1. Do you lose time from work due to gambling and alcohol or drug use?
  2. Does your gambling or use make your home life unhappy?
  3. Does your gambling or use affect your reputation?
  4. Do you ever feel remorse after gambling or use?
  5. Do you ever gamble to get money to pay debts or solve other financial difficulties?
  6. Does your gambling or use cause a decrease in your ambition of efficiency?
  7. After losing, do you feel you must return as soon as possible to win back your losses?
  8. After a win, do you gamble the winning away after telling yourself you wouldn’t?
  9. Do you often gamble until your last dollar is gone?
  10. Do you ever borrow to finance your gambling or use?
  11. Do you ever sell anything to finance your gambling or use?
  12. Are you reluctant to use “gambling money” for normal expenditures?
  13. Does gambling or alcohol/drug use make you inconsiderate about the welfare of your family?
  14. Do you ever gamble or use longer than you planned?
  15. Do you ever gamble or use to escape worry or trouble?
  16. Do you ever commit, or consider committing, an illegal act to finance gambling or chemical use?
  17. Does your gambling or use cause you to have difficulty sleeping?
  18. Do arguments, disappointments or frustrations create an urge to gamble or use substances?
  19. Do you have an urge to celebrate good fortune by gambling, drinking alcohol or using drugs?
  20. Do you ever consider self-destruction as a result of gambling or chemical use?
  21. Do you gamble, drink alcohol or use drugs alone?

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