|
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.
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 Behavior Data Systems, Ltd. (BDS)
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 Behavior Data Systems 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 Behavior Data Systems. 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 Behavior Data Systems, 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.
Behavior Data Systems 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 Behavior Data
Systems' 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
Behavior Data Systems 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. Behavior Data Systems' 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. Behavior Data Systems 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 Gambling Severity 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. Behavior Data Systems 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. Behavior Data Systems
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: Behavior
Data Systems encourages test users to delete gambler names from diskettes
before they are returned to Behavior Data Systems. 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 Behavior Data
Systems.
Staff Training:
Behavior Data Systems' 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. Behavior Data Systems gives attendees
certificates attesting to their GAI training.
Staff training is also provided on Fridays at Behavior Data Systems' 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 Behavior Data Systems 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,
Behavior Data Systems 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 Behavior Data Systems' 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
"GAI: Orientation and Training Manual," Installation CD (with instructions) and
some descriptive information. Behavior Data Systems 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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