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Identification of Gambling Problems in Primary Care

Properties of the NODS-CLiP Screening Tool

Cowlishaw, Sean PhD; McCambridge, Jim PhD; Kessler, David MD

doi: 10.1097/ADM.0000000000000429
Original Research

Introduction: There are several brief screening tools for gambling that possess promising psychometric properties, but have uncertain utility in generalist healthcare environments which prioritize prevention and brief interventions. This study describes an examination of the National Opinion Research Centre Diagnostic and Statistical Manual of Mental Disorders Screen for Gambling Problems (NODS-CLiP), in comparison with the Problem Gambling Severity Index (PGSI), when used to operationalize gambling problems across a spectrum of severity.

Methods: Data were obtained from 1058 primary care attendees recruited from 11 practices in England who completed various measures including the NODS-CLiP and PGSI. The performance of the former was defined by estimates of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs), when PGSI indicators of problem gambling (5+) and any gambling problems (1+), respectively, were reference standards.

Results: The NODS-CLiP demonstrated perfect sensitivity for problem gambling, along with high specificity and a NPV, but a low PPV. There was much lower sensitivity when the indicator of any gambling problems was the reference standard, with capture rates indicating only 20% of patients exhibiting low to moderate severity gambling problems (PGSI 1–4) were identified by the NODS-CLiP.

Conclusions: The NODS-CLiP performs well when identifying severe cases of problem gambling, but lacks sensitivity for less severe problems and may be unsuitable for settings which prioritize prevention and brief interventions. There is a need for screening measures which are sensitive across the full spectrum of risk and severity, and can support initiatives for improving identification and responses to gambling problems in healthcare settings such as primary care.

Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia (SC); Centre for Academic Primary Care, Bristol Medical School, University of Bristol, UK (SC, DK); Department of Health Sciences, University of York, UK (JM).

Send correspondence to Sean Cowlishaw, PhD, University of Melbourne, Melbourne, Victoria, Australia. E-mail:

Received 5 March, 2018

Accepted 26 May, 2018

Funding: The primary data collection was funded by the NIHR School for Primary Care Research (SPCR). This study did not receive any specific grant funding from agencies in the public, commercial, or not-for-profit sectors.

The authors have no competing interests to declare.

© 2018 American Society of Addiction Medicine