June 2000

Screening for pathological gambling

Short screening instruments for identifying pathological gambling can be useful in clinical settings where clinicians have limited time and often need to collect a variety of different data from each patient. From a research perspective, a shorter instrument that is valid and reliable can measure the same construct (e.g., pathological gambling) as a longer instrument in a more efficient manner. Johnson and colleagues1 developed a 2-question version of the DSM-IV criteria for screening pathological gambling. Their research goal was to assess the minimum number of items from a 12-item questionnaire based on the DSM-IV that would differentiate dependably between pathological gamblers and nonproblem-gambling controls. The sample for this study was 191 male pathological gamblers who were members of Gamblers Anonymous and 171 male nonproblem-gambling controls who were employees at the Department of Veterans Affairs. The two questions that consistently differentiated between the pathological gamblers and nonproblem-gambling controls in logistic regressions were (1) have you ever felt the need to bet more and more money? and (2) have you ever had to lie to people important to you about how much you gambled? Answering yes to one or both of these questions classifies the respondent as a pathological gambler on the 2-question test. For this study, using this sample, the sensitivity of the 2-question lie/bet survey (the proportion of pathological gamblers who test positive) is .99. The specificity (the proportion of nonproblem gamblers who test negative) of this test in this study .91. Although the sensitivity and specificity of this test is high within this sample, the test will not be as effective in accurately screening for pathological gambling among the general population. Sensitivity and specificity influence the predictive value of a test; however, so does the baseline rate of the disorder being screened.2 Pathological gambling is a low base rate disorder (<10% in the general adult population). This test, like most gambling screens, would therefore not do very well in classifying as "positive" those who were pathological gamblers, but would do very well in classifying as "negative" those who were not pathological gamblers, since most people are not disordered gamblers.*

Sources:

¹Johnson, E.E., Hamer, R., Nora, R.M., Tan, B, Eisenstein, N., & Engelhart, C. (1997). The lie/bet questionnaire for screening pathological gamblers. Psychological Reports, 80, 83-88.

²Glaros, A.G., & Kline, R.B. (1988). Understanding the accuracy of tests with cutting scores: The sensitivity, specificity, and predictive value model. Journal of Clinical Psychology, 44(6), 1013-1023.

Two-Question Assessment Tool^*

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

These two questions aid interviewers in identifying gambling problems. Answering "yes" to one or both questions classifies as a pathological gambler.

Four-Question Assessment Tool^**

1. Have you ever borrowed money in order to gamble or cover lost money?
2. Have you ever thought you might have a gambling problem, or been told that you might?
3. Have you ever been untruthful about the extent of your gambling, or hid it from others?
4. Have you ever tried to stop or cut back on how much or how often you gamble?

These four questions aid interviewers in identifying gambling problems. Answering "yes" to any one of these questions is suggestive of a problem deserving further exploration. Each additional "yes" increases the degree of certainty about the existence of a gambling problem. However, no one or two questions are adequate to capture the majority of those experiencing gambling problems.

^*Source: The Wager. Volume 2, Issue 28. July 15, 1997.
^**Source: Christopher Armentano, MSW, NCGC, Director, DMHAS Compulsive Gambling Treatment Program. For more information, call 860-344-2244. Connecticut.

Gambling Problems Resource Center
2720 Highway 10
Mounds View, MN 55112