Fighting Addiction in Appalachia

Tuesday, April 29th, 2014

coal mining town in West VirginiaWhen I read the powerful New York Times feature on McDowell County, West Virginia, my immediate reaction was, “That’s my community!” Although I’m not from McDowell, I grew up in Morgantown, West Virginia where I watched members of my own family fall victim to similar struggles with poverty and addiction.

As coal-mining jobs have declined, McDowell’s median household income has plunged to $22,000. Not surprisingly, many residents have turned to drug abuse and to the drug trade. While methamphetamine was long considered Appalachia’s biggest drug problem, it is clear that prescription opiates are now an even graver threat. The prescription drug scourge in counties like McDowell did not happen randomly. In the late 1990s, Purdue Pharma, the maker of OxyContin, aggressively marketed the pill to doctors in Appalachia, where injuries from hard-labor jobs often produce chronic pain. The use and abuse of OxyContin became so widespread that it eventually earned the nickname “hillbilly heroin.”

The consequences have been devastating. The rate of fatal overdose in McDowell is more than eight times the national average; McDowell’s incarceration rate is also one of the country’s highest. In 2011, nearly one out of every three babies born in the county’s hospital had been exposed to drugs. As McDowell’s sheriff put it, “Whole families have been wiped out in this county: mother, father, children.” Grandparents are raising children whose parents are in jail or caught in the throes of addiction. Adults are unable to provide for their families because they cannot pass the drug tests employers require.

This is a story I know all too well, and it is the story of countless families across Appalachia. Addiction is decimating rural America, yet we don’t hear about this tragedy nearly as often as we should. The news media has preferred instead to focus on the rising problem of prescription drug and heroin addiction in middle-class suburban communities. The people of McDowell, where shanties dot the secluded mountainous landscape, are largely forgotten.

I’m grateful to The Times for bringing attention to a region of the country that doesn’t often get a voice. However, it’s one thing to raise awareness, but unless we develop viable solutions in this area, the addiction scourge will continue to haunt the next generation. According to Deborah Taylor, R.N., regional director of Phoenix House Mid-Atlantic, rural America desperately needs “treatment on wheels.” In addition to lengthy waiting lists, a significant barrier to treatment access in rural areas is the long travel distance required to reach the nearest clinic or hospital. We cannot expect residents of these isolated areas to seek help unless we bring care directly to their doorsteps. For this reason, Taylor and other clinicians see great promise in mobile units that could provide medication-assisted treatment and management. These units should be part of a comprehensive program that would also include vocational training as well as financial incentives for those who successfully complete treatment.

Of course, we know that a program of this nature would be impossible to implement without increased funding for treatment. West Virginia continues to expand Medicaid for low-income residents, yet Medicaid funding alone won’t solve the state’s addiction epidemic. A federal demonstration project, on the other hand, would allow West Virginia to pilot a high-quality “treatment on wheels” program that could truly make a difference. Ideally, says Taylor, this project “would bring together the best minds in opioid treatment” to create a model of care that could then be replicated in rural settings across the country.

Now, I’m not naïve enough to believe that Appalachia’s drug crisis has a simple solution. However, when a situation becomes this dire, our nation has a responsibility to step in. “These are good people, good families,” McDowell’s sheriff said of his neighbors who have succumbed to addiction. His words ring true as I think of my own relatives. Above all, we must remember that these individuals are not society’s throwaways. It is up to us to ensure that their struggles are not ignored.

Karen Sodomick
Vice President & Director, Marketing and Communications
Phoenix House

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  • Kevin Hudson


    The mobile unit is a great idea, but I see some roadblocks that need to be overcome. Beginning with funding and other ones like finding approved “safe” locations for a mobile unit( an RV ?),consistent attendance, licensing issues, there’s a risk for theft of the medication’s used for opiate addictions( especially by the same people that would be receiving treatment ) and clients must be going for a minimal amount of treatment as well, not just to get medications.

    Buprenorphine works well when clients are getting treatment. Otherwise, clients will deviate from their T-Plans and fail. I worked in a Detox in Long Beach, NY and we began a medically enhanced/supervised outpatient program and the retention rates improved immensely. This lasted for 16 months until Hurricane Sandy, now there is no program and now I’m here at PH.

    I have years of experience in this area and I’m willing to help if should the need arise. About 3 years ago, I was consulting with several facilities in N. Carolina with a similar issue.

    Thank you for the informative article.

    Kevin Hudson, BA, CASAC

  • Darlene Vaughn

    As a substance abuse counselor for adolescents and adult caregivers in Appalachia I struggle daily to assist these individuals with lifestyle change in an environment of extremely restricted environmental and emotional resources. I practice in rural southwest Virginia where I work in 3 clinics and serve 5 counties. Opiate addiction is present, but has been subverted by a burgeoning pandemic of methamphetamine use. Cannabis and alcohol are still a maintenance drug for most and many continue to have benzodiazepines readily available. Appalachia not only needs mobile services for opiate users, but residential settings where adolescents can be provided with possibilities to overcome multigenerational apathy, unemployment and substance use.

  • Name: James F. Recktenwald

    I have been a drug counselor for 41 years, spending 1 year in Stephenson, Virginia at a residential program for addiction, and 8 years in the Rappahannock-Rapidan area of Virginia as a program director, helping to establish and providing the full range of services that eventually came to that area. Outpatient services were done in homes of the affected persons, from a car. The remainder of my 41 years has been spent in Central Eastern Kentucky (centering on Floyd County). A rolling treatment center is the best means to address a problem that easily affects a third of our population. (Having said that, I will tell you that there are similar high pockets of addiction all across the country. One thing that’s sold during the recent depression and its continuing fledgling recovery is drugs.) The incidence of addiction is leveling out at that high rate across the country and nowhere is there funding for the level of care that is needed–nor are services anywhere accessible enough to make accurate counts of the affected population or the needed resources. Rolling clinics can accomplish both those necessary tasks so that we can begin to build the infrastructure for widespread accessible addiction recovery.