| TWENTY QUESTIONS |
| 1. | Did you ever lose time from work or school due to gambling?
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| 2. | Has gambling ever made your home life unhappy?
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| 3. | Did gambling affect your reputation?
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| 4. | Have you ever felt remorse after gambling?
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| 5. | Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties? |
| 6. | Did gambling cause a decrease in your ambition or efficiency?
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| 7. | After losing did you feel you must return as soon as possible and win back your losses?
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| 8. | After a win did you have a strong urge to return and win more?
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| 9. | Did you often gamble until your last dollar was gone?
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| 10. | Did you ever borrow to finance your gambling?
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| 11. | Have you ever sold anything to finance gambling?
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| 12. | Were you reluctant to use "gambling money" for normal expenditures?
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| 13. | Did gambling make you careless of the welfare of yourself or your family?
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| 14. | Did you ever gamble longer than you had planned?
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| 15. | Have you ever gambled to escape worry or trouble?
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| 16. | Have you ever committed, or considered committing, an illegal act to finance gambling?
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| 17. | Did gambling cause you to have difficulty in sleeping?
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| 18. | Do arguments, disappointments or frustrations create within you an urge to gamble?
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| 19. | Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
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| 20. | Have you ever considered self destruction or suicide as a result of your gambling? |
