"DIRECT CONNECTION" IS MADE BY MPT TO SERVE ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

♪♪] >> JEFF: GOOD EVENING AND WELCOME TO YOUR "DIRECT CONNECTION."

WE BEGIN TONIGHT WITHED LATEST NEWS ON BREAST CANCER.

WHICH FINDS THE NUMBER OF BREAST CANCER CASES IS INCREASING, BUT FORTUNATELY THE NUMBER OF DEADS IS DECREASING.

WHAT'S THE BEST ADVICE NOW?

JOINING US FOR YOUR HEALTH SEGMENT IS UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL CENTER BREAST SURGEON Dr. ETHAN ROGERS THANK YOU FOR BEING WITH US.

>> MY PLEASURE.

>> Jeff: WHAT HAS BEEN SO EFFECTIVE OVER THE YEARS OVER THE DECADES IN REDUCING THE MORTALITY RATE FROM BREAST CANCER?

>> I THINK IN ONE WORD, MAMMOGRAMS.

AND THAT'S A VERY CLEAR THAT WHEN ROUTINE SCREENING MAMMOGRAPHY STARTED AND WAS ADAPTED AS STANDARD PRACTICE, THAT THE DETECTION RATE INCREASED, BECAUSE YOU ARE IDENTIFYING THINGS AT AN EARLIER STAGE.

AND OBVIOUSLY IF YOU FIND THINGS AT AN EARLIER STAGE YOU ARE MORE LIKELY TO TREAT IT WHEN IT IS NOT A PROBLEM VERSUS WHEN THE PATIENT CAN FEEL SOMETHING AND IT MORE THAN LIKELY IS GOING TO HAVE A WORSE OUTCOME THAN WHEN IT'S FOUND ON MAMMOGRAM.

THE OTHER THING THAT HAS DEFINITELY DECREASED THE MORTALITY RATE IS THE IMPROVEMENT IN THE DRUGS THAT WE HAVE TO TREAT BREAST CANCER.

BREAST CANCER IS A WELL FUNDED RESEARCH SUBJECT AND NEW DRUGS ARE COMING OUT ALMOST EVERY YEAR TO TREAT BREAST CANCER.

THAT IS WHY I TELL PATIENTS WHEN THEY ARE COMING THROUGH, EVEN IF THE WORST CASE SCENARIO HAPPENS DOWN THE ROAD THERE ARE NEW DRUGS COMING DOWN THE PIPELINE THAT MAYBE ABLE TO MANAGE THEIR PROBLEMS.

>> Jeff: I'VE HEARD IT SAID IF YOU ARE GOING TO HAVE A TOUGH DISEASE IT'S GOOD TO HAVE ONE WHERE THE MEDICAL AND PHARMACEUTICAL COMMUNITY ARE FOCUSED ON IMPROVING TREATMENTS.

>> PART OF THE REASON I GOT INTO THE BREAST CANCER BUSINESS BECAUSE OUR PATIENTS DO SO WELL RELATIVE TO OTHER CANCERS.

IT'S ALWAYS A PLEASURE FOR MY PERSPECTIVE TO SEE THOSE PATIENTS DO WELL, RATHER THAN THE OTHER WAY AROUND.

AND IT REALLY IS FORTUNATELY THE VAST MINORITY OF PATIENTS THAT DON'T DO WELL.

>> Jeff: SO WE TALKED ABOUT FINDING IT EARLY AND AS A SURGEON YOU WOULD RATHER OPERATE ON SOMEBODY WHEN IT'S AT AN EARLY STAGE?

>> SURE.

FOR A MULTITUDE OF REASONS.

ONE OF OF THE NUANCES OF BREAST CANCER SURGERY IT IS A COSMETIC FIELD.

IT DOES IMPACT PATIENTS FROM A PSYCHOSOCIAL STAND POINT AND WHAT THAT COSMETIC OUTCOME LOOKS LIKE AFTER A SURGERY.

WHEN WE CAN GET BREAST CANCERS WHEN THEY ARE SMALLER I HAVE TO TAKE OUT LESS TISSUE AND LESS INVASIVE FOR THE PATIENT.

FOR THAT REASON ALONE IT'S BENEFICIAL TO FIND THINGS EARLY.

>> LUMPECTOMY HAS THAT CHANGED AT ALL IN TERMS OF HOW OFTEN YOU DO ONE VERSUS A MASTECTOMY?

>> I FIND WE HAVE DONE MORE MASTECTOMIES OVER TIME THAT PERCENTAGE KEEPS INCREASING.

I THINK PART OF THAT IS PATIENTS ARE COMING AT IT FROM A PERSPECTIVE BOTH TREATING THEMSELVES UP HERE AND DOWN HERE AND NOT HAVING THAT PSYCHOLOGICAL IMPACT OF HAVING TO WORRY ABOUT A POTENTIAL RECURRENCE OR A NEW CANCER DOWN THE ROAD.

EVEN THOUGH FROM A STRAIGHTFORWARD STANDPOINT OF IS IT MORE LIKELY TO HAPPEN OR NOT?

MORE THAN LIKELY THEY WILL NEVER HAVE A PROBLEM EVER AGAIN.

BUT THIS WAY THEY REDUCE THEIR ANXIETY AND KEEPS THE RISK AS LOW AS POSSIBLE.

>> BACK TO MAMMOGRAMS.

IT SCARES PEOPLE BECAUSE THERE'S RADIATION AND FALSE POSITIVES WHICH PSYCHOLOGICALLY IS A TOUGH THING.

>> I THINK IF YOU TRAVELED ACROSS THE UNITED STATES IN AN AIRPLANE THAT IS THE SAME RADIATION EXPOSURE AS A MA'AM DPRAM.

IT'S VERY LOW AS FAR AS THAT IS CONCERNED.

I THINK WITH MOST PEOPLE, DENIAL IS A VERY POWERFUL POWERFUL THING AND PEOPLE WANT TO AVOID IDENTIFYING THINGS.

WHEN PATIENTS COME IN AFTER A CANCER HAS BEEN IDENTIFIED I TELL THEM THIS IS A GOOD THING THE ONLY REASON YOU HAVE BEEN GETTING MAMMOGRAMS IS TO FIND SOMETHING.

NOW THAT WE'VE FOUND SOMETHING WE CAN TAKE CARE OF IT AND MOVE ON WITH THE REST OF YOUR LIFE.

>> Jeff: I IMAGINE THE TECHNOLOGY HAS GOTTEN BETTER BUT THERE ARE OTHER WAYS OF DOING I ASCAN.

HOW OFTEN IS AN MRI AND I DON'T KNOW WHAT ELSE?

>> SPECIFICALLY WITH MAMMOGRAPHY ONE OF THE REASONS THAT DETECTION HAS BECOME SO MUCH BETTER OVER THE YEARS WE HAVE GONE FROM ANALOGUE FILMS TO DIGITAL FILMS.

AND WE WENT FROM 2D MAMMOGRAPHY TO 3D MAMMOGRAPHY.

AND OTHER THINGS THAT PLAY A ROLE IN THE WHOLE CADRE OF MESSAGING WE CAN DO, MRI'S ARE USUALLY RESERVED FOR VERY SPECIFIC PATIENTS, BECAUSE THEY ARE SO SENSITIVE.

THEY PROBABLY HAVE MORE OF A FALSE POSITIVE RATE THAN THE MAMMOGRAMS DO.

SO YOU HAVE TO BE VERY CAREFUL WHO GETS THEM AND WHO DOESN'T.

>> Jeff: REMIND OUR VIEWERS IF YOU HAVE A QUESTION ABOUT BREAST CANCER IN GENERAL YOU CAN SEND US AN E-MAIL LIVE QUESTIONS@MPT.ORG.

I READ THAT SELF EXAMS THEY USED TO TALK ABOUT SELF EXAMS ALL THE TIME.

AND IT'S KIND OF BEEN SIDELINED?

>> AS AN OFFICIAL RECOMMENDATION, IT IS NO LONGER RECOMMENDED BY THE CANCER SOCIETIES.

HOWEVER I STILL RECOMMEND MY PATIENTS DO IT, BECAUSE THERE ARE GOING TO BE A LARGE PERCENTAGE OF WOMEN WHO IDENTIFY THEIR CANCERS BY SELF PALPATION WHO MIGHT NOT VISIT A DOCTOR REGULARLY, WHO MIGHT NOT GO FOR SCREENING MAMMOGRAPHY.

THEY ARE GOING TO BE THE FIRST PERSON IS GOING TO IDENTIFY ANYTHING IN THAT SITUATION.

SO I TELL PEOPLE TO BE FAMILIAR WITH WHAT THEIR BREASTS FEEL LIKE, WHAT IS NORMAL TO THEM AND ABNORMAL TO THEM.

NOT GET BOGGED DOWN IN THE MINUTIA OF EVERY NOOK AND CRANNY BUT WHAT THEY SHOULD AND SHOULDN'T FEEL LIKE.

>> Jeff: IS BREAST CANCER TREATMENT EVER SURGERY BY ITSELF?

OR IS THERE ALWAYS RADIATION OR MEDICATION INVOLVED?

>> THERE'S CERTAIN -- SO NONINVASIVE BREAST CANCERS OR STAGE ZERO BREAST CANCERS ARE FREQUENTLY TREATED WITH SURGERY ALONE AS PATIENTS GET OLDER, THERE'S LESS OF A BENEFIT TO DOING RADIATION OR POTENTIALLY HORMONAL THERAPY WHICH CAN HAVE NEGATIVE SKBENSES WITH BONE DENSITY.

AND THE SIDE EFFECTS ARE ALWAYS GOOD FOR THE PATIENTS AS FAR AS QUALITY OF LIFE.

THEY ARE FREQUENTLY OLDER PATIENTS WHERE WE JUST DO SURGERY ALONE.

>> Jeff: EVERYBODY'S HEARD OF STAGES 1-4 IN VARIOUS CANCERS WHAT IS STAGE ZERO?

>> IT IS A NONINVASIVE BREAST CANCER WHEN IT COMES FROM THE MILK DUCKS, IT'S CALLED DCIS IT MEANS IT'S JUST CONFINED TO WITHIN THE MILK DUCTS AND IT DOES NOT HAVE ACCESS TO THE REST OF THE BODY.

THERE ARE ALL SORTS OF TYPES OF SKIN CANCER, MELANOMAS THAT CAN SPREAD, AND BASIL EXELS THAT YOU CUT OUT AND IT SOLVES THE PROBLEM.

DCIS IS MORE SIMILAR TO THAT IT IS A BREAST PROBLEM IT IS TO THE A WHOLE BODY PROBLEM.

>> Jeff: WE MENTIONED AT THE TOP THE INCIDENTS HAS GONE UP.

ANY THEORIES WERE?

AND WHO IS MOST AT RISK?

AND THE OTHER THING TO TOUCH ON IS THE INCREASED SKINSES AMONG YOUNGER WOMEN?

>> PROBABLY HAS WITH FORT D, OUR WHOLE POPULATION IS GETTING LARGER, OBESITY PROBABLY PLAYS A ROLE.

A SEDENTARY LIFESTYLE PROBABLY PLAYS A ROLE IN IT.

UNFORTUNATELY WITH MOST BREAST CANCER QUESTIONS WHEN IT COMES TO WHY, THE ANSWER IS A VERY UNSATISFACTORY I DON'T KNOW.

95% OF BREAST CANCERS YOU CAN NEVER IDENTIFY A SPECIFIC CAUSE.

AND AS THINGS TREND TOWARDS YOUNGER PATIENTS, ALMOST CERTAINLY THE ANSWER IS GOING TO BE THE UNSATISFACTORY IT'S ENVIRONMENTAL.

IT'S ALL THE THINGS WE COME IN CONTACT IN LIFE, THE FOODS WE EAT, THE THINGS WE DRINK.

ALL THOSE SORTS OF THINGS.

>> Jeff: IF SOMEBODY WANTS TO REDUCE THEIR RISK WHAT DO YOU DO?

TRY TO EAT HEALTHIER?

THAT IS NOT ALL THAT SEAING EITHER?

>> CORRECT.

WITH BREAST CANCER THERE IS APROBABLY A 30-70 SPLIT BETWEEN MODIFIABLE RISK FACTORS AND NON-MODIFIABLE RISK FACTORS.

MODIFIABLE RISK FACTORS ARE THINGS YOU CAN DO TO CHANGE THE OUTCOME.

NON-MODIFIABLE IS YOU ARE A WOMAN AND GETTING OLDER.

YOU CANNOT CHANGE THOSE.

THE MODIFIABLE RISK FACTORS ARE BMI, BODY MASS INDEX, WHETHER OR NOT YOU'RE HEALTHY AND ACTIVE.

ALCOHOL INTAKE.

ONE OF THOSE ODD THINGS WHERE YOU IF YOU DRINK TOO MUCH YOU PUT YOURSELF AT A HIGHER RISK, TOO LITTLE YOU PUT YOURSELF AT A HIGHER RISK.

BENJAMIN FRANKLIN EVERYTHING IN MODIFICATION.

>> Jeff: BLACK WOMEN ARE LESS LIKELY TO GET IT BUT IF THEY GET IT THEY ARE LIKELY TO GET AN AGGRESSIVE CASE.

WHAT WOULD YOUR RECOMMENDATIONS BE FOR MEMBERS OF THE BLACK COMMUNITY?

>> SAME RECOMMENDATIONS AS FROM ANY OTHER RACIAL COMMUNITY, IS GET SCREENING MAMMOGRAMS.

AND I THINK PART OF THE PROBLEM WITH THE STAGES AT WHICH THINGS ARE DIAGNOSED IS WITH AFRICAN-AMERICAN WOMEN OFTEN THEY ARE FOUND A LITTLE BIT LATER.

POTENTIALLY DUE TO ACCESS TO MAMMOGRAPHY, DISTRUST OF THE MEDICAL COMMUNITY.

ALL OF THOSE THINGS PLAY A ROLE.

BUT I THINK IF YOU LOOK STAGE TO STAGE WITH PARTICULARLY EARLY BREAST CANCERS, THE MORTALITY RATES ARE ABOUT THE SAME.

SO IT HAS TO DO WITH EARLY DETECTION AND FINDING THINGS WHEN IT HASN'T GONE TO THE LYMPH NODES AND BEYOND.

>> Jeff: VIEWER QUESTION IF YOU'VE HAD A MASTECTOMY BUT THE IMPLANT IS NOT SMOOTH OR RIPPLING IS THAT SOMETHING TO BE CONCERNED ABOUT?

WOULD THAT BE MORE THAN COSMETIC?

>> THERE ARE TWO THINGS RELATED TO IMPLANTEDS I WILL TRY TO FIGURE OUT WHAT THE SPECIFIC QUESTION.

THERE ARE TEXTURED IMPLANTS AND SMOOTH IMPLANTS.

PROTECTTERED IMPLANTS HAVE AN ASSOCIATION WITH A TYPE OF LYMPHOMA.

IF ANYONE IS HAVING A ISSUE -- IF IT IS JUST AN ISSUE OF RIPPLING THAT IS THE IMPLANTED ITSELF AND THE AMOUNT OF SKIN AND FAT OVER THE TOP OF IT.

YOU MIGHT SEE RIPPLES IN AN IMPLANT.

>> Jeff: I WANT TO NOTE WITH THE SHORT TIME LEFT THIS IS AN E-MAIL FROM SOMEONE WHO HAD A LUMPECTOMY FOUR WEEKS AGO AT ST. JOE'S GRATEFUL FOR THE CARE AND ENCOURAGES WOMEN TO GET MAMMOGRAMS AND TAKE ADVANTAGE OF FREE MAMMOGRAM PROGRAMS.

>> I AGREE WITH THAT.

>> WHAT IS THE MOST IMPORTANT THING?

>> BREAST CANCER IS NOT A DEATH SENTENCE UNDER THE VAST MAJORITY OF CIRCUMSTANCES.

AND I ALWAYS TELL MY PATIENTS EVERYDAY THAT THEY ARE GOING TO DO GREAT.

SO IT REALLY IS IMPORTANT TO GET MAMMOGRAMS TO FIND THINGS WHEN THEY ARE AT AN EARLY STAGE TO GUARANTEE THAT THEY HAVE DONE EVERYTHING TO BE SUCCESSFUL WITH THAT.

>> Jeff: Dr. ETHAN ROGERS WE APPRECIATE YOUR TIME.

NOW TO THE SAFEST BET IN SPORTS.

WHICH IS THAT ALL THE ADVERTISING FOR SPORTS BETTING IS LEADING MORE PEOPLE INTO GAMBLING ADDICTION.

GAMBLING HELP HOTLINES ARE BUSIER THAN EVER AS SUE COPPIN REPORTS.

>> JIM NOWLIN KNOWS WELL WHAT IT'S LIKE TO FACE A GAMBLING PROBLEM.

>> I SPENTSD THE FOUR YEARS HEIGHT TO GO FROM -- HIDING IT FROM MY WIFE.

I HAD STOMACH ISSUES ALL THE TIME FROM THE LYING AND THE DECEPTION AND THE MANIPULATION I HAD TO DO TO HIDE THE GAMBLING.

EVENTUALLY IT COST ME MY JOB.

I HAD A JOB THAT I LOVED.

I WOUND UP GETTING ARRESTED.

I FACED GOING TO JAIL.

>> JIM HAS BEEN IN RECOVERY FOR 35 YEARS NOW.

HE IS USING THIS EXPERIENCE TO HELP OTHERS.

HE IS ONE OF FIVE PEER RECOVERY SPECIALISTS WITH THE MARYLAND CENTER OF EXCELLENCE ON PROBLEM GAMBLING PART OF THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE.

>> WE CAN MEET PEOPLE THAT ARE STRUGGLING WITH THIS ADDICTION, WHETHER THEY WANT TO STOP, SLOW DOWN, OR WHATEVER SITUATION THEY'D LIKE TO BE WE CAN OFFER ASSISTANCE.

FREE, INPATIENT, FREE THERAPY, FREE LEGAL ADVICE ALL KINDS OF FREE THINGS THROUGH THE STATE OF MARYLAND FOR SOMEBODY LOOKING FOR THE HELP.

>> AND THE CALLS AND NEED FOR HELP ARE INCREASING, AS SPORTS BETTING CONTINUES TO EXPAND.

THE NATIONAL COUNCIL ON PROBLEM GAMBLING REPORTED A 45% INCREASE IN CALLS, TEXTS AND CHATS TO THE NATIONAL PROBLEM GAMBLING HELP LINE BETWEEN 2021 AND 2020.

AND FALL -- 2022.

AND CALLS ARE TICKING UP IN MARYLAND AS WELL WHERE AN ESTIMATED 4% OF RESIDENTS HAVE SOME KIND OF GAMBLING PROBLEM.

>> I CAN'T GIVE YOU AN EXACT NUMBER BUT WE ARE RISING SLOWLY AND MORE OF THE CALLS IN 2024 MAYBE A 15% INCREASE IN THE PEOPLE THAT WERE SAYING SPORTS BETTING IS MY PROBLEM SO DOUBLE FROM HEARING THAT SPORTS BETTING IS THE ISSUE.

>> THE AGE DEMOGRAPHICS ARE CHANGING, TOO.

>> WE GET A LOT OF CALLS FROM PARENTS THAT THEIR KIDS ARE STRUGGLING AND THEY DON'T KNOW WHAT TO DO.

UNFORTUNATELY, IF THEIR KIDS AND I WILL SAY KIDS BUT IF THEY ARE KIDS WHO ARE STRUGGLING UNLESS THE PERSON WANTS HELP THERE IS NOT A LOT WE CAN DO.

LIKE ANY ADDICTION UNLESS SOMEBODY WOULD LIKE TO GET SOME HELP YOU CAN'T DO A LOT.

WE SEE A LOT OF YOUNG PEOPLE COMING IN.

>> WHAT IS THE YOUNGEST YOU'VE SEEN?

>> WE'VE HAD CALLS ON 13, 14-YEAR-OLDS FROM THEIR PARENTS.

>> PROBLEM GAMBLERS AND THEIR FAMILIES FACE MANY CHALLENGES.

SOME LIFE-THREATENING.

>> WHAT HAS BEEN NOTED NATIONALLY, 20% OF INDIVIDUALS WHO HAVE A GAMBLING DISORDER, HAVE MADE ATTEMPTS AT SUICIDE.

SO THAT'S 20% OF INDIVIDUALS.

THE HIGHEST FOR ANY OTHER ADDICTION.

>> MEN ARE STILL THE MAJORITY WHEN IT COMES TO SEEKING HELP, BUT WOMEN ARE INCREASING IN NUMBER.

>> IT'S ABOUT 60%, 40% AT THIS POINT BUT THAT GAP KEEPS CLOSING.

ESPECIALLY WITH ON-LINE AND INTERNET AND THE MOBILE BETTING YOU DON'T HAVE TO BE GOING OUT TO WATCH A RACE OR A CASINO YOU CAN SIT ON YOUR COUCH IT'S AVAILABLE IT'S ACCESSIBLE.

>> NEXT UP FOR MARYLAND COULD BE INTERNET GAMBLING CURRENTLY AVAILABLE IN SIX STATES.

>> Jeff: AND JOINING US IN THE STUDIO TO ANSWER YOUR QUESTIONS ABOUT GAMBLING ADDICTION ARE MARY DREXLER AND JIM NOWLIN OF THE MARYLAND CENTER OF EXCELLENCE ON PROBLEM GAMBLING.

SO GREAT THAT YOU COULD JOIN US I APPRECIATE IT.

>> I GUESS A FEW YEARS AGO, THE STATE FUNDED A STUDY, A SURVEY OF HOW BIG GAMBLING ADDICTION WAS.

AND IT CAME UP WITH A NUMBER THREE OR FOUR PERCENT.

DOES THAT SEEM RIGHT?

>> THERE'S BEEN THREE STUDIES THUS FAR IN THE STATE AND IT AVERAGES AROUND 4% OF MARYLANDERS WHO FIND THEMSELVES WITH A GAMBLING PROBLEM OR DIAGNOSED WITH A GAMBLING DISORDER.

>> Jeff: IT SOUNDS LIKE A SMALL THING 3 OR 4%, AND IT'S MORE THAN 100,000 MARYLANDERS.

AND JIM, THAT WAS YOU?

>> THAT AWAS ME.

AND THAT'S THE THING THAT WE KNOW OF.

WE SAY 4% BECAUSE THERE'S SO MANY PEOPLE THAT ARE STRUGGLING WITH THIS DISEASE LIKE ANY ADDICTION THAT A MIGHT NOT RECOGNIZE THEY HAVE A PROBLEM, OR MIGHT NOT WANT TO COME FORWARD AND ADMIT THEY HAVE A PROBLEM TRYING TO HAJJ IT ON THEIR OWN.

SO THAT'S JUST THE PEOPLE THAT WE KNOW OF THAT HAVE REACHED OUT AND ASKED FOR HELP.

>> Jeff: I DON'T KNOW HOW DEEP YOU WANT TO GO INTO YOUR BACKGROUND.

WHAT FORM OF GAMBLING?

HOW LONG DID IT TAKE?

WAS THERE A PERIOD WHERE YOU THOUGHT I'M LOSING CONTROL OF THIS?

AND TELL US WHAT HAPPENED.

>> NO, IT'S FINE.

FOR ME AND MYSELF, I NEVER THOUGHT I HAD A PROBLEM GAMBLING.

I STARTED OUT WINNING SOME MONEY AND IT WAS FUN.

AND IT WAS ALL GOOD.

AND THIS WAS BACK IN THE DAYS BEFORE THE CASINOS WERE HERE IN MARYLAND.

AND BACK IN THE I DAYS WHERE YOU COULD BET ON A FOOTBALL GAME IT WAS WHO WON AND WHO LOST IT WAS NOT ACTION THROUGHOUT THE GAME.

IT WAS GOING BACK A WAYS.

I NEVER THOUGHT I HAD A PROBLEM.

ANYTIME I RAN INTO SOMEBODY THAT MIGHT HAVE BEEN CONCERNED ABOUT THE AMOUNT OF TIME I WAS RUNNING UP TO ATLANTIC CITY OR THE MONEY I WAS GAMBLING I WOULD TUNE THEM OUT BECAUSE I DID NOT WANT TO ADMIT I HAD A PROBLEM.

I DIDN'T THINK I HAD A PROBLEM.

I WAS SINGLE LIVING ON MY OWN AND PAYING MY BILLS, AND WHAT IS THE HARM?

AND SOMEWHERE ALONG THE LINE I CROSSED THIS IMAGINARY LINE AND IT BECAME MORE ABOUT THE ACTION AND IT WASN'T ABOUT THE MONEY.

AND THEN I FELT LIKE I WAS WINNING AND IF I DID LOSE, I'D HAVE TO PLAY AND WIN IT BACK.

SO YOU START CHASING YOUR LOSSES.

AND JUST LIKE ANY ADDICTION AT THE BEGINNING, IF I WAS PLAYING BLACK JACK AND TELL PEOPLE WHEN I TALK TO THEM, IF I'M PLAYING BLACK JACK FOR $20 AND I GET A BLACK JACK YOU WIN $35.

OVER TIME 35 WAS NOT THAT EXCITING.

THE ONLY WAY TO MAKE IT MORE EXCITING IS TO INCREASE THE BET AND INCREASE THE BET.

LIKE ALCOHOL OVER A PERIOD OF TIME OUR BODY DEVELOPS A TOLERANCE.

GAMBLING IS THE SAME WAY.

OVER A PERIOD OF TIME, WE NEED MORE HIGHER BET TO INCREASE THAT DOPAMINE HIT WE GET FROM THE ACTION.

AND IT GETS TO A POINT WHERE WE ARE OUT OF CONTROL AND DON'T KNOW HOW WE GOT THERE.

I SPENT THE MAJORITY MY WHOLE TIME GAMBLING IN DENIAL.

AND THAT'S WHAT COST ME MY JOB.

THAT'S WHAT CAUSED ME TO COMMIT A CRIME.

AND CAUSED ME TO GET ARRESTED BECAUSE I DIDN'T WANT TO ADMIT I HAD A PROBLEM.

I WAS BUSY TRYING TO HIDE THE GAMBLING THAT I WENTZ KIND OF CRAZY ON THE OTHER END.

>> Jeff: IT'S GREAT THAT YOU CAN SHARE THAT AND HELP OTHER PEOPLE.

LIKE OTHER FORMS OF ADDICTION ALCOHOLISM, YOU DON'T SAY YOU ARE A FORMER ALCOHOLIC YOU ARE A RECOVERING ALCOHOLIC FOREVER.

IS THAT HOW YOU THINK ABOUT IT?

>> ABSOLUTELY.

ABSOLUTELY.

AND IT'S BEEN THIS DECEMBER IT WILL BE 35 YEARS THAT I'VE BEEN IN RECOVERY.

I'M STILL IN RECOVERY AND I GO TO GA MEETINGS BECAUSE I WILL ALWAYS BE A PROBLEM GAMBLER I WILL ALWAYS HAVE THIS PROBLEM AND I ADMIT THAT NOW AND I CAN FACE IT NOW.

I'VE GOTTEN A LIFE THAT IS SO MUCH HEALTHIER AND EARNED THE TRUST BACK FROM MY WIFE AND FAMILY THAT I COULD PROBABLY TAKE A CERTAIN AMOUNT OF MONEY OUT AND GO TO A CASINO AND PLAY, BUT NOW I KNOW ENOUGH THAT I CAN'T STOP.

SO IF I WERE TO GO AND PLAY AND WERE TO WIN, I WOULD BE IN TROUBLE.

>> Jeff: THE WORST THING THAT COULD HAPPEN.

>> OR IF I WERE TO LOSE I WOULD BE IN TROUBLE.

I KNOW THE PROBLEM IS I CAN'T STOP.

I GO TO MEETINGS TO BE AWARE OF WHO I AM AND WHERE I'M FROM AND WHAT I'M CAPABLE OF.

>> Jeff: THE STATE FUNDS YOU SORT OF INDIRECTLY.

THERE IS AN EXCLUSION SYSTEM.

TELL US HOW IT ALL WORKS.

>> THERE IS A STATE PROBLEM GAMBLING FUND.

THOSE FUNDS WERE SETUP WHEN LEGISLATION WAS PASSED TO LEGALIZE GAMBLING HERE IN THE STATE OF MARYLAND.

SO WE DO RECEIVE THOSE FUNDS.

THEY ARE PRIMARILY FROM THE BRICK AND MORTAR CASINOS.

WHEN ON-LINE AND MOBILE SPORTS BETTING CAME THERE WAS NOT ANY FUNDING THAT WENT ALONG WITH THAT.

WE ARE LOOKING FOR THAT, BECAUSE SPORTS BETTING HAS INCREASED THE NUMBER OF CALLS TO OUR HELP LINE.

BUT THOSE PEOPLE WHO ARE CHOOSING TO GAMBLE, OUR THING IS TO PROMOTE HEALTHY CHOICES.

THOSE PEOPLE WHO ARE CHOOSING WE WANT THEM TO BE AWARE OF THE RESOURCES AVAILABLE AND ONE TOOL IS THE STATE'S VOLUNTARY EXCLUSION PROGRAM.

AND THAT'S IF THEY ARE IN A CASINO OR DOING ON-LINE BETTING, MOBILE BETTING, THERE IS AN OPPORTUNITY TO SIGN UP FOR MARYLAND'S VOLUNTARY EXCLUSION PROGRAM.

WHERE YOU ARE NOTABLE TO GAMBLE NOT EVEN TO ENTER THE CASINO IF YOU ARE ON THAT PROGRAM.

AND IN MARYLAND YOU CAN SIGN UP FOR TWO YEARS OR A LIFETIME.

THE SAME IS THE CASE ON-LINE THAT THERE IS A VOLUNTARY EXCLUSION PROGRAM AVAILABLE TO YOU.

>> Jeff: YOU WERE TALKING ABOUT HOW THE EXCITEMENT THRESHOLD CHANGES OVER TIME AND YOU GET USED TO IT.

DO THE NEWER FORMS OF GAMBLING THE IDEA YOU CAN PUT AN APP ON YOUR PHONE, AND IT'S ALL VERY FAST BETTING DURING THE GAME, NOT JUST BEFORE THE GAME.

DOES IT MAKE IT MORE ADDICTIVE?

>> ABSOLUTELY.

AND AGAIN WHEN YOU CROSS THIS IMAGINARY LINE IT'S NOT ABOUT THE MONEY.

IT'S ABOUT THE ACTION.

AND I'M ALWAYS TALKING TO PEOPLE, LIKE I SAID, IN THE OLD DAYS AND I SAY THE OLD DAYS, YOU BET ON WHO WON A FOOTBALL GAME OR WHO LOST A GAME.

AND IT MIGHT BE.

>> Jeff: YOU HAD TO GO TO VEGAS OR YOU HAD TO KNOW A GUY WHO KNEW A GUY.

>> ABSOLUTELY.

NOW YOU CAN TAKE A FOOTBALL GAME ON TONIGHT'S GAME AND I USE THE SUPER BOWL YOU BET ON A COIN TOSS.

YOU CAN BET ON THE QUARTERBACK HOW MANY INTERCEPTIONS THEY ARE GOING TO THROW.

AND IN THE SUPER BOWL LAST YEAR THEY HAD A LINE HOW MANY TIMES THE CAMERA SHOWED TAYLOR SWIFT YOU COULD BET ON THAT.

YOU COULD HAVE ACTION THROUGHOUT THE GAME IF YOU ARE LOSING, YOU COULD FIND SOMETHING ELSE TO BET ON.

>> Jeff: THE THING ABOUT SPORTS IS THAT EVERYBODY WHO READS THE SPORTS SECTION OR LISTENS TO SPORTS RADIO THINKS THEY KNOW MORE YOU DON'T HAVE TO KNOW MORE THAN EVERYBODY YOU HAVE TO KNOW MORE THAN THE AVERAGE BETTER OR THINK YOU HAVE AN INSIGHT OR AN EDGE.

AND WHERE IF YOU GO TO THE ROULETTE TABLE, NOBODY HAS AN EDGE.

IT'S JUST NUMBERS AND THE NUMBERS ARE RIGGED AGAINST YOU.

>> UNFORTUNATELY, A PROBLEM GAMBLER CAN SEE PATTERNS OR NUMBERS WHERE THERE MIGHT NOT BE ANY.

THEY CAN LOOK UP AT THE WHEEL AND SEE WHO NUMBERS HIT REGULARLY AND FIGURE THIS NUMBER IS DUE AGAIN OR THIS NUMBER IS DUE AGAIN.

AND THE SAME THING WITH BLACK JACK IF YOU GET ON A RUN YOU START PUSHING YOUR BETS BECAUSE YOU WANT TO MAKE MORE MONEY OBVIOUSLY.

AND SO WE CAN SEE PATTERNS OR BELIEVE THAT THERE ARE PATTERNS THERE THAT DON'T REALLY EXIST.

>> Jeff: THERE'S SOMEBODY WATCHING US WHO HAS A PROBLEM OR A FAMILY MEMBER OF SOMEBODY WHO HAS A PROBLEM WHO IS WATCHING US.

LET'S START WITH THE FAMILY MEMBER.

WHAT SHOULD THEY DO?

DO YOU CONFRONT SOMEBODY?

YOU WANT TO OFFER TO HELP?

YOU DON'T WANT TO INSULT THEM.

HOW DO YOU -- IT'S DIFFICULT.

>> NUMBER ONE, YOU START A CONVERSATION WITH SAYING THERE'S SOMETHING DIFFERENT GOING ON SOMETHING'S HAPPENING CAN YOU TELL ME A LITTLE BIT WHAT IS GOING ON YOU'VE BEEN ANXIOUS, IRRITABLE THEY MAY NOT WANT TO SHARE.

THAT IS THE REALITY.

BUT THAT DOESN'T MEAN THAT FAMILY MEMBER IF THEY ARE NOT BEING SUCCESSFUL IN ENGAGING THE GAMBLER CANNOT GET HELP FOR THEMSELVES AND THAT IS WHAT WE TRY AND LET FAMILY MEMBERS OR FRIENDS KNOW.

THEY CAN CALL 1-800 GAMBLER JUST LIKE THE GAMBLER CAN IF THEY FIND THEMSELVES GETTING IN TROUBLE AND THEY CAN GET SUPPORT.

WE WORK WITH THE MARYLAND COALITION OF FAMILIES THEY HAVE A FAMILY SUPPORT PEER SPECIALIST SPECIFICALLY FOR THE FAMILY MEMBERS AND OUR PEERS WORK WITH THAT PEER TO GET THE FAMILY MEMBERS THE HELP THEY NEED.

BUT IT'S DIFFICULT, BECAUSE PART OF THE ISSUES WITH THE PROBLEM GAMBLING IS PROBLEMS WITH RELATIONSHIPS.

YOU KNOW, JOBS GET LOST.

AND THEIR RELATIONSHIPS START TO BREAKDOWN.

THEY ARE LYING ABOUT THE TIME AND THE AMOUNT OF MONEY THEY ARE SPENDING GAMBLING.

AND THEN THAT SPOUSE OR FAMILY MEMBER IS TRYING TO PICK UP WHATEVER MESS HAS BEEN CREATED.

AND THAT CAN BE BY TRYING TO WORK MORE TO NOW PAY THE BILLS.

IT CAN BE LENDING MONEY TO THE GAMBLER EARLY ON IN THE GAMBLING.

BECAUSE THE GAMBLER IS GOING TO ASK.

THAT IS ONE OF THE SIGNS THEY KEEP ASKING FOR MONEY AND NOT TELLING YOU WHAT THE MONEY IS FOR.

>> Jeff: THAT IS "DIRECT CONNECTION" FOR THIS WEEK WE'RE BACK FRIDAY WITH "STATE CIRCLE" AND THE LATEST ON MARYLAND POLITICS.

JOIN US FOR THAT FRIDAY EVENING AT 7:00 P.M. ALL OF OUR PAST EPISODES ARE AVAILABLE ON-LINE, VIDEO.MPT.TV.

FOR ALL OF US AT MPT THANK YOU FOR WATCHING AND HAVE A GOOD NIGHT.

[♪♪]