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, attitudes and stress handling abilities.

The interaction of these seven attitude and behavior scales largely determines the gambler's outlook and subsequent behavior. To learn more about scale interpretation, click on the GAI Scale Interpretation link.

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):

1. Truthfulness Scale: Measures how truthful the client was while completing the GAI. This scale identifies defensiveness, denial and faking.
    
2. Gambling Scale: Measures gambling interest and involvement on a continuum from normal (Low Risk) to pathological (Severe Problem).
    
3. Suicide Scale: Identifies suicide prone individuals. Gamblers are often desperate, overwhelmed and potentially suicidal.
    
4. Alcohol Scale: Measures alcohol (beer, wine and other liquor) use and abuse. This scale measures the severity of alcohol abuse.
    
5. Drugs Scale: Measures illicit drug (marijuana, crack, cocaine, amphetamines, barbiturates and heroin) use and abuse. This scale measures the severity of drug abuse.
    
6. Attitude Scale: Measures a gambler's resistance to help, assistance and treatment. A positive, cooperative attitude is often a prerequisite to behavioral change.
    
7. Stress Coping Abilities Scale: Measures how well the gambler copes with stress, tension and pressure. Stress exacerbates emotional problems.

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The interaction of these seven attitudes and behaviors 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 5^th grade to low 6^th 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. After reviewing the report, you can return to this section by clicking on the "Return to GAI Reports Section" link.

Software

The GAI is available on MS-DOS or Windows diskettes. MS-DOS diskettes contain their own software. 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 Risk & Needs Assessment, Inc.'s (Risk & Needs') telephone line.

Proprietary GAI data diskettes contain 25 or 50 test applications. These 3½" or 5¼" 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 Risk & Needs 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 Risk & Needs. Deleting all client names insures client confidentiality and compliance with HIPAA (federal regulation 45 C.F.R. 164.501).

The "GAI: Computer Operating Guide" explains and discusses other unique GAI computer-related features.

GAI Database

The GAI system contains a proprietary database. Earlier, it was noted that all GAI used diskettes are returned to Risk & Needs, 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. Risk & Needs 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.

In summary, having all used GAI tests' data centrally filed at Risk & Needs' 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.

Annual Summary Reports

Risk & Needs 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. Risk & Needs' 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.

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. Risk & Needs 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 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 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.

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 90^th 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 90^th 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. Risk & Needs 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. Risk & Needs 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: Risk & Needs encourages test users to delete gambler names from diskettes before they are returned to Risk & Needs. 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 Risk & Needs.

GAI: Inventory of Scientific Findings: Much of the GAI research has been gathered together in this document. GAI research is summarized chronologically -- as the studies were completed. This chronological reporting format was established largely because of the GAI database, which permits annual database analysis of all tests administered that year. This chronological reporting procedure allows the reader the opportunity to see the evolution of the GAI into a state-of-the-art gambler assessment instrument or test.

Orientation and Training Manual: The "GAI: Orientation and Training Manual" (O&T Manual) explains how the GAI works. It is a must read for staff that will be using the GAI. O&T Manual content includes, but is not limited to, the following: instructions for testing, an explanation of how scores are derived, a clarification of how court-related information is used (if available), a description of unique GAI features and much much more.

Computer Operating Guide: Some computer operators want more information than others. Consequently, Risk & Needs provides a One-Page Quick Start, which includes basic instructions for scoring GAI’s, and a more comprehensive "GAI: Computer Operating Guide." The Computer Operating Guide contains instructions for using DOS and Windows software. This manual discusses hardware, software, scoring, printing reports, unique program features and much more.

Staff Training: Risk & Needs' 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. Risk & Needs gives attendees certificates attesting to their GAI training.

Staff training is also provided on Fridays at Risk & Needs' 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 Risk & Needs at least ten days in advance. Participation is on a first call, first scheduled basis.

Automated Criminogenic Structured Interview (ACSI): The Automated Criminogenic Structured Interview (ACSI) is a structured interview, not a test. The Automated Criminogenic Structured Interview (ACSI) consists of 65 multiple choice items. It obtains comprehensive background history, pattern of substance (alcohol and other drugs) abuse and criminogenic needs information. Whatever multiple choice item answer that is selected is printed in the Automated Criminogenic Structured Interview (ACSI) report. Use of the Automated Criminogenic Structured Interview (ACSI) is voluntary (not required). The ACSI is free. ACSI use is restricted to users of Risk & Needs adult tests. The ACSI is not a test, and it is not to be used as a standalone test. The ACSI is a structured interview. For more information on the ACSI and to see an ACSI report, click on this ACSI link.

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, Risk & Needs 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:

Reference to the above table shows that a problem is not identified until a scale score is at the 70^th 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 Risk & Needs' 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 MS-DOS format so that the software is contained on the diskettes. This way, the one-time Windows setup program is avoided at the demo level. The examination kit contains a 1-test demo diskette, test booklet (reusable), an answer sheet (can photocopy), a "GAI: Orientation and Training Manual," One-Page Quick Start and some descriptive information. Risk & Needs does want the demonstration diskette and test booklet returned within 30 days of receipt. To request a free examination kit, click on the Free Examination Kit Request link.

How to Proceed

To become a Risk & Needs test user, click on the Agreement & Proposals link, click on the Print Client User Agreement button and fax the completed form to (602) 266-8227, or mail your completed form to Risk & Needs. Upon its receipt by Risk & Needs, you become a Risk & Needs test user and can order tests. Established Risk & Needs test users can reorder tests by mail, telephone, fax or e-mail.

Other related links are listed for reference. They are available as needed.

Test Unit Fee (Cost) webpage link. Explains Risk & Needs' Test Unit Fees or Costs.
New Client Order webpage link. Explains steps to become a "new Risk & Needs client."
How to Order webpage link. Explains how Risk & Needs tests can be ordered.

Additional information can be provided upon request. Contact Risk & Needs Assessment, Inc., P.O. Box 44828, Phoenix, Arizona 85064-4828. Risk & Needs' telephone number is (602) 234-3506, our fax number is (602) 266-8227 and our e-mail address is hhl@riskandneeds.com.

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.

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.

Referring to the above table, a problem is not identified until a scale score is at the 70^th percentile or higher. Elevated scale scores refer to percentile scores that are at or above the 70^th percentile. Severe problems are identified by scale scores at or above the 90^th 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 89^th percentile mean that all GAI scale scores are accurate. When the GAI Truthfulness Scale score is in the 70^th to 89^th 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 90^th 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 89^th 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 (70^th to 89^th percentile) Alcohol Scale is indicative of an emerging drinking problem. An Alcohol Scale score in the Severe Problem (90^th to 100^th 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 (90^th to 100^th 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 (70^th to 89^th percentile) Drugs Scale score identifies emerging drug problems. A Drugs Scale score in the Severe Problem (90^th to 100^th 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 (90^th to 100^th 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. Attitude Scale: Measures positive or negative predispositions to react in a consistent way to situations, people or events. Attitudes convey a positive, negative or neutral response. Attitudes are complex products of learning, experience and emotional processes. The term attitude is synonymous with opinion, state of feeling or reaction. Elevated Attitude Scale scores identify negative and problematic attitudes. The higher the score, the more negative the gambler. Attitude, as measured in the GAI, is a characterological trait, which is often difficult to change. However, from a treatment perspective, the GAI establishes the attitudinal set, or einstelung, of the gambler. Elevated scorers are contrary, rejecting and negativistic clients, and counseling/therapy with them can be difficult.

An elevated Attitude Scale score in conjunction with an elevated Alcohol or Drugs Scale score can be problematic. Substance (alcohol and other drugs) abuse can "unmask" or reveal negativistic thoughts, ideas and associated behavior. And, if that person is experiencing a lot of stress, the negativism can undermine therapeutic goals. The relationship between the Attitude Scale and the Suicide Scale has not been established. However, some mental health practitioners believe elevated scale scores can only be problematic. When negativism generalizes to demoralization or even adopting a fatalistic "I give up" attitude, suicidal ideation should not be ignored. With that said, some practitioners believe some discomfort is necessary for change. The amplitude or severity of the Attitude Scale score is an important factor to be understood. In closing, some believe gamblers are notorious optimists. However, this optimism may only apply to their gambling and not their lives.

5. Gambling Scale: Measures the client’s interest and involvement in gambling on a continuum from normal (Low Risk) to pathological (Severe Problem). A massive commitment to gambling usually has an overwhelming impact on a person’s life (relationships, finances, goals and lifestyle). Consequently, most, if not all other, GAI scales directly interact with the Gambling Scale. A gambler is negatively affected by substance (alcohol and other drugs) abuse, suicidal ideation and experienced stress. These people manifest guilt, anxiety, depression and feelings of helplessness. The question often becomes "which came first: the chicken or the egg?" Are the gambler’s problems exacerbated by substance abuse, ineffective stress coping abilities and emotional, psychological problems or vice versa? Many mental health practitioners believe "pathological gamblers" (our term is serious gamblers in the 90^th to 100^th percentile score range) are characterized by persistent and recurrent maladaptive gambling behavior that disrupts the gamblers' personal, family and/or vocational pursuits.

The Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition (DSM-IV) criteria for pathological (90^th to 100^th 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 (90^th to 100^th 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 (90^th to 100^th 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 (70^th 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 (90^th to 100^th 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.

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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.

A GAI EXAMPLE REPORT FOLLOWS

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.

The first page of the three-page GAI report begins with the gambler's name and some basic demographics. The GAI profile sets forth the GAI scales, the client's attained scale scores and a graphic representation of these scores. This graph summarizes client scores quickly, usually with little more than a glance. Then, some basic self-reported court history is presented. Page one concludes with a reproduction of all the client's answers, which facilitates identification of answers to specific items.