1. Do you lose time from work due to gambling? |
| 2. Does gambling make your home life unhappy? |
| 3. Does gambling affect your reputation? |
| 4. Do you ever feel remorse after gambling? |
| 5. Do you ever gamble to get money with which to pay debts or to otherwise solve financial difficulties? |
| 6. Does gambling cause a decrease in your ambition or efficiency? |
| 7. After losing, do you feel you must return as soon as possible and win back your losses? |
| 8. After a win, do you have a strong urge to return and win more? |
| 9. Do you often gamble until your last dollar is gone? |
| 10. Do you ever borrow to finance your gambling? |
| 11. Do you ever sell anything to finance your gambling? |
| 12. Are you reluctant to use "gambling money" for normal expenditures? |
| 13. Does gambling make you careless about the welfare of your family? |
| 14. Do you ever gamble longer than you planned? |
| 15. Do you ever gamble to escape worry or trouble? |
| 16. Do you ever commit, or consider committing, an illegal act to finance your gambling? |
| 17. Does gambling cause you to have difficulty sleeping? |
| 18. Do arguments, disappointments or frustrations create within you an urge to gamble? |
| 19. Do you have an urge to celebrate good fortune by a few hours of gambling? |
| 20. Do you ever consider self-destruction as a result of your gambling? |