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The Catch-22 for Mrs. [Betty Anne Hoerr] and other staff members is that the sickest addicts often don't have insurance. And with so many nonpaying patients, the unit, by simply doing its job, may be signing its own death warrant.

For many addicts, "outpatient treatment is like spinning your wheels," says Al Respass, program administrator for Baltimore's Substance Abuse Bureau. "Detox services are critical, and there isn't much left for addicts in the city.

COLOR PHOTO 1 COLOR PHOTO 2 PHOTO; Nurse [Peggy Kuta] counsels a female patient at the Center for Chemical Dependency, part of Francis Scott Key Medical Center. A patient is skeptical about the value of a three-day program. Betty Anne Hoerr, an intake manager at [Francis Scott Key]'s detox unit, interviews a new patient./STAFF PHOTO GEORGE HOLSEY/STAFF PHOTO