As the drug-related death toll rises in the United States, communities are trying to open more treatment beds. But an ongoing labor shortage among drug treatment staff is slowing those efforts.

Each year, roughly one of every four substance-abuse clinicians nationally chooses to leave the job, according to recent research. And that's not just turnover — leaving one job for another in the same field. As an Institute of Medicine report documented in 2006, there's been a shortage of addiction workers for decades. And the demand is only increasing; the Affordable Care Act and other federal laws have given millions more people insurance to help them pay for those services. If only there were enough counselors to treat them.

Amelie Gooding runs Phoenix House in Keene, N.H., and says she's been short a full-time counselor for a year and a half.

"Everybody thinks, 'Oh, there aren't enough beds!' " Gooding says. "But there's not enough treatment staff to open more beds."

Because she's understaffed, Gooding has to leave three of her 18 residential beds empty, and she cut her outpatient groups down to 50 percent capacity.

So where have all the counselors gone?

"For me, it got to be too heavy," says former counselor Melissa Chickering, who used to work for Gooding at the Phoenix House and still lives in the area.

Clinical directors would give their right arm to hire someone with Chickering's long resume, Gooding says. She has a master's degree in social work and 10 years of experience. Instead, the valued counselor now spends her days teaching courses in psychology and health sciences at local New Hampshire colleges.

The problem with addiction treatment, Chickering says, is you take on your clients' pain. Plus, she says, she found the lack of funding and coordination from the state criminal.

She remembers a particularly bad time when she was running an addiction program for teenagers.

"I had open beds," she says. "But a girl came in and was on the waiting list — she just didn't have the right funding." Because of the rules, Chickering had to reserve empty beds for clients who had a different kind of health insurance than the girl in front of her had.

"So she died while she was sitting on the waiting list," Chickering remembers. "And I went home that night, and I was like, 'I had an open bed!' How do you sit with that and be OK the next day?"

The problem isn't just burnout, other addiction counselors say, though the job entails many late nights and loads of paperwork. The biggest problem, they say, is the low pay — addiction counselors earn an average of about $40,000 a year, according to the Bureau of Labor Statistics.

Anne Herron leads workforce development for the federal Substance Abuse and Mental Health Administration — the agency that oversees services for the treatment of substance abuse. Federal officials are well-aware of the counseling shortage and are working on it, Herron says. Her agency is reaching out to high schools and colleges, developing training curricula.

Those initiatives are a start, she says, adding, "We would like to see more."

Becky Vaughn, an executive with the National Council for Behavioral Health, an industry group for state associations of addiction services, says she would like the federal government to reimburse tuition for people who are taking courses in addiction treatment.

In the meantime, the directors of a few clinics in New Hampshire say that the expanded coverage for addiction services that has come with Obamacare is already boosting counselor salaries. Staff will come, these employers say, if the clinics have the money to pay them.

Copyright 2021 New Hampshire Public Radio. To see more, visit New Hampshire Public Radio.