If the Utah Legislature cuts the county's substance abuse funding as expected, hundreds of patients below the poverty line could be pushed out of public programs and forced to come up with big money for private treatment.

About 90 percent of the Utah County Health Department's substance abuse patients are at or below federal poverty guidelines, said Richard Nance, director of the Division of Substance Abuse. Others, like the 115 enrollees in the Drug Offender Reform Act program, are convicted felons who face long odds in landing a full-time job, let alone one with health insurance -- and even if they're that lucky, most insurance companies have phased out coverage for substance abuse treatment over the past 20 years, Nance said.

"Even if you have a job, the chances that you'd have insurance coverage for substance abuse is pretty small, and the benefits that are offered don't bear any direct relationship to how long the treatment actually takes," he said. "Since the 1980s, most of the responsibility for substance abuse treatment has been shifted off the back of commercial insurers and onto government programs."

Clients of DORA face one major additional challenge: If the program closes down, they must either find money for private treatment or risk being locked behind bars. Kent Krueger, 29, said prison time is a virtual guarantee if the program disappears before his six-month treatment is finished.

"If there wasn't this treatment available, I would go to prison," said the father of three. "I could not afford to pay the thousands and thousands of dollars. Unless you've got that money, it's not going to happen."

With funding for those government programs drying up, there's no easy answer to the treatment question. The $8-million-a-year DORA program was heavily criticized in a legislative audit Friday and could lose some or all of its state funding. The result is, many like Krueger would be forced to rely on family and friends to pay for private treatment, which can run into the hundreds and even thousands of dollars a month. That's hard enough for anyone, but perhaps uniquely so for recovering addicts, Nance said.

"A lot of them have burned all their bridges with family and friends and don't have two nickels to rub together when they come into treatment," he said. "They have many other problems in addition to their substance abuse problem when they come in here."

On the inpatient side, one business is defying convention and opening a residential treatment center in Payson even as others around the country are laying off workers and declaring bankruptcy. Steps Recovery Center will open in February -- a timing at least partially engineered to coincide with the county's funding challenges, said Director Mike Borup.

"With the budget cuts coming up and with the things going on in the county arena, that's one of the reasons we feel that we're going be such a viable option to the community," Borup said. "There's going to be a lot of these county-funded programs that are going away. I've read the articles and things, and I've talked to people and there's a huge concern in that arena."

Steps will run the average family about $7,500 a month -- no small expense, but Borup insists it's less than some other treatment centers in the area.

• Ace Stryker can be reached at 344-2556 or astryker@heraldextra.com.