Self-assessment
​The following are Yes or No questions, please answer truthfully to your best knowledge.
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Did you ever lose time from work or school due to gambling?
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Has gambling ever made your home life unhappy?
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Did gambling affect your reputation?
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Have you ever felt remorse after gambling?
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Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?
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Did gambling cause a decrease in your ambition or efficiency?
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After losing did you feel you must return as soon as possible and win back your losses?
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After a win did you have a strong urge to return and win more?
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Did you often gamble until all your money was gone?
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Did you ever borrow to finance your gambling?
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Have you ever sold anything to finance gambling?
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Were you reluctant to use "gambling money" for normal expenditures?
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Did gambling make you careless of the welfare of yourself or your family?
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Did you ever gamble longer than you had planned?
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Have you ever gambled to escape worry, trouble, boredom, loneliness, grief or loss?
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Have you ever committed, or considered committing, an illegal act to finance gambling?
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Did gambling cause you to have difficulty in sleeping?
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Do arguments, disappointments or frustrations create within you an urge to gamble?
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Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
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Have you ever considered self-destruction or suicide as a result of your gambling?​​