1. Have there ever been periods lasting 2 weeks or longer when you spent a lot of time thinking about your gambling experiences, or planning out future gambling ventures or bets?
On YES skip to #3
Yes
No
2. Have there been periods lasting 2 weeks or longer when you spent a lot of time thinking about ways of getting money to gamble with?
Yes
No
3. Have there ever been periods when you needed to gamble with increasing amounts of money or with larger bets than before in order to get the same feeling of excitement?
Yes
No
4. Have you ever tried to stop, cut down, or control your gambling?
On NO skip to #8
Yes
No
5. On one or more of the times when you tired to stop, cut down, or control your gambling, were you restless or irritable?
Yes
No
6. Have you ever tried but not succeeded in stopping, cutting down, or controlling your gambling?
On NO skip to #8
Yes
No
7. Has this happened three or more times?
Yes
No
8. Have you gambled to relieve uncomfortable feelings such as guilt, anxiety, helplessness, or depression?
On YES skip to #10
Yes
No
9. Have you ever gambled as a way to escape from personal problems?
Yes
No
10. Has there ever been a period when, if you lost money gambling one day, you would often return another day to get even?
Yes
No
11. Have you ever lied to family members, friends, or others about how much you gamble or how much money you lost to gambling?
On NO skip to #13
Yes
No
12. Has this happened three or more times?
Yes
No
13. Have you ever written a bad check or taken money that didn't belong to you from family members or anyone else in order to pay for your gambling?
Yes
No
14. Has your gambling ever caused serious or repeated problems in your relationships with any of your family members or friends?
On YES skip to #17
Yes
No
15. Has your gambling ever caused you any problems in school, such as missing classes or days of school or your grades dropping?
On YES skip to #17
Yes
No
16. Has your gambling ever caused you to lose a job, have trouble with your job, or miss out on an important job or career opportunity?
Yes
No
17. Have you ever needed to ask your family members or anyone else to loan you money or otherwise bail you out of a desperate money situation that was largely caused by your gambling?
Yes
No