Problem Gambling Awareness Month (PGAM) for Treatment Providers

Select resources and information on this page provided by the Cambridge Health Alliance Division on Addiction and Harvard Medical School Teaching Hospital.

How to Participate in Gambling Disorder Screening Day During Problem Gambling Awareness Month (PGAM)

In the Gambling Disorder Screening Day Toolkit, hosts and supporters will find resources and information on screening for Gambling Disorder and guidance on how to participate in Screening Day during Problem Gambling Awareness Month (PGAM) in March.

Introduction to Gambling Disorder Screening Day

Gambling Disorder Screening Day – Read an overview of Screening Day, including its history and purpose.

10th Annual Gambling Disorder Screening Day: Interview with Dr. Debi LaPlante – An interview with Dr. Debi LaPlante about the history, growth, and future expansion of Screening Day.

Why Host a Screening Day Event – Learn why Gambling Disorder screening is important year-round and how problem gambling impacts individuals and loved ones.

Gambling Disorder Screening Day: A Guide for Screeners – A comprehensive guide for screeners on how to prepare for and host a Screening Day event.

Materials for Screening Day Hosts

Brief Biosocial Gambling Screen (BBGS) – Brief screens can help people decide whether to seek formal evaluation of their gambling behavior. The 3-item BBGS is based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for Gambling Disorder. Download a printable copy of the BBGS or access the FCCG’s e-Screener BBGS.

Screening Day Promotion Guide – This guide provides outreach ideas and promotional language for Screening Day hosts and supporters.

Screening Day Graphics and Logos – Access and download our official promotional graphics and logos for all your Screening Day communications.

Screening Day Flyer Template – This downloadable and customizable flyer helps hosts spread the word about Screening Day.

The next Gambling Disorder Screening Day is March 12, 2024

Screening Day is an annual, one-day event intended to educate and support providers in screening for Gambling Disorder. Screening helps to identify individuals who should seek further assessment for potential gambling-related problems. It does not provide a diagnosis. Each year, this event takes place on the second Tuesday in March during Problem Gambling Awareness Month.

Client-facing organizations, community groups, other organizations, and individuals can participate in this event by screening their patients/clients for Gambling Disorder on Screening Day. We refer to this as ‘hosting’ a Screening Day event and these participants are called ‘Screeners.’

Anyone can host. This grassroots event is open to everyone interested. You do not need to be a gambling-specific organization to screen. Some other organizations who could screen are:

• Addiction service providers
• Mental health service providers
• Physicians (e.g., primary care and emergency medicine)
• Gerontologists
• Pediatricians
• Educators
• Youth community leaders
• Employee Assistance Plan service providers
• Veterans groups
• Corrections officials

Many cases of Gambling Disorder go undetected, in part due to limited assessment for this problem. Relatedly, very few people experiencing gambling-related problems actually receive treatment. Screening for Gambling Disorder by mental health providers is important, because many individuals experiencing gambling harms might already be seeking services for other expressions of addiction or mental health concerns. By screening clients in your setting, you are well positioned to find clients struggling with Gambling Disorder who may not have otherwise been connected with resources. Check out Why Screen for Gambling Disorder? for more information.

We provide a free Gambling Disorder Screening Day Toolkit to make hosting easy. We will guide you through how to use the Toolkit in the following sections. This Toolkit is freely available to the public and no official registration is required to use these resources. However, we strongly encourage organizations to register by sending us an email letting us know your intention of hosting a Screening Day event. This allows us to promote your organization’s efforts, and guides our yearly Toolkit updates to ensure it contains everything you need for a successful Screening Day. If you are in Florida and would like to register, please email The Florida Council on Compulsive Gambling (FCCG) at fccg@gamblinghelp.org. We will then know to promote and thank your organization on our PGAM Microsite as one of our screening partners.

10th Annual Gambling Disorder Screening Day: Interview with Dr. Debi LaPlante

This interview was conducted with Dr. Debi LaPlante, Director of the Division on Addiction at Cambridge Health Alliance. She helped found Gambling Disorder Screening Day in 2014. In this interview, we hear about the history of Screening Day, its growth over the last ten years, and Dr. LaPlante’s hopes for future expansion.

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Gambling Disorder Screening Day (Screening Day) is a one-day event held annually on the second Tuesday of March during Problem Gambling Awareness Month. Established in 2014, Screening Day has included supporters and screeners from Cambridge Health Alliance, Massachusetts and New England, the United States, and around the world. Screening Day has helped identify individuals in those regions who might have Gambling Disorder and should seek further assessment.

Although the FCCG supports year-round screening for gambling-related problems, Screening Day is an international movement designed to support providers in the identification of Gambling Disorder. Gambling Disorder leads to financial, emotional, social, occupational, and physical harms, yet many cases of Gambling Disorder go undetected, due to limited assessment for this problem. Screening Day addresses the imperative to detect gambling-related problems as early as possible, and the FCCG encourages all organizations and providers to participate in this annual event.

Why Screen for Gambling Disorder?

• Gambling Disorder leads to financial, emotional, social, occupational, and physical harms.
• Gambling Disorder affects about 1% of the general population, and subclinical past year gambling-related problems affect 2 – 3% of the general population.
• As much as 10% of primary care patients report lifetime Gambling Disorder, and an additional 5% report lifetime subclinical problems.
• People with gambling-related problems are more likely to smoke, consume excessive amounts of caffeine, have more emergency department visits, and be obese.
• Although nearly 50% of people who have gambling problems are in treatment for “something,” national studies have failed to identify anyone who currently reports being in treatment specifically for gambling-related problems.
• Many cases of Gambling Disorder go undetected, due to limited assessment for this problem.

What Should Happen at Gambling Disorder Screening?

• Complete a brief Gambling Disorder screen
• Provide educational materials on Gambling Disorder
• Individuals who screen positively or want to learn about additional help, resources, and information should be referred to the 24/7, Confidential, and Multlingual 888-ADMIT-IT Problem Gambling HelpLine for Florida

Hosting a screening event on Screening Day has never been easier. The Division’s Screening Day Toolkit contains a variety of free online tools and resources, including a printable and customizable Screening Day Flyer, BBGS e-Screener (Brief Biosocial Gambling Screen) and a one-page article What Is Gambling Disorder? The Division encourages organizations and individuals to share these tools and resources to educate staff and patients.

The following interview was conducted with Dr. Debi LaPlante, Director of the Division on Addiction at Cambridge Health Alliance. She helped found Gambling Disorder Screening Day in 2014. In this interview, we hear about the history of Screening Day, its growth over the last ten years, and Dr. LaPlante’s hopes for future expansion.

Getting Started

1. Familiarize yourself and your staff with the Gambling Disorder Screening Day Toolkit.

2. How knowledgeable are you and/or your organization about Gambling Disorder? If you need some background information, read What is Gambling Disorder? and Treating Addiction as a Syndrome. You should also watch How Gambling Becomes an Addiction.

3. Familiarize yourself and your staff with the Brief Biosocial Gambling Screen (BBGS). This is a three-question screener that you and your staff can use on Screening Day. A “yes” response to any single item indicates potential gambling-related problems and the need for additional evaluation. A “yes” response is not a diagnosis for Gambling Disorder. Your organization should develop a plan for how to screen on Screening Day. The BBGS is available in printable and electronic forms to best fit the needs of your staff.

4. Promote your event! We offer a Screening Day Promotion Guide that includes outreach ideas and promotional language for the event. Access and download our official promotional graphics and logos for your Screening Day communications. You can also customize the Screening Day flyer with the time and location of your event and display it with your announcements to let everyone know that you are hosting a Screening Day event.

5. Individuals who screen positively or want to learn about additional help, resources, and information should be referred to the 24/7, Confidential, and Multlingual 888-ADMIT-IT Problem Gambling HelpLine for Florida! Learn more about the HelpLine.

What to Do the Week Before Screening Day

1. Make sure to share information about Gambling Disorder and Screening Day through your channels. Tweet or post about the event (#GamblingScreen #GDSDToolkit, #GDSD), feature it in your newsletter, and talk about it with colleagues. Screening Day is an international grassroots event that uses word of mouth as its primary mode of sharing information and resources. Our Screening Day Promotion Guide includes outreach ideas and promotional language that you can use.

2. Communicate with your staff that when an individual screens positive with the BBGS, they should be referred to the 24/7, Confidential, and Multlingual 888-ADMIT-IT Problem Gambling HelpLine for Florida for additional help and resources.

What to Do on Screening Day

1. It’s time to screen. Let clients know today is Screening Day, and explain why you’re screening everyone today and request consent to proceed. Next, go through the three questions on the BBGS with them.

a. If clients screen negative: let the client know they screened negative. Share the 24/7, Confidential, and Multlingual 888-ADMIT-IT Problem Gambling HelpLine for Florida with them if they express interest or are concerned about their gambling or a loved-one’s gambling. Direct them to the FCCG’s website at gamblinghelp.org, and conduct the rest of the visit as you normally would.

b. If clients screen positive: let the client know they screened positive and need further assessment. Make clear that this is not a diagnosis, but is an indication that they would benefit from formal assessment for Gambling Disorder beyond the brief screen. Individuals who screen positively or want to learn about additional help, resources, and information should be referred to the 24/7, Confidential, and Multlingual 888-ADMIT-IT Problem Gambling HelpLine for Florida.

What to Do after Screening Day

1. Share your Screening Day results, including how many people were screened, and photos with the FCCG by emailing pgam@gamblinghelp.org. We will share your efforts as part of our PGAM outreach campaign!

Overview

Brief screens can help people decide whether to seek formal evaluation of their gambling behavior. The 3-item BBGS is based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for Gambling Disorder.

Scoring

A “yes” response to any single item indicates potential gambling-related problems and the need for additional evaluation.

Psychometric Properties

For identifying individuals with Gambling Disorder, Gebauer and colleagues (2010) report that the BBGS has good psychometric characteristics: high sensitivity (0.96) and high specificity (0.99). The Positive Predictive Value of the BBGS is 0.37. This suggests that one of the three individuals who screen positive on the BBGS will be identified as having Gambling Disorder after full follow-up.

Additional Evaluation

Researchers other than the original authors have completed independent evaluation of the BBGS. For example, Brett et al. (2014) concluded that the BBGS was psychometrically robust to the DSM-5’s diagnostic protocol changes, but specifically would improve if a two-item endorsement were adopted: high sensitivity (0.99) and high specificity (0.83). Likewise, an evaluation of the BBGS among a substance using population also suggested solid psychometric features: high sensitivity (0.91) and high specificity (0.87). Clinical researchers have used the BBGS with a number of populations, including veterans, college students, and opioid substitution therapy patients, among others.

Whether you’re hosting an event on Screening Day or simply support the goals of this initiative, you can do your part to get the word out! You can:

• Host a Screening Day event
• Promote your Screening Day event
• Encourage self-screening with the e-BBGS, a free digital resource
• Raise awareness about Gambling Disorder and the importance of screening
• Encourage clinical and client-facing organizations to participate in Screening Day and share with them the free Screening Day Toolkit

There are many ways that you or your organization can promote Screening Day, including:

• Social media posts
• Blog posts
• Email blasts
• Announcements in newsletters or on websites
• Press releases
• Signage and materials in waiting rooms or lobbies of healthcare or community centers

How you choose to promote Screening Day is up to you. As a starting point, consider the networks you have available to you and the message you’d like to communicate. For example, a healthcare provider might choose to promote their Screening Day event to patients via signage in their building’s lobby. They might also choose to encourage other providers to participate in Screening Day through an announcement in their organization’s newsletter. Non-client-facing individuals or organizations who support Screening Day might disseminate information about Gambling Disorder or encourage self-screening via an email blast to contact lists or through posts on social media.

Promotional Graphics

We encourage you to use our official promotional graphics and logos for your Screening Day communications. You can access and download these materials via our Dropbox.

Promoting on Social Media

Social media is a great way to promote Screening Day. If you or your organization uses social media, you already have a built-in audience for whatever you post!

When promoting this event on social media (e.g., Instagram or Twitter), we recommend using any combination of the following hashtags:

• #GDSD
• #GamblingScreen
• #PGAM2024

Below are a few sample social media posts. These can be adapted for various social media platforms.

• Gambling Disorder Screening Day is an international event that supports and encourages providers to screen their clients for Gambling Disorder. Find out how to participate this year on Tuesday, March 12: https://gamblinghelp.org/pgam/treatmentproviders #GDSD #PGAM2024
  
  
• Gambling Disorder Screening Day is a grassroots event that any person or organization can host. Want to screen this year on March 12? Check out the free #GDSD Toolkit and find out how you can participate in Florida: https://gamblinghelp.org/pgam/treatmentproviders #GamblingScreen #PGAM2024
  
  
• Screening for gambling problems is easy with free, anonymous resources! Check out the 3-question e-BBGS if you want to know more about your gambling. #GamblingScreen #PGAM2024 https://fccg.wufoo.com/forms/brief-biosocial-gambling-screen-bbgs/
  
  
• Gambling Disorder Screening Day is Tuesday, March 12! The free Screening Day Toolkit includes resources, educational content, and promotional materials from the Division on Addiction. #GamblingScreen #GDSD https://gamblinghelp.org/pgam/treatmentproviders

Promoting on Other Platforms

Below you will find a couple sample paragraphs about Gambling Disorder Screening Day. These can be tailored and adapted for newsletter or website announcements, blog posts, email blasts, and more.

• The 11th Annual Gambling Disorder Screening Day is Tuesday, March 12. Gambling Disorder leads to financial, emotional, social, occupational, and physical harms, yet many cases go undetected and untreated. Failure to detect gambling harm is due, in part, to limited screening for this problem. Gambling Disorder Screening Day is an international grassroots event designed to increase awareness of gambling harm, and support and encourage providers to screen for Gambling Disorder in a variety of settings. This event was established by the Division on Addiction at Cambridge Health Alliance, a Harvard medical school teaching hospital, in 2014. Screening Day occurs every year on the second Tuesday of Problem Gambling Awareness Month (March).
  
  
• Participating in Gambling Disorder Screening Day has never been easier with the free Screening Day Toolkit, which includes promotional materials, educational content, treatment resources, and an electronic version of the 3-question Brief Biosocial Gambling Screen. To learn more about Gambling Disorder Screening Day and how to participate, visit the FCCG’s website or email pgam@gamblinghelp.org.
  
  
• The 11th Annual Gambling Disorder Screening Day is Tuesday, March 12. Did you know that worldwide, less than 10% of people experiencing Gambling Disorder seek treatment for it? Screening is a low-cost way to raise awareness and help people learn when their gambling has crossed a line. To get more people thinking about their relationship with gambling, you can share the 3-question Brief Biosocial Gambling Screen.
  
  
• The 11th Annual Gambling Disorder Screening Day is Tuesday, March 12. Have you ever wondered if gambling has gone too far for you or someone you care about? Answer three simple questions to learn more about your relationship with gambling.

Gambling is betting something valuable on an event that is determined by chance. The gambler hopes that he or she will ‘win,’ and gain something of value. Once placed, a bet cannot be taken back. When most people think of gambling, they think of slots machines and casinos. But, it’s important to understand that playing bingo, buying lottery tickets, even betting on office pools – all of these, and many other activities, are forms of gambling.

Mental health professionals have developed criteria that help to identify when someone has a problem. For example, many professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. The DSM is a handbook published by the American Psychiatric Association. Professionals use the DSM to diagnose psychological problems. The newest version of the DSM lists Gambling Disorder alongside other addictive behaviors.

The DSM-5 provides a series of symptoms commonly found among people with gambling problems. The symptoms include:

A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period:

1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
2. Is restless or irritable when attempting to cut down or stop gambling.
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

B. The gambling behavior is not better explained by a manic episode.

People meet the DSM standard for Gambling Disorder when they satisfy four of these criteria. Gambling problems exist with every form of gambling activity. It’s not just associated with casinos or Internet gambling. Bingo players, lottery players, casino players, and friends playing poker all can develop Gambling Disorder.

People with Gambling Disorder continue gambling despite bad consequences. For example, they might not fulfill work or home duties, or have legal problems. They also might have repeated social problems, like getting into fights and conflicts with other people. People with Gambling Disorder are preoccupied with gambling. They may try to quit unsuccessfully or hide their behavior. They might also commit crimes to pay for their gambling.

In this video segment, Dr. Howard J. Shaffer, Director of the Division on Addiction, describes how gambling can become an addiction.

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The Division’s research agenda is driven, in part, by the Syndrome Model of Addiction, an overarching theoretical framework that conceptualizes various expressions of addiction (i.e., chemical or behavioral) as opportunistic disorders that have common underlying etiological factors. Figure 1 illustrates of these relationships. The Division uses a syndrome framework to understand addiction as a cluster of symptoms and signs with multiple opportunistic expressions, as well as to test various aspects of the model and disseminate findings.

Treating Addiction as a Syndrome

The following is an excerpt from Treating Addiction as a Syndrome: Bridging Research and Clinical Practice (Shaffer et al., 2017). This article first appeared in Trends in Medicine, a Harvard Medical School online blog.

“Addictive behaviors often coexist with other common mental health problems (Regier et al., 1990; Kessler et al., 2008), but traditional treatment models view different expressions of addiction as unique disorders (e.g., substance use disorder, alcohol use disorder, gambling disorder, etc.). When patients seeks treatment for a particular expression of addiction, clinicians usually refer them to services that “specialize” in the presenting problem. Consequently, because of the extent of co-occurring disorders among people with addiction, treatment-seekers might experience confusion and treatment fragmentation, leading to a decrease in clinical compliance.”

“One alternative, contemporary view conceptualizes addiction–expressed as behavioral (e.g., gambling) and substance (e.g., alcohol) involved–as a syndrome that shares common etiological vulnerabilities. Viewing addiction as a syndrome suggests that not all signs of symptoms are present all of the time. The hypothesis that there is a singular addiction with multiple expressions forms the basis of the Syndrome Model of Addiction (Shaffer et al., 2004). The Syndrome Model suggests that people inherit, encounter, and accumulate different life influences and experiences, which can interact or accumulate to form factors, ranging from neurobiological to psychosocial. Some factors or combinations of factors can increase the likelihood of addiction. If people then gain access to an object of addiction, they might develop increased motivation to seek and use the object (e.g., alcohol, drugs, gambling). Within the Syndrome Model, the emphasis is on the relationship between the person and their object of addiction. Addiction resides in the relationship and not in the object.”