South Oaks Gambling Inventory

1. Please indicate which one of the following types of gambling you have done in your lifetime. For each type, mark one answer: “Not at all,” “less than once a week, “ or “Once a week or more”.
   



Please “X” one answer for each state0ent	Not at all	Less than once a week	Once a week or more
a. Played cards for money.
b. Bet on horses, dogs or other animals (at OTB, the track or with a bookie).
c. Bet on sport (parlay cards, with bookie at Jai Alai).
d. Played dice games, including craps, over and under or other dice games.
e. Went to casinos (legal or otherwise).
f. Played the numbers or bet on lotteries.
g. Played Bingo.
h. Played the stock market and/or commodities market.
i. Played slot, poker or other gambling machines.
j. Bowled, shot pool, played golf or some other game of skill for money.
k. Played pull-tabs or “paper” games other than lotteries.
l. Some form of gambling not listed above (please specify).



2. What is the largest amount of money you have ever gambled within one day?

__________ Never Gambled __________$1.00 or less __________ More than $1.00 up to $10.00 __________ More than $10.00 up to $100.00 __________ More than $100.00 up to $1,000.00 __________ More than $1,000.00 up to $10,000.00  __________ More than $10,000

3. Check which one of the following people in your life has (or had) a gambling problem:

__________ Father __________ Mother __________ Brother/Sister
__________ My Spouse/partner __________ Child(ren) __________ Another relative
__________ A friend or someone important in my life __________ Grandparent

4. When you gamble, how often do you go back another day to win back money you have lost?

__________ Never __________ Some of the time(less than half the time I lost)
__________ Most of the time I lose __________ Everytime I lose

5. Have you ever claimed to be winning money gambling, but weren't really? In fact, you lost?

__________ Never __________ Yes, less than half the time I lost
__________ Yes, most of the time

6. Do you feel you have ever had a problem with betting money or gambling?

__________ No __________ Yes __________ Yes, in the past, but not now

7. Did you ever gamble more than you intended to? _____ Yes _____ No


8. Have people criticized your betting or told you that you had a problem, regardless of whether or not you thought it was true? _____ Yes _____ No
   
9. Have you ever felt guilty about the way you gamble, or what happens when you gamble?
   _____ Yes _____ No
   
10. Have you ever felt you would like to stop betting money on gambling, but didn't think you could? _____ Yes _____ No
    
11. Have you ever hidden betting slips, lottery tickets, gambling money, IOU's or other signs of betting or gambling from your spouse, children or other important people in your life? _____ Yes _____ No
    
12. Have you ever argued with people you live with over how you handle money? _____ Yes _____ No
    
13. If you answered yes to 12, have money arguments ever centered on your gambling?
    _____ Yes _____ No
    
14. Have you ever borrowed from someone and not paid them back as a result of your gambling?
    _____ Yes _____ No
    
15. Have you ever lost time from work (or school) due to betting money or gambling? _____ Yes _____ No
    
16. If you borrowed money to gamble or to pay gambling debts, who or where did you borrow from? (check yes or no for each item)
    
1. From household money _____ Yes _____ No
2. From your spouse _____ Yes _____ No
3. From other relatives or in-laws _____ Yes _____ No
4. From banks, loan companies, or credit unions _____ Yes _____ No
5. From credit cards _____ Yes _____ No
6. From loan sharks _____ Yes _____ No
7. You cashed in stocks, bonds, or other securities _____ Yes _____ No
8. You sold personal or family property _____ Yes _____ No
9. You borrowed on your checking accounts (passed bad checks) _____ Yes _____ No
10. You have (had) a credit line with a bookie _____ Yes _____ No
11. You have (had) a credit line with a casino _____ Yes _____ No

South Oaks Gambling Screen

Scoring Sheet

Scores on the South Oaks Gambling Screen itself are determined by adding up the number of questions that show an “at risk” response:

Question 1, 2 and 3 are not counted

Question 4: Most of the time I lost, or every time I lost

Question 5: Yes, less than half the time I lost, or yes most of the time

Question 6: Yes, in the past, but not now or yes

Question 7: Yes

Question 8: Yes

Question 9: Yes

Question 10: Yes

Question 11: Yes

Question 12: Not counted

Question 13: Yes

Question 14: Yes

Question 15: Yes

Question 16a: Yes

Question 16b: Yes

Question 16c: Yes

Question 16d: Yes

Question 16e: Yes

Question 16f: Yes

Question 16g: Yes

Question 16h: Yes

Question 16i: Yes

Question 16j and 16 k: Not counted

TOTAL _____________ (20 questions are counted)

5 or more=probable pathological gambler

Copyright: 1986— South Oaks Foundation, Inc