A few questions...

Thanks for your interest in this project. This is a university-based research study that is being conducted by David Ledgerwood, PhD of the University of Windsor (Ontario), Dr. Lisa Najavits (Treatment Innovations), and Dr. Tracie Afifi of the University of Manitoba. The goal of the research is to help improve treatment. 

This project has clearance from the University of Windsor Research Ethics Board and adheres strictly to research ethics. 

Please fill out this brief questionnaire.  It does not obligate you in any way. You can also read a detailed document that describes what the study involves and what you would receive. Everything you write here is entirely confidential and there are no right or wrong answers to this survey.

We will get back to you. (Please be sure to provide a phone or email.) You can then decide if you want to participate and you would do an initial assessment. When you complete the initial assessment, you would be paid $55 CD (via an amazon.ca e-gift card).

If you prefer, we can go over this survey with you by phone.  Email us (info@seekingsafety.org) or call or text us (+1 617-299-1620).

Question Title

* 1. Are you interested in receiving up to 12 individual sessions of free counseling to help you reduce gambling? The sessions would be via telephone (you can do it from any location using a mobile phone, tablet, or computer)?

Question Title

* 2. Are you over age 18?

Question Title

* 3. Do you live in Ontario (the province of Canada)?

Question Title

* 4. If you said "yes" to all three questions above, please list an email address and/or phone below so that we can contact you back about this study. This is required -- but please know that any information you provide is totally confidential and will not be released or shared with anyone. If you do not want to provide that information then please get in touch with us directly by emailing info@seekingsafety.org or calling or texting +1-617-299-1610 (this is a US number). Thanks.

Question Title

* 5. Can we text to this number

Question Title

* 6. Answer "yes" or "no" for each of the following questions.
Please note that "gambling" below refers to bingo, VLT machines, lottery, casino, sports betting, business speculation, dog/horse track, jai alai, etc.-- any use of money for gaming/wagering. 

  Yes No Unclear
Have you ever felt the need to bet more and more money?
Have you ever had to lie to people important to you about how much you gamble?
This screen is from Johnson, E. E., Hamer, R., Nora, R. M., Tan, B., Eistenstein, N., & Englehart, C. (1988). The lie/bet questionnaire... Psychological Reports(80), 83-88.

Question Title

* 7. In your life, have you ever had any experience that was so frightening, horrible, or upsetting that you...

  Yes No Unclear
In the past month had nightmares about it or thought about it when you did not want to?
In the past month tried hard not to think about it or thought about it when you did not want to?
In the past month were constantly on guard, watchful or easily started?
In the past month felt numb or detached from other, activities or your surroundings?
Source: Kimerling, R., Ouimette, P., Prins, A., Nisco, P., Lawler, C., Cronkite, R., et al. (2006). Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care. Journal of General Internal Medicine, 21(1), 65-67.

Thanks for filling this out! We'll be in touch very soon. You can also contact us at any time: coordinator@treatment-innovations.org
Najavits, L. M. (2016). Adapted Initial PG/PTSD screen, Manitoba study. Unpublished measure. Treatment Innovations, Newton Centre, MA.