Michael Rosen, a recovering gambling addict, helps manage the state’s increasingly busy 1-800-GAMBLER helpline. He directs the desperate to Gambler’s Anonymous because the state offers almost no free treatment to addicts. (Andre Chung/For The Washington Post)

Michael Rosen listens to the wreckage that the $1 billion gambling industry has wrought in Maryland.

He listens to the man, $400,000 in debt, whose wife threw him out of the house and told him he couldn’t see his kids again unless he gave up gambling. He listens to the gambler who went on a three-day blackjack binge without sleeping and rarely eating. He listens to the woman facing a jail term for embezzling $135,000 to feed her gambling addiction.

Rosen, who helps manage the state’s increasingly busy 1-800-GAMBLER help line, commiserates with the desperate and directs many to Gamblers Anonymous meetings. But he can’t suggest any free treatment programs because Maryland, one of the country’s most concentrated casino markets, doesn’t offer any. That sets it apart from Delaware, Connecticut and many other casino states, even as experts believe that gambling addiction in Maryland is on the rise.

The problem is “absolutely getting worse,” according to Rosen, a recovering gambling addict who works as a counselor for the Maryland Center of Excellence on Problem Gambling at the University of Maryland School of Medicine.

The state’s toll-free hotline has taken calls in the past year from 619 people seeking help. That was up from 533 calls the year before and 431 calls the year before that.

A dealer picks up a card during a 2013 poker game at Maryland Live Casino. The state has five casinos, thousands of gambling addicats and almost no free treatment programs. (Sarah L. Voisin/The Washington Post)

Nearly 900 people have legally barred themselves from stepping inside a casino through the state’s Voluntary Exclusion Program. Two years ago, only 204 people were on the list.

In the first five months of this year, police were called to Maryland casinos four times to respond to children or seniors being left alone in cars while their parents or caregivers were inside gambling, according to reports compiled by the Maryland Lottery and Gaming Control Commission. And the 893 people who had themselves banned from casinos? Thirty-seven couldn’t stay away and were reported for trespassing on casino property.

Many of the problem gamblers most in need of help don’t have the funds or health insurance to cover private addiction treatment.

“When gamblers reach out to us, they’re in crisis . . . it’s out of control, they don’t have any money,” said Deborah Haskins, president of the Maryland Council on Problem Gambling. “When the person doesn’t have treatment as an option, it’s like you’re putting a brick wall in front of them. You’re commending them for taking the first steps, but then you have nothing else to provide them. It’s very frustrating.”

‘Vegas came to Maryland’

The first casino in Maryland opened its doors five years ago this month. Since then, four more have debuted, and a giant, the $1.3 billion MGM National Harbor in Prince George’s County, is set to open late next year.

From a financial standpoint, the casinos have been big winners for the state. Led by Maryland Live and Horseshoe Baltimore, they took in just over $1 billion in the fiscal year ending June 30. The state’s cut was $487 million, with the bulk of the money — $388 million — earmarked for Maryland’s Education Trust Fund.

The rewards are well documented, but the gambling fallout is harder to calculate.

The calls to the help line and the additions to the Voluntary Exclusion list represent just the tip of the addiction iceberg, experts say, and tens of thousands of Marylanders are in danger of becoming casualties.

“Many of the effects are not obviously visible,” said Keith Whyte, executive director of the National Council on Problem Gambling. “Things like bankruptcy for example, unpaid credit card debt. We call it the hidden addiction because it’s often a hidden driver of health-care and criminal-justice costs.”

Marie is one of the estimated 150,000 Marylanders who a 2009 state survey found suffer from a moderate to severe gambling addiction. (The state was supposed to release a follow-up study this year but decided to postpone it until after the opening of MGM National Harbor in 2016.)

Marie was a full year into recovery when she pulled into a Northern Virginia 7-Eleven in early 2013. She had already had herself officially banned from casinos in Maryland, Delaware and West Virginia. She was regularly attending Gamblers Anonymous meetings and was getting her life back in order after years of personal and professional chaos.

But the pull was still there. In the gas station, Marie, who agreed to be identified by her middle name and asked that her last name not be used, bought an instant lottery ticket, took out a quarter and scratched to see if any numbers matched. Then she bought another. And another. Three hours later, down $400, Marie left the convenience store feeling guilty and ashamed, vowing, again, to kick gambling for good.

But for the self-employed 51-year-old woman with a college degree, temptation lurks everywhere. Last year, Horseshoe Baltimore opened just a few miles from where she lives. Traveling down Interstate 95 for work takes Marie past signs for Maryland Live, the state’s busiest and most profitable casino. And the opening of MGM National Harbor next year lurks in her mind.

“I stopped going to Las Vegas,” she said, “but then Las Vegas came to Maryland.”

The Gamblers Anonymous meetings provided comfort and relief, but getting additional treatment for gambling addiction was out of reach. “I was flat broke,” she said. “How do you get to go to one of these places when you’re flat broke?”

Marie’s question is one that Maryland has not answered. Other states have.

Two years ago, a national survey showed that the vast majority of the states that provide funding to address problem gambling direct specific funding for treatment. In neighboring Delaware, free treatment is available for anyone with a gambling issue, including family members of problem gamblers. Connecticut, which has two casinos, spends $1.3 million on clinical services for problem gambling treatment. Free treatment is available at 16 locations around the state.

In Maryland, the casinos are required to contribute to a fund that helps address problem gambling and is administered by the state’s Department of Health and Mental Hygiene. The casinos are assessed $425 per slot machine and $500 per table game each year.

In the past fiscal year, that came to just under $4 million — or less than half a percent of the casinos’ annual total revenue. Most of that money went to the Maryland Center of Excellence on Problem Gambling, where it’s used to increase the number of trained counselors and health providers equipped to deal with gambling addiction issues and fund research, public awareness campaigns, the addiction hotline and peer counseling services conducted by Rosen.

What it is not used for, so far, is actual treatment. Outside of self-help groups such as Gamblers Anonymous, free counseling is almost nonexistent. In Maryland, pretty much the only way to get real treatment is to have private insurance that will pick up the tab.

So far, legislators in Annapolis have not made publicly funded treatment a priority, acknowledges Del. Eric G. Luedtke (D-Montgomery County), the House chairman of the Joint Committee on Gaming Oversight.

“It doesn’t make a whole lot of sense for us to put a ton of effort into prevention, but then just ignore the people who got the addiction despite the prevention efforts. I’d like to see us do that,” Luedtke said. “It’s a challenge with the budget climate, but I would argue that with the amount of money the state’s bringing in, we should release some of that to helping subsidize treatment.”

But, so far, no bills have been introduced in Annapolis.

Sen. Paul G. Pinsky (D-Prince George’s) led the charge against allowing the expansion of gambling in Maryland and pushed for casinos to give a higher percentage of their revenue to address problem gambling issues. He says that he was unaware that none of the funding was being used directly for treatment and that he believes that should be changed.

“It’s just like a drug addiction,” said Pinsky. “And just like you don’t put cocaine in front of an addict, building casinos near where working people who have limited disposable income, that was always a concern for me.”

Thomas Truss, a Baltimore psychologist who has nearly four decades of experience dealing with addiction, believes treatment well beyond the peer support offered by Gamblers Anonymous is required for problem gamblers to conquer their problems.

The state and the casinos need to act, says Truss, who is now in private practice but once served as the clinical director at the now-closed Johns Hopkins Center for Pathological Gambling.

“To do nothing is increasing the likelihood of attempted suicides,” he argues. “To do nothing is certainly to worsen the person’s financial history and, in most cases, family despair.”