Early Intervention Gambling Health Test (EIGHT) Gambling Screen

Developed by Dr. Sean Sullivan for the Compulsive Gambling Society of NZ, Inc., and the Department of General Practice and Primary Health Care at the Auckland School of Medicine

Scoring Guide

Affirmed 4 or more questions: Gambling is likely to be affecting patient's well-being and may even meet criteria for gambling pathology.

Appropriate Intervention

• Indicate the test is not diagnostic, and is just indicative. (Some of the patient's answers may refer to the past and not the present, or may refer to isolated incidents. These would be false positives).

• Intervene (such as using the Motivational Interviewing steps).

• Ascertain level of patient's concern about their gambling—if they have concern, offer an assessment (using DSM-IV-TR criteria)— nb, it is not only gambling pathology that warrants intervention in this progressive behavior, while some DSM-IV-TR criteria are not easily acknowledged because of guilt and shame.

• If their concern is low, offer information; offering of information is appropriate also where gambling pathology exists. Request their permission before offering information—this will enhance acceptance.

• Framing the gambling as a health issue will reduce resistance.

• Offer support—guilt and shame may prevent their discussing their gambling with others.

• Ongoing monitoring—problem gambling is often progressive, with high suicidal ideation, depression, and anxiety in advanced cases (check extent of their answer to question one on the screen).

•‘Sowing the seed’ as a possible health matter may prevent progression of gambling behavior even if help is refused.

• Consider alcohol misuse, depression, anxiety, suicidal ideation.

Guidelines that May Help

• In offering the screen, emphasize that gambling is a common pastime but that sometimes it can cause health problems and problems socially—this frames the inquiry as health related rather than inquiry into lifestyle.

• The screen is not diagnostic and mistakes can be made—more important is how the patient feels their gambling is affecting their lives; the screen results may assist them to focus on effects that gambling is having on them—avoid terms like compulsive or pathological gambling, even if a subsequent assessment using DSM meets this criteria.

• Refer instead to the screen, suggesting that ‘gambling is causing you problems that may be affecting your health or well-being.’ This avoids labeling and allows a discussion of an external (health) problem—being the reason patients see their GPs—and avoids focussing on personal behavior and circumventing emotions (guilt, self esteem) that the patient may often defend against.