GAI

This questionnaire is designed to help identify your

concerns and needs.
Your cooperation and
truthfulness are important.
Answer the questions as to how you feel now or
how you felt in the last 30 days.
Complete the information at the top of your answer
sheet. Then answer every statement or question.
All statements must be answered on your answer
sheet.
Do not make any marks on this booklet.
Section 1
The following statements must be answered True or
False. If a statement is True, put an X under T for
True. If a statement is False, put an X under F for
False on your answer sheet.
1. Sometimes I worry about what others think
or say about me.
2. To be honest, I gamble a lot.
3. I am concerned about my drinking.

12. I have no quality of life (fun, enjoyment

or joy) in my life anymore.
13. There are times when I really worry about
myself and my happiness.
14. No matter how hard I try I cant stop
gambling.
15. My drinking has caused family or social
problems for me.
16. There are times when I feel guilty about my
gambling.
17. When offered drugs, I may or may not use
them. It depends on how I feel at the time.
18. At this point in my life, it would be less
painful to die than to try and endure living.
19. I get annoyed when someone is critical of
my gambling.
20. When I drink my personality changes and I
seem like a different person.
21. I use drugs like marijuana or cocaine to feel
good.
22. It bothers me when I am overlooked or
ignored by people I know.

4. I think a lot about gambling.

5. I have used drugs (marijuana, crack,
cocaine, amphetamines, barbiturates or
heroin) more than I should.
6. I have nobody I can talk with about the
things that are really bothering me.
7. I have done some things that were wrong
for which I was not caught.
8. To make gambling more exciting I will
increase my bets or take greater risks.

23. I get restless and irritable when I cut down or

try to stop gambling.
24. I have had two or more memory losses
(blackouts) after drinking.
25. There have been times when I have
gambled much longer than I had planned.
26. My use of drugs has threatened my
happiness and success in life.
27. I often think about different ways I can
accidentally kill myself.

9. At times I feel guilty about my drinking.

28. Sometimes I get angry or upset at myself.
10. I have gambled more than I should.
11. I have been told I have a drug problem.

29. Gambling helps me escape from my

problems and worries.

30. I have been told I have a drinking problem.

48. Nobody really cares about me anymore.

31. I have missed work (or school) because of

my gambling.

49. I have wished I could go back in time and

do some things over -- but differently.

32. I have been in a chemical dependency

program for my drug problem.

50. To finance my gambling I have done some

things that were not legal.

33. I cannot stand the embarrassment, pain and

humiliation that is coming.

51. I have asked for help with my drinking.

34. There have been times when I knew I

should not gamble, but did.
35. Even after losing I will continue to gamble
so I can get even.

52. There have been times when I have

gambled until I lost all my money.
53. There have been times I have felt guilty
about using drugs.
54. A family member has committed suicide.

36. I have attended Alcoholics Anonymous

(AA) or Rational Recovery (RR) meetings
because of my drinking.

55. There are times when I am down and

depressed.

37. I am concerned about my gambling.

56. Because of my gambling I have risked

losing some important relationships.

38. After using drugs, I have seen or heard

things that were not really there.

57. I have missed work because of my drinking.

39. I have attempted suicide.

58. Once I begin gambling, it often seems as if I

cannot stop.

40. There are times when I am discouraged and

unhappy.

59. I have had to use more drugs to get the same

effect that I used to.

41. Even though I gamble, I usually deny

gambling or say I gamble less than I really
do.

60. My status and reputation will be destroyed

because of what I have done.

42. I do not want to live in pain and agony

anymore.

61. There are times when I daydream about

being rich or famous.

43. I have done things when angry that I later

regretted.

62. Largely because of my gambling my family

has had to help me pay my bills.

44. I lie to family and others to conceal the

extent of my gambling.

63. My repeated alcohol and/or drug use has

resulted in poor performance and absences
at school or work, or neglecting my
household duties and even children.

45. In the last year, drinking has been a problem

for me.
46. There have been times when I have felt a lot
of guilt, remorse or regret after gambling.
47. I have lied to people about my use of drugs-either minimizing how much I really use,
or hiding the fact that I use drugs at all.

64. I have sold or pawned things so that I could

gamble.
65. A close family member told me to get help
for my drug problem.
66. I have the reputation of being a gambler.

67. I have threatened suicide before.

68. I do not always tell the whole truth about
my finances or gambling.

86. I need help to overcome my drinking

problem.
87. Gambling has threatened my happiness and
success in life.

69. My gambling has caused family or social

problems for me.

88. I use and sometimes abuse drugs.

70. I am preoccupied with gambling.

89. Within the last three years, I was a patient

in a mental hospital.

71. People tell me that gambling is ruining my

life.
72. My drinking is more than just a little or
minor problem.
73. I have had a gambling problem in the past.
74. I have a drug problem.
75. I have borrowed money from family and
friends so that I could gamble.
76. I never thought I would say this, but death
would be a blessing to me.
77. There are times when I worry about my
responsibilities and future.
78. Sometimes I increase my bets to make
gambling more exciting.
79. I have repeatedly used alcohol and/or drugs
in physically hazardous or dangerous
situations like driving, swimming or
boating.
80. I go to Gamblers Anonymous (GA)
meetings because of my gambling.
81. In the last year, using drugs has been a
problem for me.
82. Life just is not worth living anymore.
83. There are times when I get real frustrated or
angry.
84. My gambling is more than just a little or
minor problem.
85. I have repeatedly tried to cut down and stop
gambling -- but I never can.

90. There have been times when I have been

jealous of others success.
91. My drinking and/or drug use has resulted in
legal problems and/or arrests.
92. When I cut down or try to stop gambling I
get grouchy and quarrelsome.
93. I have lied to people about my drinking-either minimizing how much I drink, or
hiding the fact that I drink at all.
94. A family member has told me to get help for
my gambling problem.
95. I have gone to Narcotics Anonymous (NA)
or Cocaine Anonymous (CA) meetings
because of my drug use.
96. I often feel profoundly hopeless or helpless.
97. There are times, because of my gambling,
that I cannot be trusted with money.
98. I gamble to escape from my problems and
worries.
99. I have a drinking problem.
100. I have a gambling problem.
101. I am going to be publicly humiliated,
embarrassed and disgraced. And, there is
nothing I can do to prevent it.
102. I am concerned about disapproval from
others.
103. To overcome a loss or series of losses I will
continue gambling.
104. Death will be a welcome escape for me.

105. Drinking has interfered with my happiness

and success in life.
106. I have been desperate and even suicidal
after losing at gambling.
107. I have used drugs like marijuana, cocaine,
crack, amphetamines, barbiturates or heroin
within the last six months.
108. I think about suicide a lot.

126. I have continued drinking and/or using

drugs despite recurrent social or family
arguments about my substance use.
127. I am addicted to gambling.
Section 2
Rate each statement by selecting the answer that
you think describes you best. Put an X on your
answer sheet under the number that you select for
your answer. Use the following rating scale.

109. There are times when I am very unhappy.

1.
2.
3.
4.

110. I will lie to cover up the extent of my

gambling involvement.
111. The loneliness is becoming unbearable for
me.
112. I have been unsuccessful in controlling,
cutting back or stopping gambling.

Rare or Never
Sometimes
Often
Very Often

Answer each statement as it applies to you now.

128.

Positive Attitude/Outlook

129.

Dissatisfied with Life

130.

Anxious/Worried/Fearful

114. I have committed some illegal acts to

finance my gambling.

131.

Depressed/Discouraged

115. I am an alcoholic.

132.

Manage Time Effectively

116. I have considered or even committed illegal

acts such as forgery or theft to bankroll or
finance my gambling.

133.

Insomnia/Trouble Sleeping

134.

Satisfied with Self/Like Self

117. I am in treatment for a drug problem.

135.

Bored/Restless

118. I do not want to live any longer.

136.

Financially Stable/Responsible

119. There have been times when I have done

something wrong and was not caught.

137.

Enthusiastic/Involved in Life

138.

Tension/Stress

139.

Fatigued/Tired

121. I want and need help to stop gambling.

140.

Directly Deal with Problems

122. I am dependent on drugs and may be

addicted to them.

141.

Emotionally Upset/Crying

142.

Share My Thoughts Comfortably

143.

Lonely/Unhappy

144.

Able to Handle Life's Problems

145.

Nervous/Unable to Relax

113. I have been embarrassed or worried about

some of my gambling problems.

120. I have lost a job or jeopardized my career

because of gambling.

123. To be honest, I am suicidal.

124. I have gotten upset or angry at another
gambler.
125. I know I shouldnt, but I have been jealous
of other gamblers success.

Section 2, continued
146.

Patient/Tolerant/Understanding

147.

Can't Make Decisions/Indecisive

148.

Work/Job Satisfaction

149.

Fearful/Anxious

150.

Difficulty with Others

151.

Trust My Own Judgment

152.

Express My Feelings Comfortably

153.

Adaptable/Adjustable

154.

Marital/Family Problems

155.

Self-Reliant/Independent

156.

Satisfied/Contented with Life

157.

Borrow Money to Gamble

158.

I Gamble

Section 3
The statements in this section should describe you
or your situation. Select the answer that is accurate
for you. Put an X under the number (1, 2, 3 or 4) on
your answer sheet that you select for your answer.
159. How would you describe your gambling?
1. Serious problem
2. Moderate problem
3. Slight problem
4. Not a problem
160. How would you describe your drinking?
1. Serious problem
2. Moderate problem
3. Slight problem
4. Not a problem
161. How would you describe your drug use?
1. Serious problem
2. Moderate problem
3. Slight problem
4. Not a problem

162. How would you describe your desire to get

gambling treatment or help?
1. I want help (highly motivated)
2. I may need help (moderately motivated)
3. Maybe, not sure (slightly motivated)
4. No need (not motivated)
163. How would you describe your desire to get
alcohol treatment or help?
1. I want help (highly motivated)
2. I may need help (moderately motivated)
3. Maybe, not sure (slightly motivated)
4. No need (not motivated)
164. How would you describe your desire to get
drug treatment or help?
1. I want help (highly motivated)
2. I may need help (moderately motivated)
3. Maybe, not sure (slightly motivated)
4. No need (not motivated)
165. Recovering means having a substance
(alcohol or other drugs) abuse problem, but
not drinking or using drugs anymore. I am a
recovering:
1. Alcoholic
2. Drug abuser
3. Both 1 and 2
4. None of the above
166. Rate your gambling on a scale from one to
ten. One represents no problem, and ten
represents a very serious problem. I rate
myself as:
1. 1 or 2 (no gambling problem)
2. 3, 4 or 5 (gambling under control)
3. 6, 7 or 8 (gambling is a problem)
4. 9 or 10 (severe gambling problem)

G A I Response Form
Name:
Age:

Sex:

Ethnicity (Race):

Education (Highest grade completed):

Marital Status:

Date of Birth:

Todays Date:

1. Number of alcohol-related arrests: ___________ 2. Number of drug-related arrests:

3. Average times gambling per month:
4. Number of months employed in the
None , 1 or 2 , 2 or 3 , 3 or 4 , 5 or more
last 12 months:
Gambling refers to: Bingo, Lottery, Slot Machines, Sports Betting,
Dog or Horse Tracks, Table Games (Casinos), etc.

________
________

Section 1
If a statement is True put an X under T for True. If a statement is False put an X under F for False
T
F
T
F
T
F
T
F
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127. ___ ___

Section 2
Put an X under the number (1, 2, 3, or 4) that
describes you best. Use the following scale to
select your answers.
1. Rare or Never
3. Often

2. Sometimes
4. Very Often

Section 3
The statements in this section should describe
you or your situation. Select the answer that is
accurate for you. Put an X under the number (1,
2, 3, or 4) on your answer sheet that you select
for your answer.
159.

1
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2
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3
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4
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160.

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161.

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162.

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163.

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164.

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165.

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135.

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166.

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136.

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137.

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138.

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139.

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140.

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141.

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142.

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143.

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144.

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145.

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146.

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148.

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149.

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150.

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151.

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152.

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156.

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157.

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158.

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128.

1
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2
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3
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4
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129.

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131.

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132.

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133.

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134.

Thank you for your cooperation, please

return the booklet and response form to the
supervisor.

Gambler Addiction Index Copyright 1997, 2004.

ALL RIGHTS RESERVED