Understanding GAI: Interpreting Gambling Risk Levels

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.

GAI RISK RANGES Risk Category Risk RangePercentile TotalPercentage Low Risk 0 - 39% 39% Medium Risk 40 - 69% 30% 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.

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 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.

Truthfulness Scale

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. 2.Alcohol Scale: 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.

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 (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.

3.Drugs

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.

4.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. Problem 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?

DSM-IV

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 classification system.

In 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.

5. 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. Since 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.

CLASSIFICATION-MEASUREMENT COMPARISON DSM-IV Gambling Scale Gambler Severity Scale Synonyms/Classification 1 or 2 admissions... ..... 0 to 69th percentile..... .... abstainer, social gambler 3 or 4 admissions... ..... 70 to 89th percentile... .... Problem gambler 5+ admissions......... ..... 90 to 100th percentile. .... Very serious or pathological A growing 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 models. 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 (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. 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 (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. GAI LINKS Test Comparison Checklist Cost (Test Unit Fee) Example Report Free Examination Kit GAI Research How To Order Tests