In greater numbers than ever before, Islanders are looking for - and finding - the help to get clean and sober.

At the counseling branch of Martha's Vineyard Community Services, the caseload of clients hoping to kick a drug or alcohol habit has nearly tripled in the last four years. In 1996, substance abuse counselors there worked with 109 clients. In 2000, that number grew to 312.

In that same time period, advocates supplied a missing link on the Island when they established Vineyard House 1 and 2, residential homes for recovering addicts to get back on their feet after treatment for drug or alcohol addiction. Leaders of that group now plan to buy a third house to meet the needs of women in recovery.

Working closely with both Island Counseling and Vineyard House, the hospital is also doing its share to get services to people who need it. Most recently, the hospital has provided a home for a new acupuncture treatment program for people hooked on drugs, alcohol, tobacco or caffeine.

And finally, counselors say police here are increasingly willing to funnel some Islanders with drug or alcohol problems into treatment or counseling, and not straight into the court system.

"There are just many more treatment programs available on the Island now. It's sort of a case of if you build it they will come," said Jane Dreeben, the head of substance abuse counseling at Island Counseling.

Dr. Alan Hirshberg, the head of emergency services at the hospital, agrees. "As these programs become available, people are using them," he said. "There has been a need for a long time, and now people are reaching out."

Ms. Dreeben is reluctant to blame the increase in her agency's caseload on an alarming rise in drug or alcohol abuse across the Island. Rather, she points to population growth on the Island and a changing awareness about drugs and alcohol.

"I think that information about these issues is more accessible," she said. "The media is more interested, and substance abuse is more spoken about. People are looking at their own situations and thinking, ‘Maybe there's something going on here.' "

To be sure, the Vineyard is fertile territory for such problems. Counselors point to the isolation of Island life, especially in the bleak winter months, combined with the financial stresses brought on by a seasonal tourist economy. And according to West Tisbury police chief Beth Toomey, the more viable shoulder seasons coupled with a shortage of workers mean that many Islanders who own a business now get less downtime.

The Island also seems to attract newcomers who are seeking a place to recover from hard times. Hazel Teagan, the alcohol counselor at the hospital, acknowledged the notion that some people come here with broken wings, hoping to heal.

"People come here, thinking it's a utopia and that all their problems will go away," she sad. "But they actually just bring their problems with them."

Those problems get played out every day in the hospital, where many visits to the emergency room can be linked to alcohol or drugs - accidents, anxiety, dementia or depression, just to name a few, said Ms. Teagan.

"Substance abuse is not uncommonly part of the picture," said Dr. Hirshberg, adding that emergency room staff follow a protocol to refer such patients for alcohol counseling. In some cases, that's enough to get action, but doctors also run into resistance. "If a person is not willing to speak with a counselor or denies it's a problem, it's very difficult to assist them in getting the treatment," he said. Still, the track record is improving as health care providers in various agencies have established a close network.

"We see it as a team that is running more smoothly now," said Tom Bennett, head of Island Counseling. "We're all trying to coordinate and collaborate better."

Island Counseling is the only Island agency licensed to offer outpatient treatment and counseling for substance abuse. Their menu of services is broad. An early recovery group meets twice a week at the hospital for people who are thinking about stopping or have decided to quit their alcohol or drug use. In addition to individual counseling, there are family groups and sessions geared toward teenagers.

The newest additions are a community corrections programs, offering counseling to jail inmates and as an alternative to serving jail time, and an acupuncture detox service. Mr. Bennett said the majority of his agency's clients have no private health insurance, and he said that lack of insurance should not deter anyone from seeking out services.

The hospital once operated a substance abuse clinic, but that service was cut during the bankruptcy crisis five years ago. Now, the hospital offers emergency and evaluative services for people in trouble with substance abuse, and, as of October, has provided office space for the acupuncture detox center.

Other developments have also beefed up services. Mr. Bennett said the arrival of Dr. Charles Silberstein, a psychiatrist specializing in addiction, five years ago has made a difference. Dr. Silberstein was among the group that helped establish the the first Vineyard House, giving a home to recovering addicts and filling a gap on the Island.

"Before Vineyard House, we would send people to detox, and they would come back to outpatient treatment. But they'd end up in the same environment, and they would relapse," said Mr. Bennett. Now, residents of the Vineyard Houses commit to a one-year stay, and they attend at least four 12-step meetings a week.

None of the counselors who spoke with the Gazette this week underestimated the strength of 12-step programs on the Island. Indeed, they feel their work is bolstered by the presence of Alcoholics Anonymous and Narcotics Anonymous. "They do tremendous work," said Mr. Bennett. And there are also the Al-Anon groups where family members of drug addicts or alcoholics can find help.

Another front where Island Counseling has focused is the high school, where rates of substance abuse are known to be high, according to a recent survey of risk behaviors. Last week, Rob Doyle, a counselor at Island Counseling, invited a social worker from Maine to meet with school counselors and plan for a series of workshops in March.

Stephen Andrew of Portland, Me., said he hopes to get people to see teenagers here in a different light. "We need to invite students, parents and providers into a conversation about what works in the community and what needs to be enhanced," he said. "What doesn't work is for all the adults to gather and talk about kids, but that's the usual model."

Mr. Andrew said the goal should be focusing on teenagers' strengths and how to enhance them. "The fact that you have 99 kids in a SafeRides program," he said, "is amazing for a small Island."

While counselors are collaborating with the high school to address substance abuse among teens, they have also developed a new relationship with Island police. According to Mr. Bennett, "Most law enforcement here would prefer to see people get help."

Oak Bluffs police chief Joseph Carter, a member of the board at Vineyard House, put it this way. "It's important that we go after and detect illegal traffickers and dealers, but there are also a lot of folks who are sick. It's an illness, and they need help," he said. "We're very selective about who we approach and who we feel needs to be steered toward Island Counseling or Vineyard House."

Chief Carter said he intentionally got involved with the Vineyard House leadership to send a message to his officers. "I wanted to set an example that there's more than one approach," he said. "We can't lock everybody up."