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.
|Low Risk||0 - 39%||39%|
40 - 69%
|Problem Risk||70 - 89%||20%|
|Severe Problem||90 - 100%||11%|
Referring to the above table, a
problem is not identified until a scale score is at the 70th percentile or
higher. Elevated scale scores
refer to percentile scores that are at or above the 70th
percentile. Severe problems are
identified by scale scores at or above the 90th 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.
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 89th percentile mean that all GAI scale scores
are accurate. When the GAI Truthfulness Scale score is in the 70th to 89th
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 90th 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.
scores at or below the 89th 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.
Measures alcohol use and
the severity of abuse. Alcohol
refers to beer, wine and other liquors. An elevated (70th to 89th
percentile) Alcohol Scale is indicative of an emerging drinking problem.
An Alcohol Scale score in the Severe Problem (90th to 100th
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 structured interview (items 159 to 166)
answers are printed for easy reference.
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 (90th to 100th 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.
Scale: Measures drug (marijuana, ice, crack, cocaine, amphetamines,
barbiturates and heroin) use and severity of drug abuse. An elevated (70th
to 89th percentile) Drugs Scale score identifies emerging drug
problems. A Drugs Scale score in the Severe Problem (90th to 100th
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 (90th to 100th
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.
Gambler Severity Scale:
measures gambling involvement on a continuum from none or some
gambling (low risk, zero to 39th percentile), through social
gambling (medium risk, 40 to 69th percentile), to problem
gambling (problem risk, 70 to 89th percentile) and severe
problem (90 to 100th percentile) gambling. The Gambler
Severity Scale measures the severity of gambling problems.
gamblers (70 to 89th percentile) manifest emerging gambler
problems. These individuals are losing control over their gambling.
Problem gamblers are experiencing gambling-related problems (not just
losing money) and their consequences go beyond DSM-IV pathological
gambling criteria. Consequently most, if not all, other GAI scales
directly interact with the Gambler Severity Scale. There is general
consensus that gamblers are often negatively affected by substance
(alcohol and other drugs) abuse, experienced stress and even suicidal
ideation. The question often becomes “which came first?” Are the
gambler’s problems exacerbated by substance abuse, ineffective stress
coping abilities and emotional problems or vice versa?
How do the Gambling Severity Scale and the DSM-IV Gambling Scale Differ?
Gambling Scale criteria only pertains to pathological gambling. A person
admitting to 5 or more of the DSM-IV criteria is classified a
“pathological gambler.” Fisher (1996) included admissions to 3 or 4
criteria to identify “problem gamblers.” And GAI methodology extended
this logic to include people admitting to 1 or 2 of these criteria being
classified as “social gamblers.” The DSM-IV criteria methodology is a
contrast, the “Gambler Severity Scale” consists of 53 items and
incorporates gambling-related attitudes, feelings/emotions, behavior and
consequences. This is a much broader and inclusive approach to gambler
involvement. The Gambler Severity Scale measures the severity of gambling
involvement and gambling-related problems. It is an understatement to say
the etiology of problem gamblers is complex.
DSM-IV Gambling Scale:
is based upon individual’s admissions to ten DSM-IV pathological gambler
criteria. This procedure stipulates that a person admitting to 5 or more
of the DSM-IV criteria is classified as a pathological gambler. Fisher
(1996) in her university of Plymouth publication identified people
admitting to 3 or 4 of the 10 DSM-IV criteria as “problem gamblers.”
Expanding this logic, people admitting to 1 or 2 of these 10 criteria are
designated “social gamblers” in the GAI’s DSM-IV Gambling Scale.
the DSM-IV ten criteria represent the “gold standard” for identifying
pathological gamblers, the ten criteria were reworded and reformatted for
use in the GAI’s DSM-IV Gambling Scale. This DSM-IV criteria procedure is
a classification procedure, whereas the Gambler Severity Scale is a
gambler problem “severity” measure. The GAI now classifies gamblers as
“No Gambling Problem,” “Social,” “Problem,” or “Pathological” and
concurrently measures the severity of gambler problems. Comparison of
these two methodologies classification-measurement procedures helps in
understanding their relationship.
1 or 2 admissions...
..... 0 to 69th
3 or 4 admissions...
..... 70 to 89th
..... 90 to 100th
debate appears to be focusing on the measurement or classification models
used. On the one side is DSM-IV diagnostic criteria and on the other side
is a continuum measurement model that measures gambler problem severity.
Toce et al. (2003) in their adolescent article note “these different
measurement models may serve different purposes and are conceptually
compatible with each other.” With the inclusion of the GAI DSM-IV
Gambling Scale, the GAI is one of the few tests containing both assessment
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 (90th to 100th
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.
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 (70th 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 (90th to 100th 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.
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.
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