spouse's life has (or bad) a gambling problem.
Father
Mother
A brother-in-law
A grandparent
My spouse or partner
My Child (ren)
Another relative
A friend or someone else important in my life
4. When your spouse gambles, how often does he/she goes back another day to win back the money your spouse lost?
Never
Some of the time (less than half of the time I lost
Everytime I lost
Most of the time I lost
5. Has your spouse ever claimed to be winning money gambling but were not really? In fact, your spouse lost?
Never
Yes, most of the time
Yes, less then half the time I lost
6. Does your spouse feel he/she has ever had a problem with betting money or gambling?
No
Yes
Yes, in the past but not now
7. Does your spouse ever gamble more than he/she intended to?
No
Yes
8. Have people criticized your spouse's betting or told your spouse that he/she had a gambling problem, regardless of whether or not he/she thought it was true?
No
Yes
9. Has your spouse ever felt guilty about the way he/she gamble or what happens when he/she gamble?
No
Yes
10. Has your spouse ever felt like he/she would like to stop betting money or gambling but didn't think he/she could?
No
Yes
11. Has your spouse ever hidden betting slips, lottery tickets, gambling money, IOUs or other signs of betting or gambling from you, the children, or other important people in his/her life?
No
Yes
12. Has your spouse ever argued with people you live with over how you handle money?
No
Yes
13. (If you answered yes to question 12): Have many arguments ever centered around your spouse's gambling?
No
Yes
14. Has your spouse ever borrowed from someone and not paid them back as a result of his/her gambling?
No
Yes
15. Has your spouse ever lost time from work (or school) due to gambling?
No
Yes
16. If your spouse borrowed money to gamble or to pay gambling debts, who or where did he/she borrow from?
No - Yes
a. from household money
No - Yes
b. from you
No - Yes
c. from other relatives or in-laws
No - Yes
d. from banks, loan companies or credit unions
No - Yes
e. from credit cards
No - Yes
f. from loan sharks
No - Yes
g. your spouse cashed in stocks, bonds, life insurance or other securities
No - Yes
h. your spouse sold personal or family property
No - Yes
i. your spouse borrowed on his/her checking account (passed bad checks)
No - Yes
j. your spouse have (had) a credit line with a bookie
No - Yes
k. your spouse have (had) a credit line with a casino