Gambling Addiction Screening Tool by Cognitio+

Validated, Culturally Grounded, and Compliant with International & Philippine Standards

Purpose: To screen for vulnerability to online or offline gambling addiction among Filipino adolescents and adults in schools, workplaces, communities, and clinical settings.

✅ Compliance Framework

DSM-5-TR (Gambling Disorder): Diagnostic alignment
ICD-11 (6C50 – Gambling Disorder): Global classification
APA, AERA, NCME, ITC: Psychometric validity, ethical use
RA 9287 (Anti-Illegal Gambling Act): Distinguishes illegal vs. regulated gambling
RA 11036 (Mental Health Act): Early detection, destigmatization, access to care
Data Privacy Act (RA 10173): Secure, confidential handling
PCPG: Evidence-based risk assessment

Gambling Addiction Screening Tool

The following questions concern your involvement with gambling activities in the past 12 months. ⓘGambling includes: e-sabong, color/number games (e.g., "555", "6D"), live casino, sports betting, etc.
This does not include legal lotteries (like PCSO Lotto), or fantasy sports without real-money stakes.
❗ Please answer every question honestly.
If unsure, choose the answer closest to the truth.
This is a screening tool, not a diagnosis.

Demographic Information

Your information is confidential and used only for risk stratification.

Full Name

Age

Gender

Male Female LGBTQ+ Prefer not to say

Region Occupation/Status Monthly Income

Screening Questions (Past 12 Months)

Please answer based on your experience in the last year.

Have you placed bets or played games online for money (e.g., e-sabong, color game, live casino)? ⓘIncludes any real-money online gambling.
No Yes

Yes

Do you use more than one online gambling platform (e.g., 2+ apps or websites)?
No Yes
Have you tried to stop or cut down on online gambling, but couldn’t?
No Yes
Do you hide your gambling from family, friends, or employer?
No Yes
Do you feel guilty, anxious, or ashamed after gambling?
No Yes
Has your family or partner complained about your gambling habits?
No Yes
Have you missed school, work, or family duties because of gambling?
No Yes
Have you borrowed money, sold items, or used savings to fund gambling?
No Yes
Have you lied to cover up how much you gamble or lose?
No Yes
Do you chase losses (bet more to win back lost money)?
No Yes
Have you felt restless, irritable, or anxious when trying to stop?
No Yes
Have you used gambling to escape from stress, sadness, or problems?
No Yes
Have you gambled until your wallet is empty or your load is gone?
No Yes
Have you experienced legal or financial problems (e.g., debt, collection calls) due to gambling?
No Yes
Have you considered self-harm or felt hopeless because of gambling losses?
No Yes
Have you gambled with money meant for bills, food, or medicine?
No Yes
Do you gamble longer or spend more than you planned?
No Yes
Have you used gambling apps during class or work hours?
No Yes
Have you been involved in illegal activities (e.g., theft, scams) to get gambling money?
No Yes
Do you spend 3+ hours daily on gambling apps or groups?
No Yes

Informed Consent & Declaration Type Fullname (as a digital signature): Date:

🔐 Data Privacy & Ethical Safeguards

Encrypted storage in Philippine-based servers
No data shared with law enforcement or POGO employers
Anonymized reporting for schools/companies (e.g., % at risk)
Contact: hello@cognitioplus.com

⚠️ Legal Note: While online gambling is regulated under PAGCOR, participation by minors, employees during work hours, or using illegal platforms may violate RA 9287 and other laws.