On the upper floor of a modest church, the walls are alive with color and compassion. Artwork depicting outstretched helping hands brightens the main room, surrounded by handwritten messages of encouragement and photos of smiling people finding their way through darkness.
Once solely a place of worship, Central Methodist Church — also known as Galveston Central Church — now serves a broader mission. Since 2018, the church has housed a clinic and refuge for people struggling with substance use disorder (SUD), staffed by doctors, nurses, medical aides, and other support personnel. At Grace Clinic, the focus is on a simple message: No one must face recovery alone.
Dr. Carlos Dostal, who directs the Internal Medicine Primary Care Pavilion SUD Clinic at The University of Texas Medical Branch (UTMB Health), sets the tone for the workday at Grace by asking a room full of busy, noisy staff to take a pause.
“Let’s all stop and reflect for a moment,” Dostal said. “We need to think about how we can best help our patients, our co-workers, and our preceptors.”
The room falls silent. After a few moments, everyone resumes work. Groups of researchers huddle around laptops. Nurses and aides begin speaking with patients, while doctors step into exam rooms for consultations.
So begins each Tuesday morning at the clinic, from 8 to 11 a.m. On average, about 20 patients are seen during that time. Patients have access to a physician as well as a care team that includes a counselor, an occupational therapist, and social workers who help address additional needs.
Dostal said the church’s clinical substance use disorder efforts are supported by funding from the Sealy & Smith Foundation through the Galveston Safe Against Fentanyl Emergencies (G-SAFE) grant. The grant was awarded to Kathryn Cunningham, PhD, who leads the Center for Addiction Sciences and Therapeutics at UTMB, and Dr. Miles Farr, medical director of Grace Clinic as well as St. Vincent’s Hope Clinic.
“Drs. Cunningham and Farr are my mentors, and I’ve had the privilege of working with them since the initial Grace SUD pilot clinics in 2023,” Dostal said.
The clinic was designed as a walk-in model to meet patients where they already gathered, with a focus on serving uninsured and unhoused individuals.
“Over time, we also began caring for individuals who had insurance but still lacked access to appropriate substance use disorder services elsewhere,” Dostal said. “Because the Grace SUD model does not allow us to bill insurance, we quickly recognized another significant unmet need in our community. Many insured individuals are still unable to find the right type of treatment for their substance use challenges.”
In response, Dostal opened the Internal Medicine Primary Care Pavilion SUD Clinic in 2024 and developed an internal referral network within Epic, the electronic health record system used by UTMB.
“This enables providers to refer patients directly from outpatient clinics or through the discharge navigator when they are leaving the hospital or the emergency department,” he said. “Some patients engage with us after just a single referral, while others require several touchpoints before they feel ready. We’re encouraged by how many do come in, and when they do, we partner closely with them to create individualized plans that support sobriety and long-term recovery.”
Cunningham said the team has remained committed to its goals despite numerous challenges.
“We ask ourselves, 'how are we training our medical students?'” she said. “There is no formal way for many students and residents to learn how to talk with patients about substance use disorder.”
For example, physicians may ask questions in ways that can unintentionally shut down honest communication.
“When you go to the doctor, they might ask, ‘How much do you drink in a day?’ And patients may not want to answer that,” Cunningham said. “So, how do we help physicians ask those questions the right way? We must train them to be compassionate and empathetic.”
Because many patients seeking treatment are especially vulnerable, Cunningham said it can take time to build trust between doctors and patients. A key goal of the clinic is to train the next generation of primary care providers to better understand substance use disorder and provide specialized treatment to anyone who needs it, regardless of housing or insurance status.
“These patients often aren’t going in for vaccines, wound care, or other basic health services,” she said. “Substance use, whether from street drugs or prescription drugs, affects the entire body. That’s where primary care comes in.”
Primary care providers are often the first point of entry into treatment.
“Doctors like Dr. Dostal and others bring the sensitivity and empathy needed to meet patients where they are,” Cunningham said.
Dostal, who completed his internal medicine residency at UTMB in 2023, said that at that time, there was no UTMB clinic medically managing patients with SUD.
In the years since those early efforts began, the clinic’s reach has grown dramatically.
The Grace SUD program first began seeing patients at the church in mid-December 2023, recording just 11 visits during its first few weeks. By the end of its first full year in 2024, the clinic had logged 428 patient visits. Demand for services continued to rise in 2025, when the clinic more than doubled the number of patients treated, providing care to 1,014 patients seeking treatment and recovery support.
Those numbers reflect a broader expansion of services at Grace Clinic, which has become more than a point of access. It’s a true medical home for the most vulnerable members of the community.
Dostal emphasized that the clinic ultimately belongs to the patients.
“We’re the visitors here,” he said. “This is their space. Our role is to meet them where they are, to honor the courage it takes to walk through the door, and to help them feel safe, respected, and truly welcome. By building trust and offering compassionate, evidence-based care, we’re helping our most vulnerable neighbors restore dignity, hope, and health. I’m humbled and grateful to be part of this work.”