Catholic organizations running addiction treatment programs around the country are feeling the economic pinch not only from a drop in donation dollars and public funding but also in a ripple effect on intake and outcome.

"The economy affects the public systems that we depend on for referrals," said Maureen Dee, assistant executive director of Catholic Charities Services in the Diocese of Cleveland, which runs Chemical Dependency Services. "As their caseloads get bigger and the level of needs becomes more complex, they're not able to make those linkages, and people are falling through the cracks."

For instance, she said, the shrinking staff at the Department of Children and Family Services is unable to keep up with "engaging in leverage" to get families in crisis into treatment.

In the Diocese of Omaha, Neb., the tightened job market is affecting people in post-treatment.

"Going to a halfway house is a continuation of treatment, and getting a job is part of recovery," said Mike Phillips, director of behavioral health for Catholic Charities Campus for Hope. "But that's not necessarily working well. Some folks who lost their high status jobs are flowing into the [lower] market, and if an employer has a choice of hiring someone who was working for a Fortune 500 company versus someone who is just 30 days sober, you know which one they'll pick."

The program in Cleveland has residential facilities for men, women, women with children, and adolescent males, plus outpatient services.

"What we're also seeing is a growing concern for people who don't have a source of [insurance] reimbursement for getting the typical treatment services," said Dee, a licensed independent clinical social worker.

Many people who are marginally employed may not have health insurance as a benefit and can't afford premiums on their own. Others can't continue to pay for coverage when they lose their jobs, yet they don't qualify for Medicaid.

"We can get funds through the state and county public systems for medically indigent people, but, unfortunately, they aren't sufficient," Dee said. "We usually exhaust those funds, and then we have to absorb the costs of serving individuals who are not reimbursed for those services."

Intensifying pressures

Funding for addiction treatment is tight overall in Nebraska.

"It's usually at the bottom 10 of state spending," said Phillips, a licensed mental health practitioner with credentials in treating co-occurring chemical dependency and mental illness.

Campus for Hope has a 93-bed residential treatment facility, including detox and short- term therapy, plus outpatient services and 17 programs of various levels in the 23-county diocese.

"We're seeing the effect as far as how some people under stress cope with money and the economy," Phillips said. "They become helpless and feel hopeless, and their addictions really start blooming. Because they're anxious, they start using substances and it gets away from them. So we're seeing an increase in demand for services and a decrease in terms of available funds for treatment."

Budget cuts for public health care in Massachusetts are affecting Catholic Charities' Family Counseling and Guidance clinics in the Archdiocese of Boston.

"Funds are being limited by changes in the state health program and are limiting the amount of care that someone can access," said Debbie Rambo, vice president of programs and a licensed clinical social worker. "And at this time, we are seeing more people with an intense need, many with the dual diagnosis of mental health needs and substance abuse needs."

One of the challenges of delivering services, she added, is that 20 years ago, Massachusetts, like other states, began closing its state hospital system and created a system of community care.

"Now all the community services are being negatively impacted," Rambo said. "They did away with one system, created another and are dismantling the new system. Now there's no place for some people to get care."

Asking for assistance

The economic downturn is impacting related family services, too.

"People who are experiencing alcohol and drug problems themselves, and their loved ones, usually need a continuum of services and help, often financial, that's not available," said Deacon John T. O'Neill, spiritual director of the Alcohol and Drug Assistance Ministry in the Diocese of Austin, Texas.

For instance, addictive behaviors and the money involved may lead to default in paying for housing or utilities, or create an emergency need for food and other necessities.

"They might have legal, marital, emotional and a whole range of problems that fit right on top of alcohol or drugs," he said. "Normally, they would be helped by the St. Vincent de Paul Society and Catholic Charities, but donations to those organizations have dropped off."

O'Neill is a nationally recognized addictions specialist and author of several books in the field. He was ordained to the diaconate in 1998, and is part of the diocesan ministry of deacons who serve as a spiritually based gateway to helping people get into recovery.

Another problem, he noted, is that current health care may not fully address addiction treatments.

"It's a disease," he said, "and I think that everybody in this field is hopeful that whatever health care reform takes place, they won't leave this disease in the dregs."

Guest House, based in Lake Orion, Mich., runs addiction recovery programs for religious men and women. According to president and chief executive officer Daniel A. Kidd, donors to the program remain loyal, but giving is down.

"Maybe someone who gave $50 a month last year is only giving $25," he said. "But they're still committed."

More than 50 people a year name Guest House in their wills, but it's taking longer to settle estates because real estate sales are slow and property often is sold for less than expected. Stocks left to Guest House are worth less, too.

"Our board of trustees is committed to our mission," Kidd said. "So if anything is cut back, it will be corporate overhead, not our services."

Tough economic times are making one positive impact on addiction treatment.

"We're getting more calls from people who are desperate," Dee said. "They're saying: 'I'm down and out. I have no income and I can't even support myself, let alone my habit.' So they're asking for help."

Outreach service

According to the National Catholic Council on Addictions, now a component of Guest House, only 25 percent of dioceses have offices for addiction ministries or recovery programs. The other Catholic Charities services refer clients to community-based programs.

"We're doing all we can to increase our outreach," executive director Richard Thibodeau said.

NCCA can help parishes or dioceses to establish substance abuse ministries to provide interventions, resources and referrals to inpatient or outpatient facilities, or 12-Step programs like Alcoholics Anonymous and Narcotics Anonymous. NCCA also distributes "Prayers for Addicted Persons and Their Loved Ones", and is active in prison ministries.

"We have seen an increasing attendance in 12-Step programs, and the whole thing is being aggravated by the economy," Thibodeau said. "This is a critical time for people who are struggling with addictions."

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Maryann Gogniat Eidemiller writes from Pennsylvania.