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Description
The Gambler Addiction Index (GAI) is designed for gambler (male and female) assessment. The
Gambler Addiction Index (GAI) contains seven measures (scales) that measure client truthfulness,
gambling involvement, suicidal ideation, substance (alcohol and other drugs) use
and abuse, and stress handling abilities.
The GAI has been standardized on
gamblers. More specifically, the GAI's standardization studies involved
people being treated for gambling and related problems and probationers
with gambling-related problems. GAI research is summarized in the document
titled "GAI: An Inventory of Scientific Findings."
Seven GAI Scales (Measures)
The GAI contains 7 separate scales (measures):
- Truthfulness Scale:
Measures how truthful the client was while completing the GAI.
This scale identifies defensiveness, denial and faking.
- Gambling Severity Scale:
Measures gambling interest and involvement on a continuum from normal
(Low Risk) to pathological (Severe Problem).
- Suicide Scale:
Identifies suicide prone individuals. Gamblers are often desperate,
overwhelmed and potentially suicidal.
- Alcohol Scale: Measures alcohol (beer,
wine and other liquor) use and abuse. This scale measures the severity of alcohol abuse.
- Drugs Scale: Measures illicit drug
(marijuana, crack, cocaine, amphetamines, barbiturates and heroin) use and abuse. This scale
measures the severity of drug abuse.
- DSM-IV Gambling Scale:
In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) a person must agree to 5
or more of 10 criteria to be classified a Pathological Gambler. This classification scale
identifies pathological gamblers.
- Stress Coping Abilities Scale: Measures how
well the gambler copes with stress, tension and pressure. Stress exacerbates emotional problems.
* * * * *
The interaction of these seven
largely determines the gambler's outlook and
subsequent behavior. For more information on scale interpretation, click
on the
GAI Scale Interpretation link.
Many mental health practitioners believe these 7 (scales or measures) variables are necessary,
if not essential, to understanding seriously committed gamblers.
GAI Test
Booklets
GAI test booklets are provided free. These booklets contain 166 items (127 true/false, 39 multiple
choice). These booklets are written at a high 5th grade to
low 6th grade reading level. If a person can read the newspaper,
they can read the GAI. It takes 35 minutes to complete the GAI. GAI test booklets are available in
English and Spanish.
GAI
Reports
In brief, GAI reports summarize
the gambler's self-reported court history, explain what attained scale
scores mean and offer specific score-related recommendations.
Within 3 minutes from test data
computer entry, automated (computer-scored) reports are printed on-site.
These reports summarize a lot of information in an easily understood
format. For example, these reports include a gambler profile (graph), which
summarizes client findings at a glance. Also included is an explanation of
what each score means and specific score-related recommendations. Emphasis
has been placed on having helpful and easily understood GAI reports.
To go directly to the example GAI report, click on the
GAI Report
link. After reviewing the report, you can return to this section by
clicking on the "Return to GAI Reports Section" link.
Software
The GAI is available on Windows diskettes.
Windows diskettes require a one-time computer setup procedure after which GAI
data diskettes containing 25 or 50 test applications are used. Training
manuals are provided, and new test users can be walked through these
procedures over Risk & Needs Assessment, Inc. (Risk & Needs) telephone line.
Proprietary GAI data diskettes
contain 25 or 50 test applications. These 3½" diskettes score,
interpret and print GAI reports on-site. Once a GAI account is
established, ordered diskettes are mailed to users. When all test
applications (25 or 50) are used, diskettes are returned to Risk & Needs where the test data and
demographics are downloaded into the GAI database for subsequent research
analysis. The proprietary "delete names program" is activated by the test
user with a few keystrokes to delete and remove all client names from
diskettes before they are returned to Risk & Needs. Deleting all client names
insures client confidentiality and compliance with HIPAA (federal
regulation 45 C.F.R. 164.501).
GAI
Database
The GAI system contains a proprietary database. Earlier, it was noted that all GAI used diskettes
are returned to Risk & Needs, and the test data along with related demographics are
downloaded into the GAI database. This database allows ongoing research
and testing program summary capabilities that were not available before.
Ongoing database research insures quality control. Annual test program
summary reports provide for program self-evaluation. Risk & Needs does not charge
for ongoing database research or annual summary reports - they are free.
The GAI is restandardized annually - at no cost to test users.
No personal information, names, social security numbers, etc. are ever downloaded into any
test database.
In summary, having all used GAI
tests' data centrally filed at Risk & Needs' offices has many advantages. Database
analysis permits cost efficient research that includes scale alpha
coefficients, frequency distributions, correlations, ANOVA, cross-tab
statistics along with reliability, validity and accuracy determinations.
To review a research study involving 190 gamblers, click on the
GAI Research Study link.
After downloading test data returned diskettes are destroyed.
Annual
Summary Reports
Risk & Needs can access each of its
tests' built-in databases for statistical analysis and summarization of all
tests administered in a year. Annual Summary Reports are prepared
for state, department, agency and even some individual providers -- at no
cost to them. These reports are provided as a professional courtesy
to large volume test users. Summary reports include demographics,
court-history when relevant, and test statistics (reliability, validity
and accuracy). Has anyone offered to summarize your testing program?
Annually? At no additional cost to you? Minimum testing volume for
annual reports is 350 tests. There is no maximum limit. Risk & Needs' annual reports range in size from 350 tests to over 55,000 tests annually.
An example Annual Summary Report can be viewed by clicking on this
Annual Summary Reports link.
Reliability, Validity and Accuracy
The GAI has a built-in database
that insures inclusion of all tests administered in a confidential (no
names) manner. Reliability, validity and accuracy statistics are reported
in the document titled "GAI: An Inventory of Scientific Findings." Annual
database analyses have revealed that GAI scales maintain very high
reliability coefficients and minimum inter-scale correlations.
For example, the internal
consistencies (coefficient alphas) for GAI scales are reported below for
190 gamblers screened in the year 2002. This is one among several studies
reported in the "GAI: An Inventory of Scientific Findings" document.
A GAI research study is presented at the end of this webpage. To go directly to this research,
click the
GAI Research Study link.
|
RELIABILITY OF THE GAI (N=190, 2002) |
GAI
Scales |
Coefficient
Alpha |
Significance
Level |
| Truthfulness Scale |
.90 |
p<.001 |
| Alcohol Scale |
.95 |
p<.001 |
| Drugs Scale |
.94 |
p<.001 |
| Gambling Severity |
.97 |
p<.001 |
| Suicide Scale |
.91 |
p<.001 |
| DSM-IV Gambling Scale |
.90 |
p<.001 |
| Stress Coping Abilities |
.98 |
p<.001 |
All GAI scales have alpha coefficients well above the professionally accepted standard of .75 and
are highly reliable. All coefficient alphas are significant at the p<.001 level.
GAI research extends over 20 years. Many studies have been conducted on thousands of gamblers
using several validation methods.
Early studies used criterion measures and were validated with many other tests, e.g., Minnesota
Multiphasic Personality Inventory (MMPI) L-Scale and F-Scale, MacAndrews,
experienced staff ratings, etc. Much of this research is summarized in the
document titled "GAI: An Inventory of Scientific Findings." Subsequently, database analyses
continues to support GAI validity.
GAI norms are based on gamblers, and these studies are updated annually. This database research
is ongoing.
Staff Member
Input
Some people advocate fully
automated assessment. Risk & Needs does not. The GAI is to be used in conjunction
with experienced staff judgment. When available, court records should be
reviewed because they can contain important information that was not
provided or was incorrectly provided by the client. Experienced evaluators
should also interview the client. For these reasons, the following
statement is contained on each GAI report: "GAI results are confidential
and should be considered working hypotheses. No diagnosis or decision should be based solely
upon GAI results. The GAI is to be used in conjunction with experienced staff judgment."
Unique GAI
Features
Truthfulness Scale:
Identifies denial, problem minimization and faking. It is now known that
most gamblers attempt to minimize their problems. A Truthfulness Scale is
a necessary component in contemporary tests. The GAI's Truthfulness Scale
has been validated with the Minnesota Multiphasic Personality Inventory (MMPI),
polygraph exams, other tests, truthfulness studies and experienced staff
judgment. The GAI's Truthfulness Scale has been demonstrated to be reliable,
valid and accurate. In some respects, the GAI's Truthfulness Scale is similar
to the MMPI's L and F-Scales. It consists of a number of items that most
people agree or disagree with.
Truth-Corrected
scores: Have proven to be very important for
assessment accuracy. This proprietary truth correction process is
comparable to the MMPI's K-Scale correction. The GAI's Truthfulness Scale has
been correlated with the other scales. The Truth Correction equation then
converts raw scores to Truth-Corrected scores. Truth-Corrected scores are
more accurate than raw scores. Raw scores reflect what the client wants
you to know. Truth-Corrected scores reveal what the offender is attempting to hide.
Gambling Severity
Scale: Measures the client's gambling involvement on a
continuum from normal (Low Risk) to pathological (Severe Problem). The 12+
million addicted gamblers in the United States manifest a multitude of
serious emotional and mental health problems. The Gambler Scale quantifies
gambling involvement. This scale assesses attitudes and behaviors
important for understanding gamblers.
Suicide
Scale: Identifies suicide prone individuals. These are
usually people who are emotionally overwhelmed, desperate and potentially
suicidal gamblers. Gamblers, or perhaps unsuccessful gamblers, are often
concerned with "getting even" and taking "financial risks" in an effort to
get even. Many of these individuals spend their wages or borrow money or
pawnshop monies in their need to "win." These gambling-related stressors
often put pressure on a gambler's relationships with family, friends and
creditors. When such individuals "bottom out," they can be desperate.
Gamblers have a higher probability of suicide than most other clinical groups.
DSM-IV Gambling Scale:
Incorporates DSM-IV pathological gambler criteria. The ten DSM-IV criteria were reworded and
reformatted into the "DSM-IV Gambling Scale." Admission to 5 or more of these
criteria items results in classification as a pathological gambler. This is a
classification procedure. Admission to 3 or 4 of these DSM-IV criteria
classifies the respondent as a "problem gambler." And admission to 1 or 2
of these DSM-IV criteria classifies the respondent as a "social gambler."
Alcohol
Scale and
Drugs Scale:
Refers to substance (alcohol and other drugs) use and abuse. Gamblers have
a high percentage of alcohol and other drug problems. Most gambling
situations are associated with drinking and/or illicit drug use. When a
gambler encounters "bad luck," they often self-medicate with substance
abuse. Substance (alcohol and other drugs) abuse is often associated with
gambling and, in many cases, it becomes one of many focal issues in this
milieu or setting.
Stress Coping
Abilities Scale: Measures how well the gambler handles stress,
tension and pressure. How a person handles stress can directly affect
their emotional and mental health symptoms. This scale is a
non-introversive way to screen diagnosable mental health problems. A
person scoring at or above the 90th percentile on the Stress Coping
Abilities Scale should be referred to a certified or licensed mental
health professional for a more comprehensive evaluation, diagnosis and
treatment plan. A person scoring at or above the 90th
percentile very likely has a diagnosable DSM-IV disorder; however, many GAI assessors are not
certified or licensed in the mental health field,
consequently the referral recommended earlier.
More than just
another alcohol or drug test. In addition to
alcohol and drugs, the GAI assesses other important areas of inquiry like
truthfulness, quantifies gambling involvement, analyzes resistance,
determines suicide potential and measures the gambler's ability to cope
with stress. The GAI is much more than just another alcohol or drug test.
The GAI is specifically designed for gambler assessment. It provides the
information needed for comprehensive gambler assessment.
Three ways to give the GAI. The GAI can be administered in
three different ways:
1.
Paper-pencil test booklet format is the most popular testing procedure. GAI English and
Spanish test booklets and answer sheets are available.
2. Tests can be given directly on
the computer screen. Some agencies dedicate computers for GAI testing. And,
3. Human Voice Audio in English
or Spanish. This involves earphones and simple instructions. As the client
goes from question to answer with the arrow key, that question or answer
is highlighted on the monitor and concurrently read to the client. These
three test administration options are discussed in the "GAI: Orientation
and Training Manual." Each test administration mode has advantages and
some limitations. Risk & Needs offers these three test modes so test users can
select the administration mode that is optimally suited to their needs.
Reading Impaired Assessment: Reading
impaired gamblers represent 20+ percent of the gamblers tested. This
represents a serious problem to other gambler tests. Risk & Needs has developed an
alternative for dealing with reading impaired assessment: Human Voice Audio.
Human Voice Audio:
Presentation of the GAI is in English and Spanish. Gamblers' passive
vocabularies are often greater than their active (spoken) vocabularies.
Hearing items read out loud often helps reduce cultural and communication
problems. This test administration mode requires earphones and simple
instructions to orient the client to the up-down arrow keys on the
computer keyboard. Human Voice Audio is an alternative approach for reading impaired testing.
Confidentiality:
Risk & Needs encourages test users to delete gambler names from diskettes before
they are returned to Risk & Needs. Once client names are deleted, they are gone and
cannot be retrieved. Deleting client names does not delete demographics or
test data, which is downloaded into the GAI database for subsequent
analysis. This proprietary name deletion procedure involves a few
keystrokes and insures client confidentiality and compliance with HIPAA
(federal regulation 45 C.F.R. 164.501).
Test Data Input
Verification: Allows the person that inputs test
data from the answer sheet into the computer to verify the accuracy of
their data input. In brief, test data is input twice, and any
inconsistencies between the first and second data entries are highlighted
until corrected. When the first and second data entries match or are the
same, the staff person can continue. This proprietary Data Input
Verification procedure is optional, yet strongly recommended by Risk & Needs.
Staff
Training: Risk & Needs' staff are available to participate in GAI training
programs conducted by statewide programs, departments and high volume
agencies in the United States. Sometimes, smaller volume providers get
together for collective (multiple providers) on-site training. This
training can involve hands-on computer scoring, as desired. Risk & Needs
gives attendees certificates attesting to their GAI training.
Staff training is also provided on Fridays at Risk & Needs'
Phoenix offices from 8:30 a.m. to 11:30 a.m. or from 1:30 p.m. to 4:30
p.m. These training sessions are free. To participate, contact Risk & Needs at least ten days in advance. Participation is on a first call, first
scheduled basis.
Why Select the GAI?
The GAI meets and exceeds most
gambler assessment and screening criteria. Its use is spreading throughout
the U.S.A. Ongoing research continues to study and adjust for demographics
like age, gender and ethnicity (race).
The GAI's seven scales measure
truthfulness, classify substance (alcohol and other drugs) abuse, assess
suicidal potential, and measure resistant attitudes along with gambling
involvement and non-introversive quantification of stress handling
abilities. Screening stress coping abilities allows identification of
established (diagnosable) emotional and mental health problems.
The GAI's built-in database facilitates cost efficient database analysis and annual testing program
summary reports. These two unique features -- ongoing database analysis and
annual summary reports -- are provided
free.
GAI reports are timely (35 minutes to administer, 3 minutes to score and print reports on-site).
Score-related recommendations are relevant. Click on this
GAI Example Report link to
review a GAI report. It's reasonable to conclude
the GAI is one of the few tests designed just for gamblers. It is the
state-of-the-art in contemporary gambling assessment. And, Risk & Needs doesn't stop
there! The GAI is very affordable. Click on the
GAI Test Unit Fee
link to review GAI cost.
Advantages of Screening
Screening or assessment instruments filter out individuals with serious problems that may require
referral for a more comprehensive evaluation and/or treatment. This filtering system works as follows:
|
GAI RISK RANGES |
Risk
Category |
Risk Range
Percentile |
Total
Percentage |
| Low Risk |
0 - 39% |
39% |
|
Medium Risk |
40 - 69% |
30% |
| Problem Risk |
70 - 89% |
20% |
|
Severe Problem |
90 -100% |
11% |
Reference to the above table shows that a problem is not identified until a scale score is at
the 70th percentile or higher. And, these risk range percentiles are based upon the
thousands of gamblers that have taken the GAI. This procedure is eminently
fair, and it avoids extremes, i.e., over-identification and
under-identification of gamblers' problems.
A state program, department, court or agency's policy might refer clients with severe problems for
further evaluation, intervention or treatment. In that case, eleven
(11%) percent of the people screened (Severe Problem) would be referred.
Or, policy might refer clients with identified problems -- twenty (20%) percent of the people
screened (Problem Risk). If people with problems (20%)
and severe problems (severe cases) were referred, this would represent
thirty-one (31%) percent of the people screened. In the Problem Risk (20%)
scenario, 80% of the people screened would not be referred, and in the
Severe (11%) Problem case, 89% of the people screened would not be
referred for additional (and expensive) services.
Budgetary savings
(dollars) would be large with no compromises in needy people receiving
appropriate evaluation and/or treatment services. Indeed, more needy people
would receive help. Without a screening
program, there is usually more risk of over or under-utilization of
additional professional services.
Test Unit Fee (Cost): GAI cost information
can be reviewed by clicking on the
Test Unit
Fee (Cost) link. There is only the one cost or charge, and that is the test unit
fee. Everything else is included at no additional cost to the test user. This
includes test booklets, answer sheets, training manuals, upgrades, ongoing
database research, annual summary testing reports, staff training, and support
services. Do not be misled by some test publishers' à la carte pricing like
separate costs for each test administration as well as for each of the
test-related items listed above. Instead of asking for the test administration
cost, ask for the total cost involved in using a test. We believe Risk & Needs' one test
unit fee is very affordable.
Free Examination Kit
A 1-test
GAI demonstration diskette is available on a 30-day cost free basis. Demo
diskettes are in Windows format. The examination kit contains a
1-test demo diskette, test booklet (reusable), an answer sheet (can photocopy),
a Training Manual, Installation CD (with instructions) and some descriptive information.
Risk & Needs does want the demonstration diskette and test booklet returned
within 30 days of receipt.
Selecting a Screening Test for Gamblers
If you are selecting a gambler assessment instrument, the following Comparison Checklist
should prove helpful. It lists important screening test qualities. The "Other" column
represents any other test you might want to compare to the GAI.
|
TEST COMPARISON CHECKLIST |
|
COMPARISON CATEGORIES |
GAI |
Other |
| Designed Specifically for Gambler Evaluation |
Yes |
|
| Test Reliability and Validity Research Provided |
Yes |
|
| A Test, Not an Interview Procedure |
Yes |
|
| Test Completed in 35 Minutes |
Yes |
|
| On-Site Reports Printed within 3 Minutes |
Yes |
|
| Truthfulness Scale to Detect Faking |
Yes |
|
| Truth-Corrected Scores for Accuracy |
Yes |
|
| Three Test Administration Options |
Yes |
|
| 1. Paper-Pencil (English and Spanish) |
Yes |
|
| 2. On Computer Screen (English and Spanish) |
Yes |
|
| 3. Human Voice Audio (English and Spanish) |
Yes |
|
| Gambler Scale Quantifies Gambling Assessment |
Yes |
|
| Suicide Scale Establishes Probability of Suicide |
Yes |
|
| Alcohol Scale Measures Severity of Drinking |
Yes |
|
| Drugs Scale Measures Severity of Drug Use |
Yes |
|
| Stress Coping Abilities Scale Measures Emotional Problems |
Yes |
|
| Delete Client Names (Insures Confidentiality) |
Yes |
|
| HIPAA (federal regulation) Compliant |
Yes |
|
|
Test Data Input Verification (Insures Accuracy) |
Yes |
|
|
Available in English and Spanish |
Yes |
|
| Built-in Database at No Additional Cost |
Yes |
|
|
Annual Database Summary Report (Free) |
Yes |
|
| Easily Understood Reports |
Yes |
|
|
Meaningful Score-Related Recommendations |
Yes |
|
| More Than Just Another Alcohol or Drug Test |
Yes |
|
|
Staff Training (Free) |
Yes |
|
| Examination Kits (Free) |
Yes |
|
|
Very Affordable Test Unit Fee |
Yes |
|
GAI INTERPRETATION
An example 3-page GAI report follows this discussion of the GAI scale
interpretation. The example report is provided as a ready reference to
augment this dialogue. There are several levels of GAI interpretation
ranging from viewing the GAI as a self-report to interpreting scale
elevations and scale interrelationships.
The following table is a starting point for interpreting GAI scale scores.
|
GAI RISK RANGES |
|
Risk Category |
Risk Range
Percentile |
Total
Percentage |
| Low Risk |
0 - 39% |
39% |
|
Medium Risk |
40 - 69% |
30% |
| Problem Risk |
70 - 89% |
20% |
| Severe Problem |
90 - 100% |
11% |
Referring to the above table, a
problem is not identified until a scale score is at the 70th percentile or
higher. Elevated scale scores
refer to percentile scores that are at or above the 70th
percentile. Severe problems are
identified by scale scores at or above the 90th percentile.
Severe problems represent the highest 11% of gamblers evaluated
with the GAI. The GAI has been normed on gamblers. And, this normative
sample continues to expand with each GAI test that is administered.
SCALE INTERPRETATION
1. Truthfulness Scale: Measures how
truthful the gambler was while completing the test. It identifies guarded
and defensive people who attempt to fake good. Truthfulness Scale scores
at or below the 89th percentile mean that all GAI scale scores
are accurate. When the GAI Truthfulness Scale score is in the 70th to 89th
percentile range, other GAI scale scores are accurate because they have
been Truth-Corrected. In contrast, when the Truthfulness Scale score is at
or above the 90th percentile, this means that all GAI scales are
inaccurate (invalid) because the gambler was overly guarded, read things
into test items that aren't there, was minimizing problems, or was caught
faking answers. If not consciously deceptive, gamblers with elevated
Truthfulness Scale scores are usually uncooperative (likely in a
passive-aggressive manner), fail to understand test items or have a need
to appear in a good light.
Truthfulness Scale
scores at or below the 89th percentile mean that all
other GAI scale scores are accurate.
One of the first things to check when
reviewing a GAI report is the Truthfulness Scale score.
2. Alcohol Scale: Measures alcohol use and
the severity of abuse. Alcohol
refers to beer, wine and other liquors. An elevated (70th to 89th
percentile) Alcohol Scale is indicative of an emerging drinking problem.
An Alcohol Scale score in the Severe Problem (90th to 100th
percentile) range identifies established and serious drinking problems.
Elevated Alcohol Scale scores do not occur by chance.
A history of alcohol problems (e.g., alcohol-related arrests, etc.) could result in
an abstainer (current non-drinker) attaining a Low to Medium Risk scale
score. Consequently, safeguards have been built into the GAI to identify
"recovering alcoholics." For example, the gambler's self-reported court
history is summarized on the first page of the GAI report. And, on page 3
of the report, the gambler's multiple choice (items 159 to 166)
answers are printed for easy reference.
The gambler's answer to the
"recovering alcoholic" question (item 165) is printed on page 3 of the
GAI report.
Items 45, 72, 86
and 115 refer to present tense alcohol-related admissions. In addition,
elevated Alcohol Scale paragraphs caution staff to establish if the
offender is a recovering alcoholic. If recovering, how long?
Severely elevated Alcohol and
Drugs Scale scores indicate polysubstance abuse, and the highest score
usually identifies the gambler's substance of choice. Scores in the Severe
Problem (90th to 100th percentile) range are a malignant
prognostic sign. Elevated Alcohol Scale, Drugs Scale and Suicide Scale
scores identify a particularly dangerous gambler. Here, we have a suicidal
individual who is even further impaired when drinking or using drugs.
Stress exacerbates emotional and mental health symptomatology, and alcohol abuse magnifies
these problems even further. Consequently, alcohol abuse magnifies the pathology associated
with GAI scales.
In intervention and treatment settings, the Alcohol Scale score can help staff work through gambler
denial. More people accept objective standardized assessment results as
opposed to someone's subjective opinion. This is especially true when it
is explained that elevated scores do not occur by chance. The Alcohol
Scale can be interpreted independently or in combination with other GAI scales.
3.
Drugs
Scale: Measures drug (marijuana, ice, crack, cocaine, amphetamines,
barbiturates and heroin) use and severity of drug abuse. An elevated (70th
to 89th percentile) Drugs Scale score identifies emerging drug
problems. A Drugs Scale score in the Severe Problem (90th to 100th
percentile) range identifies established drug problems and drug abuse.
A history of drug-related
problems (e.g., drug-related arrests, drug treatment, etc.) could result
in an abstainer (current non-user) attaining a Low to Medium Risk Drugs
Scale score. For this reason, precautions have been built into the GAI to
insure correct identification of "recovering drug abusers." Many of these
precautions are similar to those discussed in the above Alcohol Scale
description. And, the gambler's answer to the "recovering drug abuser"
question (item 165) is printed on page 3 of the GAI
report.
Items 21, 74, 81, 107, 117 and 122 refer
to present tense drug-related admissions. In addition, elevated Drugs
Scale paragraphs caution staff to establish if the gambler is a recovering
drug abuser. If recovering, how long?
Concurrently elevated Drugs and
Alcohol Scale scores are indications of polysubstance abuse, and the
highest score reflects the gambler's substance of choice. Very dangerous
gamblers are identified when both the Drugs Scale and the Suicide Scale
are elevated. Any Drugs Scale score in the Severe Problem (90th to 100th
percentile) range should be taken very seriously. And, elevated Drugs Scale
scores can be exacerbated when the gambler is abusing drugs. The Drugs
Scale can be interpreted independently or in combination with other GAI scales.
4. Gambling Severity Scale:
Measures gambling involvement on a continuum from none or some gambling (low risk,
zero to 39th percentile), through social gambling (medium risk, 40 to 69th
percentile), to problem gambling (problem risk, 70 to 89th percentile) and
severe problem (90 to 100th percentile) gambling. The Gambling Severity
Scale measures the severity of gambling problems.
Problem gamblers (70 to 89th percentile) manifest emerging gambler problems.
These individuals are losing control over their gambling. Problem gamblers are experiencing
gambling-related problems (not just losing money) and their consequences go beyond DSM-IV
pathological gambling criteria. Consequently most, if not all, other GAI scales directly
interact with the Gambling Severity Scale. There is general consensus that gamblers are
often negatively affected by substance (alcohol and other drugs) abuse, experienced stress
and even suicidal ideation. The question often becomes "which came first?" Are the gambler's
problems exacerbated by substance abuse, ineffective stress coping abilities and emotional
problems or vice versa?
5. DSM-IV Gambling Scale:
Is based upon individual's admissions to ten DSM-IV pathological gambler criteria. This procedure stipulates
that a person admitting to 5 or more of the DSM-IV criteria is classified as
a pathological gambler. Fisher (1996) in her university of Plymouth
publication identified people admitting to 3 or 4 of the 10 DSM-IV criteria
as "problem gamblers." Expanding this logic people admitting to 1 or 2
of these 10 criteria are designated "social gamblers" in the GAI's DSM-IV
Gambling Scale.
Since the DSM-IV ten criteria represent the "gold standard" for
identifying pathological gamblers, the ten criteria were reworded and
reformatted for use in the GAI's DSM-IV Gambling Scale. This DSM-IV
criteria procedure is a classification procedure, whereas the Gambling
Severity Scale is a gambler problem "severity" measure. The GAI now
classifies gamblers as "No Gambling Problem," "Social," "Problem," or
"Pathological" and concurrently measures the severity of gambler
problems. Comparison of these two methodologies classification-
measurement procedures helps in understanding their relationship.
|
CLASSIFICATION-MEASURE COMPARISON
|
|
DSM-IV Gambling Scale
|
Gambling Severity Scale
|
Synonyms / Classification
|
| 1 or 2 admissions
| 0 to 69th percentile
| abstainer, social gambler
|
| 3 or 4 admissions
| 70 to 89th percentile
| Problem gambler
|
| 5+ admissions
| 90 to 100th percentile
| Very serious or
pathological |
A growing debate appears to be focusing on the measurement or
classification models used. On the one side is DSM-IV diagnostic criteria
and on the other side is a continuum measurement model that measures
gambler problem severity. Toce et al. (2003) in their adolescent article
note "these different measurement models may serve different purposes
and are conceptually compatible with each other." With the inclusion of
the GAI DSM-IV Gambling Scale, the GAI is one of the few tests
containing both assessment models.
The Diagnostic and Statistical
Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for pathological
(90th to 100th
percentile) gambling is paraphrased as follows: preoccupation with
gambling; gambling with increased amounts of money; repeated unsuccessful
attempts to control gambling; gambles to escape problems; after losing,
tries to "get even"; lies to conceal the extent of gambling; lost
important relationships over gambling; and may commit illegal acts
(thefts, fraud, forgery, etc.) to finance gambling. It's an understatement
to say the etiology of pathological gambling is complex. Yet, many
gamblers mistakenly believe that money is both the cause and cure for
their problems. In brief, Severe Problem (90th to 100th
percentile) gamblers often manifest a loss of judgment along with excessive gambling.
6. Suicide
Scale: In almost every act of suicide, there are hints of
suicidal thinking before the suicide occurs. Currently, one of the major
obstacles in suicide prevention is not remediation, rather it is in
identification. Most individuals who are contemplating suicide are acutely
aware of their intentions. On the other hand, the suicidal person may be
unaware of their own lethality yet, nonetheless, usually give many hints
of their intention. Most suicidal acts stem from a sense of emotional
isolation and some intolerable emotion. Many believe suicide is an act to
stop an intolerable existence. Unfortunately, each of us defines
"intolerable" in our own way. Yet, in almost every case, there are
precursors to suicide. Recognizing these clues is a necessary first step
in suicide prevention.
The Suicide Scale in the GAI
assesses verbal clues such as "I can't stand it anymore" and behavioral clues
like "successive approximations" with instruments of suicide like razors,
pills, and moods like depression or emotional isolation. An
elevated Truthfulness Scale score can reflect early symptoms of emotional
detachment, defiance and loss of interest or withdrawal. Substance
(alcohol and other drugs) abuse is often associated with the suicidal act.
It's like striving for numbness of mind, a non-think state that can
facilitate an impulsive act. A person's attitude, particularly if
resistant and negativistic, can foreshadow emotional isolation and "giving up" or
"internalization." Although
depression is the most recognized syndrome for suicide, it is not the
only one. Consequently, the presence of emotional or mental health
problems should not be ignored.
To accurately identify suicidal
individuals, we must combine separate symptoms when no one symptom by
itself would necessarily be a good suicide predictor. And, to a large
extent, that is what the GAI does. When you have an elevated Suicide Scale
score, particularly in the Severe Problem (90th to 100th
percentile) range, with another elevated scale score, the assessor must
consider suicide a possibility and take appropriate steps. The higher the
scores, the more serious the situation. And, the more elevated the scale
scores, the more serious the situation.
Appropriate steps could include
alerting other staff, obtaining a consultation, promptly referring the
client to a licensed mental health professional or requesting a
comprehensive psychological evaluation. The assessor's judgment and
experience will influence the decision involving the client's family, friends and support group.
7. Stress
Coping Abilities Scale: Measures the gambler's ability to cope
effectively with stress, tension and pressure. How well a person manages
stress affects their overall adjustment. A Stress Coping Abilities Scale
score in the elevated (70th percentile and higher) range
provides considerable insight into co-determinants while suggesting
possible intervention programs like stress management, lifestyle
adjustment and Gamblers Anonymous.
A gambler scoring in the Severe
Problem (90th to 100th percentile) range should be referred to a
mental health specialist for further evaluation, diagnosis and a treatment
plan. We know that stress exacerbates emotional and mental health
problems. The Stress Coping Abilities Scale is a non-introversive way to
screen for established (diagnosable) mental health problems. And gambling,
particularly when losing, can be a very stressful experience.
A particularly unstable and
perilous situation involves an elevated Stress Coping Abilities Scale with
an elevated Alcohol Scale, Drugs Scale or Suicide Scale. Poor stress
coping abilities along with substance (alcohol or other drugs) abuse in a
suicide prone individual defines high risk.
The higher the elevation of
these scales, the worse the prognosis.
The Stress Coping Abilities Scale
can be interpreted independently or in combination with other GAI scales.
* * * * *
In conclusion, it was noted that
several levels of GAI interpretations are possible -- they range from using
the GAI as a self-report to interpreting scale elevations and
inter-relationships. Staff can then put a gambler's GAI findings within
the context of the gambler's lifestyle.
The GAI assesses client truthfulness, gambling involvement, suicidal ideation, substance
(alcohol and other drugs) abuse, along with the client's attitude (positive or
negative) and stress handling abilities. These seven scales help in our
understanding of gamblers.
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