TWENTY QUESTIONS

1. Did you ever lose time from work or school due to gambling?

Yes No

2. Has gambling ever made your home life unhappy?

Yes No

3. Did gambling affect your reputation?

Yes No

4. Have you ever felt remorse after gambling?

Yes No

5. Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?

Yes No

6. Did gambling cause a decrease in your ambition or efficiency?

Yes No

7. After losing did you feel you must return as soon as possible and win back your losses?

Yes No

8. After a win did you have a strong urge to return and win more?

Yes No

9. Did you often gamble until all your money was gone?

Yes No

10. Did you ever borrow to finance your gambling?

Yes No

11. Have you ever sold anything to finance gambling?

Yes No

12. Were you reluctant to use “gambling money” for normal expenditures?

Yes No

13. Did gambling make you careless of the welfare of yourself or your family?

Yes No

14. Did you ever gamble longer than you had planned?

Yes No

15. Have you ever gambled to escape worry, trouble, boredom, loneliness, grief or loss?

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