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Recognizing Gambling-Related Problems
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Name
*
Email Address
*
During the past 12 months, have you become restless irritable or anxious when trying to stop/cut down on gambling?
*
Yes
No
During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
*
Yes
No
During the past 12 months did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends or welfare?
*
Yes
No
Choose the option that is most applicable.
*
I never think about my gambling.
Sometimes I think about gambling less.
I have decided to gamble less.
I am already trying to cut back on my gambling.
I changed my gambling. I now do not gamble, or gamble less than before.
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