Gambling rarely walks in the door as the presenting problem. People come in for drinking, anxiety, depression or money stress, and the betting stays out of the conversation unless someone asks. Plenty of people never get that far because nobody asks the question.
Why screen
A meta-analysis of studies in substance use treatment found that about 14% of patients had pathological gambling and about 23% had problem gambling across the broader spectrum. The overlap runs both ways: in a large national survey, 73.2% of people with pathological gambling also had an alcohol use disorder.
Debt, secrecy and chasing losses add stress, and that's hard on any recovery.
A three-question screen
The Brief Biosocial Gambling Screen, from the Division on Addiction at Cambridge Health Alliance, asks about the past 12 months:
- Have you become restless, irritable or anxious when trying to stop or cut down on gambling?
- Have you tried to keep your family or friends from knowing how much you gambled?
- Did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends or welfare?
A yes to any one of them suggests a fuller assessment. It takes under a minute and fits on any intake form.
What to do after a yes
- Thank them for saying it. Shame keeps gambling hidden, and a calm response makes the next conversation possible.
- Assess more fully. The DSM-5 lists nine criteria for gambling disorder. A clinician trained in gambling can sort out severity.
- Refer if you need to. Many states fund gambling counseling at no cost to the client. The National Problem Gambling Helpline, 1-800-MY-RESET (1-800-697-3738), can point to providers.
- Address money early. A nonprofit credit counselor through NFCC.org can help with debt while treatment does its work.
- Block access. Help the person self-exclude from sportsbooks and install a blocker. Every bet they can't place is one fewer setback.
Plan for after discharge
The weeks after a program ends are when people need support most and have the least of it. A daily plan on their phone, a meeting schedule and the program's number in easy reach help bridge that gap. Gamblers Anonymous and SMART Recovery both meet in person and online.
FAQ
Should we screen people who don't mention gambling?
Yes. Most people with gambling problems don't raise them on their own. Asking everyone takes the stigma out of the question.
Can the screen be self-administered?
It can. Three yes-or-no questions work on paper, a tablet or a patient portal. Follow up in person on any yes.
Bring Unbettable to your program
A personal 90-day plan for after discharge, daily tools for urges, your program's number first, and a family plan for the people at home. Start with a pilot.
See how it worksSources: Cowlishaw and colleagues: gambling in substance use treatment, a meta-analysis; Nevada Council on Problem Gambling: 5 reasons to screen; Division on Addiction: Brief Biosocial Gambling Screen; Nevada Council on Problem Gambling: DSM-5 criteria; National Foundation for Credit Counseling.