Am I a Gambling Addict?

Do you wonder if you are a compulsive gambler or if you are a gambling addict? You can find out by completing this self-assessment form.

1. Have you ever lost time from work or school due to gambling? Yes No
 
2. Has gambling ever made your home life unhappy? Yes No
 
3. Has gambling affected your reputation? Yes No
 
4. Have you ever felt remorse after gambling? Yes No
 
5. Have you ever gambled to get money with which to pay debts or otherwise solve financial difficulties? Yes No
 
6. Has gambling caused a decrease in your ambition or efficiency? Yes No
 
7. After losing do you feel you must return as soon as possible and win back your losses? Yes No
 
8. After a win do you have a strong urge to return and win more? Yes No
 
9. Do you often gamble until your last dollar was gone? Yes No
 
10. Do you ever borrow to finance your gambling? Yes No
 
11. Have you ever sold anything to finance gambling? Yes No
 
12. Have you been reluctant to use "gambling money" for normal expenditures? Yes No
 
13. Does gambling make you careless of the welfare of yourself or your family? Yes No
 
14. Have you ever gambled longer than you had planned? Yes No
 
15. Have you ever gambled to escape worry, trouble, boredom or loneliness? Yes No
 
16. Have you ever committed, or considered committing, an illegal act to finance gambling? Yes No
 
17. Did gambling cause you to have difficulty in sleeping? Yes No
 
18. Do arguments, disappointments or frustrations create within you an urge to gamble? Yes No
 
19. Did you ever have an urge to celebrate any good fortune by a few hours of gambling? Yes No
 
20. Have you ever considered self destruction or suicide as a result of your gambling? Yes No

 

If you have answered:

YES to any one of these questions, there is a definite warning that you may be a compulsive gambler.

YES to any two, the chances are that you are a gambling addict.

YES answers to three or more, is definitely consistent with compulsive gambling.

 

*2. Congratulations on completing the twenty questions.

If you wish for one of our A Home Away counsellors to contact you for a free, personal consultation, please complete your contact information for how you wish to be reached.

NB: Your confidentiality is strictly respected; your information will not be provided to any outside person or agency.

 

Name:
 
Email:
 
Phone Number:
   
Address:
 
City/Town:
 
Province/State:
 
Postal Code/ZIP:

3. You deserve to get the type of help you need.
Are you ready to consider treatment at A Home Away?

Yes

No

What is the best time to call you?

4. What is your preferred method of contact?

Telephone

E-Mail

Additional Comments