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Are online gambling and sports betting new to your area? Are gambling advertisements catching your eye? Have you noticed sports and news shows covering the spread? Recent changes in laws have made gambling widely accessible, and its popularity has soared.

Occasional bets are rarely an issue. But uncontrolled gambling can lead to financial, psychological, physical, and social consequences, some of which are extreme. Understanding whether gambling is becoming a problem in your life can help you head off the worst of these issues and refocus on having more meaning, happiness, and psychological richness in your life. Gambling screening is a good first step.

Can you screen yourself for problem gambling?

Yes. Screening yourself is easy. The Brief Biosocial Gambling Screen (note: automatic download) is a validated way to screen for gambling disorder. It has three yes-or-no questions. Ask yourself:

• During the past 12 months, have you become restless, irritable, or anxious when trying to stop/cut down on gambling?
• During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
• During the past 12 months, did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends, or welfare?

What do your answers mean?

Answering yes to any one of these questions suggests that you are at higher risk for experiencing gambling disorder. Put simply, this is an addiction to gambling. Like other expressions of addiction, for gambling this includes loss of control, craving, and continuing despite bad consequences. Unique to gambling, it also often means chasing your losses.

A yes doesn’t mean that you are definitely experiencing a problem with gambling. But it might be valuable for you to seek a more in-depth assessment of your gambling behavior. To find an organization or person qualified to help, ask a health care provider, your local department of public health, or an advocacy group like the National Council on Problem Gambling.

Are you ready for change?

Your readiness to change a behavior matters when deciding the best first steps for making a change. If someone asks you whether you want to change your gambling, what would you say?

Depending on your answer, you might seek out different solutions. What’s most important initially is choosing a solution that feels like the right fit for you.

What if you don’t feel ready to change? If you haven’t thought about your gambling or only occasionally think about changing your gambling, you might explore lower intensity actions. For example, you could

• read more about how gambling could create a problem for you
• listen to stories of those who have lived experience with gambling disorder.

If you are committed to making a change or are already trying to change, you might seek out more engaging resources and strategies to support those decisions, like attending self-help groups or participating in treatment.

Read on for more details on choices you might make.

What options for change are available if you want to continue gambling?

If you want to keep gambling in some way, you might want to stick to lower-risk gambling guidelines:

• gamble no more than 1% of household income
• gamble no more than four days per month
• avoid regularly gambling at more than two types of games, such as playing the lottery and betting on sports.

Other ways to reduce your risk of gambling harm include:

• Plan ahead and set your own personal limits.
• Keep your entertainment budget in mind if you decide to gamble.
• Consider leaving credit cards and debit cards at home and use cash instead.
• Schedule other activities directly after your gambling to create a time limit.
• Limit your use of alcohol and other drugs if you decide to gamble.

What are easy first steps toward reducing or stopping gambling?

If you’re just starting to think about change, consider learning more about gambling, problem gambling, and ways to change from

• blogs, like The BASIS
• books like Change Your Gambling, Change Your Life
• podcasts like After Gambling, All-In, and Fall In, which offer expert interviews, personal recovery stories, and more.

Some YouTube clips demystify gambling, such as how slot machines work, the limits of skill and knowledge in gambling, and how gambling can become an addiction. These sources might help you think about your own gambling in new ways, potentially identifying behaviors that you need to change.

What are some slightly more active steps toward change?

If you’re looking for a slightly more active approach, you can consider engaging in traditional self-help experiences such as helplines and chatlines or Gamblers Anonymous.

Another option is self-help workbooks. Your First Step to Change is a popular workbook that provides information about problem gambling, self-screening exercises for gambling and related conditions like anxiety and depression, and change exercises to get started. A clinical trial of this resource suggested that users were more likely than others to report having recently abstained from gambling.

Watch out for gambling misinformation

As you investigate options, keep in mind that the quality of information available can vary and may even include misinformation. Misinformation is incorrect or misleading information. Research suggests that some common types of gambling misinformation might reinforce harmful beliefs or risky behaviors.

For example, some gambling books, websites, and other resources exaggerate your likelihood of winning, highlight win and loss streaks as important (especially for chance-based games like slots), and suggest ways to change your luck to gain an edge. These misleading ideas can help you to believe you’re more likely to win than you actually are, and set you up for failure.

The bottom line

Taking a simple self-screening test can start you on a journey toward better gambling-related health. Keep in mind that change can take time and won’t necessarily be a straight path.

If you take a step toward change and then a step back, nothing is stopping you from taking a step forward again. Talking with a care provider and getting a comprehensive assessment can help you understand whether formal treatment for gambling is a promising option for you.

About the Author

Debi LaPlante, PhD, Contributor

Dr. Debi LaPlante is director of the division on addiction at the Cambridge Health Alliance, and an associate professor of psychiatry at Harvard Medical School. She joined the division in 2001 and is involved with its … See Full Bio View all posts by Debi LaPlante, PhD

Recently, a friend asked me about tonsil stones. He has sore throats several times a year, which are instantly relieved by gargling to remove them. When I told him I thought tonsil stones were pretty rare, he asked: “Are you sure about that? My ear, nose, and throat doctor says they’re common as rocks.” (Get it? stones? rocks?)

It turns out, my friend and his doctor are on to something. Tonsil stones are surprisingly common and often quite annoying. Here’s what to know and do.

What are tonsil stones?

Tonsil stones (medical term: tonsilloliths) are small white or yellow deposits on the tonsils. They develop when bacteria, saliva, food particles, and debris from cells lining the mouth get trapped in tiny indentations called crypts.

They vary considerably between people, including:

• Size. They may be so small that you can’t see them with the naked eye. Or they may grow to the size of gravel or, rarely, much larger.
• Consistency. They’re often soft but may calcify, becoming hard as a rock. Hence, the name.
• How long they last. Tonsil stones can last days to weeks, or may persist far longer before they break up and fall out.
• How often they occur. New tonsilloliths may appear several times each month or just once or twice a year.

While they’re more likely to form if you have poor oral hygiene, good oral hygiene doesn’t provide complete protection. Even those who brush, floss, and see their dentists regularly can develop tonsil stones.

How common are tonsil stones?

You’ve heard of kidney stones and gallstones, right? Clearly, those conditions are better known than tonsil stones. Yet tonsil stones are far more common: studies suggest that up to 40% of the population have them. Fortunately, unlike kidney stones and gallstones, tonsil stones are usually harmless.

What are the symptoms of tonsil stones?

Often people have no symptoms. In fact, if tonsil stones are small enough, you may not even know you have them. When tonsil stones do cause symptoms, the most common ones are:

• sore throat, or an irritation that feels as though something is stuck in the throat
• bad breath
• cough
• discomfort with swallowing
• throat infections.

Who gets tonsil stones?

Anyone who has tonsils can get them. However, some people are more likely than others to form tonsil stones, including those who

• have tonsils with lots of indentations and irregular surfaces rather than a smooth surface
• smoke
• drink lots of sugary beverages
• have poor oral hygiene
• have a family history of tonsil stones.

How are tonsil stones treated?

That depends on whether you have symptoms and how severe the symptoms are.

• If you have no symptoms, tonsil stones may require no treatment.
• If you do have symptoms, gargling with salt water or removing tonsil stones with a cotton swab or a water flosser usually helps. Avoid trying to remove them with sharp, firm objects like a toothpick or a pen, as that can damage your throat or tonsils.
• If your tonsils are inflamed, swollen, or infected, your doctor may prescribe antibiotics or anti-inflammatory medications.

Is surgery ever necessary?

Occasionally, surgery may be warranted. It’s generally reserved for people with severe symptoms or frequent infections who don’t improve with the measures mentioned above.

Surgical options are:

• tonsillectomy, which is removing the tonsils
• cryptolysis, which uses laser, electrical current, or radio waves to smooth the deep indentations in tonsils that allow stones to form.

Can tonsil stones be prevented?

Yes, there are ways to reduce the risk that tonsil stones will recur. Experts recommend the following:

• Brush your teeth and tongue regularly (at least twice a day: in the morning and before sleep).
• Floss regularly.
• Gargle with salt water after eating.
• Eliminate foods and drinks that contain a lot of sugar, which feeds bacteria that can help stones form.
• Don’t smoke, because smoking irritates and inflames tonsils, which can encourage stone formation. The same may apply to vaping, though there is limited research to rely upon.

The bottom line

Considering how common tonsil stones are and how bothersome they can be, it seems strange that they aren’t more well known. Maybe that’s because they often get better on their own, or people figure out how to deal with them without needing medical attention.

I hope you aren’t one of the many millions of people bothered by tonsil stones. But if you are, it’s good to know that they’re generally harmless and can be readily treated and prevented.

Now that you know more about them, feel free to spread the word: tonsil stones should be a secret no more.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD