The Appalachian Regional Commission is shifting its focus toward recovery.
The organization, led by the governors of the 13 Appalachian states and a federal co-chair appointed by the president, announced this week the creation of its Substance Abuse Advisory Council. The 24-member group consists of representatives from communities throughout the region who will “develop recommendations for ARC to consider as part of a strategic plan to build and strengthen a recovery ecosystem in Appalachian communities by drawing on their own experiences.”
The ARC is an agency created to link federal, state and local governments in support of people doing community and economic-development work on the ground in the region. Its goal is to help strengthen the economy through workforce development and investments in infrastructure, among other things.
The ARC is not a health care provider. But Federal Co-chair Tim Thomas said developing a “recovery ecosystem” and strengthening the Appalachian economy go hand in hand.
“Getting folks in recovery back into work not only helps the economy, it also helps in their continued recovery. That sense of self-confidence and self-esteem is so important to sustainable recovery, and that’s what a job brings to an individual,” Thomas said at an ARC event in Morgantown, West Virginia, earlier this year, where he announced the commission’s top funding priorities for the upcoming grant cycle: broadband and substance-misuse recovery.
The ARC’s Substance Abuse Advisory Council’s work, along ARC grant dollars, will support people in long-term recovery who are looking to get back into the workforce, Thomas said in a press release Monday, and the agency has already started work in that regard.
Re-engaging in the Economy
On the afternoon of April 5, some 80 people from Appalachian Ohio and neighboring Kentucky and West Virginia gathered on the campus of Shawnee State University in Portsmouth to discuss the lessons they’ve learned from the enormous toll the opioid crisis has taken on their communities.
It was one of a handful of listening sessions hosted by the ARC throughout the region since December, bringing together health care and recovery providers, government and law-enforcement officials, employers, educators and individuals and families living with substance-abuse disorders to more effectively confront the crisis at the community level.
A recurring theme at the gathering in Portsmouth was the need for improved coordination across agencies that provide services for those living with substance-abuse disorders and to engage employers in the recovery process.
Thomas said that as he’s traveled the region since his appointment in 2018, employers have consistently told him they can’t find people to fill open jobs. “One of the reasons for that is substance abuse,” Thomas said. “We have to find ways to get people re-engaged in the economy.”
But there are barriers to re-engagement, many of which were discussed in Portsmouth. Jeanne Wilson, Ohio Sen. Sherrod Brown’s Appalachian regional representative, said that Brown has advocated foreliminating the box on job applications that asks if an applicant has a criminal record.
Another issue Wilson cited is that Medicaid will stop paying for medication-assisted treatment in the midst of that treatment if the recipient begins to make sufficient money to no longer qualify for Medicaid coverage.
Wilson acknowledged that these issues aren’t under the ARC’s purview. But consistently at the listening session the discussion returned to a need the agency can help fill: more effective coordination of existing services and supports, including access to transportation, housing and jobs.
If the ARC wants to be effectively involved in counteracting the opioid crisis in Appalachia, Thomas and his colleagues were told at the Ohio listening session, it should be in ensuring that existing services are well coordinated and that those in need of those services know they are available.
A ‘Multifaceted Public Health Threat’
In 2000, the opioid-overdose death rate in Appalachia was roughly equal to that of the rest of the country, according to a study from the National Association of Counties and the ARC. By 2017,the rate in Appalachia was 72 percent higher.
By that year, four Appalachian states – West Virginia, Ohio, Pennsylvania and Kentucky – had the highest rates of drug-related overdose deaths in the country, found another study from East Tennessee University and the independent research organization NORC at the University of Chicago.
As its authors attest, a number of factors contribute to the higher rates of opioid misuse and overdose in Appalachia. Among them are more prevalent rates of poverty, higher rates of injury-prone employment, aggressive marketing of prescription pain medications to physicians and less access to health care and recovery services.
These factors, the researchers assert, “create a multifaceted public health threat. Equally multifaceted intervention strategies are needed to address opioid misuse and overdose deaths in Appalachia.”
Just prior to the listening session in Portsmouth, the ARC announced a $1.1 million grant for the Appalachian Recovery Project, based at Ohio University’s College of Health Sciences and Professions, to assist women in five Appalachian Ohio counties in their recovery efforts.
Tracy Plouck, a former director of the Ohio Department of Mental Health and Addiction Services and now an executive in residence at the College of Health Sciences and Professions, described the Recovery Project as the type of coordinated effort the ARC has tasked itself to pursue.
A former prison in Nelsonville is being renovated to provide a range of services to women who were previously involved in the legal system but are now engaged in recovery. The facility will offer residential-style treatment for women who are leaving jail or are enrolled in a drug court program. The ARC grant will help fund this treatment.
The Nelsonville program will also partner with health agencies to offer primary care, outpatient addiction treatment and other clinical services in the community. And it will offer vocational training and job placement and a music and arts program. It will employ community health worker interns to assist the women in connecting with the services and supports available to them. Plouck anticipates creating 31 jobs in the community.
The renovations to the facility will be done with financial assistance from the Ohio Department of Rehabilitation and Correction.
“We’re pulling together a network of partners to help fill a gap in southeastern Ohio,” Plouck said. “There are a lot of resources that are available.”
She said that in confronting the opioid crisis, “there have been a lot of communities where people just roll up their sleeves and figure out how to get it done.”
But Plouck emphasized the importance of collaboration within and between communities and with state and federal agencies, echoing the attendees of the Portsmouth session.
Robert Ware, police chief of the city of Portsmouth, attended that session and said he was pleased to hear from employers in his area that they have jobs available and are “willing to employ these folks in recovery.” He called it a sign of hope for his city, still struggling with the epidemic.
Ware serves on the Alcohol, Drug Addiction and Mental Health Services Board for three southern Ohio counties, which he believes has “really made strides in the prevention and treatment and, to some extent, recovery processes.”
The chief was appointed this week to the ARC’s Substance Advisory Council. He says facilitating access to jobs will be high on his agenda.
“We need that extra step of completing the transition [from addiction] back into productivity and being able to hold gainful employment,” Ware said.
“Without employment, you have stressors, sometimes a lack of hope, and that despair forces you to seek escapes,” he said. “And I think that’s why a lot of people get involved with drugs in the first place.”
In his closing remarks in Portsmouth, Tim Thomas said of the ARC’s role in addressing the crisis of opioids in Appalachia, “To the extent that we were not doing what we should be doing as early as we should have been doing it, please accept my apologies. But we are here with you; we’re going to do the best we can to support you going forward.”
Chillicothe Street in Downtown Portsmouth. Photo: Aaron Payne, Ohio Valley ReSource
This article was originally published by Ohio Valley ReSource.
Addiction specialists, business leaders, law enforcement officials and other community members gathered around tables at Shawnee State University to talk about two big challenges in Scioto County, Ohio: a shrinking economy and a growing addiction crisis.
The Appalachian Regional Commission brought them together as part of a listening tour to learn about connections between addiction recovery and economic recovery.
Several speakers pointed out how the opioid epidemic has left employers with job openings and a workforce unprepared to fill them.
“There’s a problem in making sure that the workforce is ready, ready with soft skills, ready with hard skills, ready just psychologically,” ARC Communication Director Wendy Wasserman said. “Employers are spooked. They don’t know how to engage and make the best of workers [in recovery] who are eager and ready to go back to work.”
When author and journalist Sam Quinones was writing his book about the opioid crisis, “Dreamland,” he chose Portsmouth as the country’s key example of how economic decline fueled the rise of opiate addiction in the 1990s.
“The factories and shops on Chillicothe Street were replaced by [pain management clinics], which found cheap space in the town’s abandoned buildings,” he wrote. “Pill mills were about the only locally owned businesses to open.”
Quinones tracked the origins of what is now a national epidemic to Portsmouth and other struggling towns in the region.
“Portsmouth…acted like the canaries in those now-shuttered Appalachian coal mines,” he wrote. “Just no one in the country listened much.”
The problem requires many solutions, and ARC Federal Co-Chair Tim Thomas believes the people they spoke with will find those solutions.
“If a problem exists in a community, ultimately, the solution to that problem will be found in the same community,” he said.
Those working on addiction and economic recovery in Scioto County believe they can both prepare workers in recovery and help employers. Two programs aim to build up people struggling with addiction while rebuilding the local economy.
Teams workshopped a wedding planning business, a local farm-to-table restaurant, a video game cafe and other plans into full-fledged business models.
The Kricker Innovation Hub at Shawnee State played host to the weekend-long event and encourages an entrepreneurial community through events like these.
The organization sees a role for itself in assisting the business-minded people who are also in recovery from addiction to jumpstart their ideas.
“People who are starting businesses and are in the recovery community will need resources, perhaps more so than the general public,” Program Director David Kilroy said. “We can leverage this infrastructure.”
Thanks in part to its association with the LIGHTS Regional Innovation program and other partnerships, members of the hub have access to high-speed internet, an immersive technology lab, mentors and other resources to help bring their product or business idea to market.
Those in the recovery process can apply the skills they learned in treatment, such as discipline, organization and independence to run their own business.
The hub’s goal is to foster these skills and bring in the recovery community without fear of judgment.
“They should feel just as included,” Kilroy said. “The outreach that we do to people that we know who are starting businesses, should apply to them as well. It’s about making them feel included in this community.”
The innovation hub builds on the skills people already have. Another program in Scioto County focuses on those who need more basic tools to reenter the workforce.
People can be referred to the program if they have been convicted of charges or have pending charges related to their addiction.
Clients receive holistic services that include addiction treatment, housing and wellness programs.
Administrative Director Nick Ferrara previously worked as a probation officer in the county for 19 years. During that time he learned employment is a big obstacle for sustained recovery.
“A lot of these guys don’t have an education, they don’t have a trade,” he said. “So they’re getting back into the community going back to the same environment they came from. And the vicious circle continues.”
The Scioto County Career and Technical Center, Scioto County Aspire and Mountwest Community and Technical College are three of the main educational partners with the program.
They offer clients GED classes and job training in fields that include electrical, plumbing and maritime deck work.
“As long as you have people sitting around unemployed, continuing with criminal behavior, drug use, that’s just going to continue to weigh society down,” Ferrara said.
The goal is to get these people the help they need and then get them back into the communities and their families.
“If we can get people substance abuse treatment, the mental health treatment they need, give them a trade and actually get them out in the workforce, that can only help the economic recovery,” Ferrara said.
The crisis has so deeply affected the community in Portsmouth that many people now rally around those who were previously shunned due to the stigma surrounding addiction.
Quinones, who frequently speaks at events in the region, has kept tabs on the community since “Dreamland” was published. He’s pleased to see the resurgence in community pride.
“The antidote to opiates is not naloxone,” he wrote in a blog post last year, referencing the overdose reversal medication commonly known as Narcan. “It is community. Rebuilding community (in a million different ways) is crucial…I’m glad to see Portsmouth leading the way on that, too.”
Business leaders are realizing addiction recovery and economic recovery can work together. And a community once defined by its fall invests in its rise, together.
This is the second story in an occasional series exploring the links between addiction recovery and a recovering economy.
Autumn McCraw has been working at Cafe Appalachia for about four months. She is lead barista and helps with the desserts. Photo: Brittany Patterson, Ohio Valley ReSource
This article was originally published by Ohio Valley ReSource.
It’s lunch hour, and Cafe Appalachia is bustling.
Located in South Charleston, West Virginia, the former church turned restaurant has a funky, yet calming vibe. Twinkle lights and mismatched dining room sets dot the space. For $8 to $10 a plate, diners can enjoy a locally-sourced meal. The menu today is apple sage pork tips, spiralized zucchini (or “zoodles”), roasted broccoli and a salad of spinach grown just a few miles away.
Autumn McCraw helped prepare today’s meal. The 35-year-old Charleston resident sports a maroon apron and greets every customer with a smile. Her days here typically start around 8 a.m.
“I start my tasks as the barista here and making coffee, make sure the tea’s prepared. I also try my best to make the desserts,” she said. “It’s something that I really like to do.”
But this cafe is more than just a job. It’s a second chance. McCraw heard about Cafe Appalachia while participating in a long-term addiction recovery treatment.
“As addicts in society we’re shunned,” she says. “To know that the community is supporting me and having my back is such an essential part of my recovery.”
Almost everyone who works at Cafe Appalachia is in recovery and McCraw says being part of a team that understands what that means and can support her has been a game-changer.
“If I’m struggling, if it happens to be one of those days, you know, I have a whole support system here that understands,” she said.
Cafe Appalachia is just one example of a growing effort around the Ohio Valley that puts people in recovery in food service and agriculture jobs. In a region with some of the highest overdose death and addiction rates in the country, people are looking to programs like these as a way to both nurture recovery and provide more nutritious food to communities.
Farm to Table
The cafe is part of a larger program that aims to use agriculture to create jobs for those in recovery and coming out of prison called the Appalachian Food Enterprise, or AFE. Last October, the AFE received a $760,000 federal grant from the Department of Health and Human Services’ Office of Community Services.
The AFE comprises the cafe and an urban farm located just a few miles away.
“Welcome to Paradise Farms,” Reggie Jones greets visitors to a greenhouse as ventilation fans whir above beds of greens.
“The idea of the enterprise as a whole is that we want to be able to take a seed, put it in the ground, grow it, harvest it, process it and get it out to the social enterprises, like the cafe, like the catering business, like the food truck and create training opportunities and jobs along that entire continuum,” Jones said. He’s CEO of the Kanawha Institute for Social Research and Action, or KISRA, which is a project partner.
The women in recovery participating in the program begin their training at KISRA’s Paradise Farms. They learn about farming and working in the food service industry both in the classroom and in the two hydroponic greenhouses.
Then they can move to work at the cafe and, soon, a food truck and catering service. Jones said the project aims to not only create 42 jobs for those in recovery or coming out of prison over the grant’s three-year life cycle, but to use the cafe and other food businesses as social enterprises to provide training and empowerment for those who may struggle to find employment.
Farming and food service is traditionally more flexible than other sectors, and the program hopes to capitalize on that.
“So not only are we really working to increase healthy food access, we’re also working to address the issue of finding jobs for individuals who are coming out of recovery, and who are coming out of prison,” he said. “If we do not hire them, they’re still a marketable person because of the skills that they developed along that continuum.”
Jones believes jobs in food and agriculture provide more flexibility for people in recovery that might need to schedule out appointments for services like therapy.
For Cheryl Laws, CEO and founder of Pollen8, another AFE project partner, the initiative has the power the transform more than just the lives of the participants they work with, it can be a model.
“[In West Virginia] we have the highest rate for obesity, and we have the highest rate for overdoses,” she said. “But what we’re trying to do with the Appalachian Food Enterprise is take that negativity and show how to fix it.”
Laws said local food and agriculture is something that she thinks has economic staying power, and she isn’t the only person in the Ohio Valley who believes that.
A Community Effort
DV8 Kitchen, situated along one of the main thoroughfares of Lexington, Kentucky, started serving breakfast and lunch fare more than a year-and-a-half ago.
The restaurant would seem inconspicuous among the chain fast food joints that surround it, if it wasn’t for a mural, depicting vibrant, phoenix-like wings on the nearby wall. Almost all employees working inside are currently recovering from some form of addiction.
“When we’re trying to make the best bread, the best sandwich, the best salad that we can possibly make, it is so therapeutic to serve someone,” DV8 Kitchen co-founder and operator Rob Perez said.
Perez and his wife, Diane, started DV8 Kitchen after seeing 15 employees from their former restaurants die from addiction over the past dozen years. Perez also has personal experience with addiction, suffering from alcoholism in his restaurant career. He’s been in recovery for 28 years.
A 2015 report from the Substance Abuse and Mental Health Services Administration showed the food and accommodations industry had the highest rate of illicit drug use and substance use disorders by occupation.
“[Diane] saw that the restaurant business either finds people in addiction or addiction finds the restaurant business, either or,” Perez said. “In addition to that, we’ve also had some of our best people have to be fired because of it.”
They believe the bonding power of making and serving food can help create a restaurant culture that’s focused on recovery. But DV8 Kitchen goes beyond just food in creating that.
Employees are required to be in sober living housing to work at the restaurant. The kitchen closes in the early afternoon to let employees attend therapy appointments. And locals, including therapists, yoga instructors, police officers and more come in every Tuesday to lead the employees in talks and activities.
“That, I think, has been super important. And to let them know that it’s not just us giving them a job. It’s the whole community rallying around them,” Diane said.
But it took time for the community to be there. Diane and Rob struggled for months to get customers because of the stigma that people in recovery as employees would mean bad service or even a threat to one’s safety.
“When they heard ‘second-chance’ restaurant, they heard ‘second rate,’” Rob said. “We are trying to offer 23 people jobs in a second-chance environment. But really, [the employees’] job is to try to make the 300 customers we have each day, help them figure out how to think differently about people in recovery serving them.”
And experts in the Ohio Valley who coordinate employment opportunities for those in recovery say that stigma is a common issue among businesses hiring people recovering from addiction.
Zandia Lawson is a peer support administrator with the Ohio Department of Mental Health and Addiction Services. Lawson said when businesses look past that stigma, employment can be a boon for those who are recovering.
“Often times when you’re in a social situation, the first thing a person asks you is what do you do. Work is a huge identifier in our society,” Lawson said. “It helps people with their self-esteem, their self-confidence. Employment is what typical people do on a typical day.”
And while hiring recovering individuals is a worthy cause, Lawson emphasizes these initiatives still need to be sustainable. Many of these grassroots initiatives are grant-funded, and that funding doesn’t last forever.
“Whether it’s agriculture, a cleaning business, a lawn care business or what have you, the business rules still apply in that you have to have a need or demand for the service or the product that is being provided,” Lawson said.
And that’s why leaders of these grassroots efforts believe in food and agriculture — because of what they see as its potential for sustainability.
“You can’t grow a pepper and someone say ‘that’s a waste,’” Jeannie Harrison said with a laugh. “Because food is fundamental. And I think that it’s one of those great uniting things about just being a human.” Harrison is the founder of Gro Huntington, a nonprofit that runs an urban farm in Huntington, West Virginia, managed by recovering individuals from local treatment centers.
The organization got its start in 2016 through a successful crowdfunding campaign and has supplied local food to farmers’ markets and restaurants the past few years.
Her nonprofit gives steady employment to people in recovery, but she said the urban farm also provides nutritious, high-quality produce for a community that was once considered the unhealthiest city in the country.
“We called it a ‘food desert farm stand,’ because we were in the middle of a food desert. Which means if you were a neighbor to the Gro farm, you did not have access to fresh food if you didn’t have a car,” Harrison said.
Yet Harrison says she’s cognizant that financial stability can be fleeting, as she continues now to apply for grants through philanthropic organizations. She’s also planning on turning the urban farm into a fruit orchard, as she says it’ll be easier to financially sustain while also still providing local food.
Harrison said community buy-in is critical for these grassroots efforts to support themselves in the long term, and she hopes a recent partnership with Marshall University to start a composting program will be a boost to Gro Huntington.
Harrison and several others believe the payoff of recovery, through a foundation of food, is worth it.
“Fresh local food and work for people that may not be able to find it as easily? Absolutely. That is a powerful, powerful way to create change,” Harrison said.
This is the first story in an occasional series exploring the links between addiction recovery and a recovering economy.
Rush tends to the chickens at the Utterback farm. The henhouse is moved regularly in order to fertilize the farmland and maintain healthy soil. The eggs are gathered, sold, and used for meals at Jacob’s Ladder. Photo: Rebecca Kiger
Editor’s Note: Below are a series of photos taken by West Virginia photographer Rebecca Kiger at Jacob’s Ladder, a residential addiction recovery program run by Dr. Kevin Blankenship in the rural community of Aurora, West Virginia.
The men featured in the photo series attended the farming-based rehab and are the subjects of the 2018 feature-length documentary “Recovery Boys,” directed by Academy Award nominee and West Virginia native Elaine McMillion Sheldon. “Recovery Boys” can be viewed on Netflix and is available for community screenings.
Jacob’s Ladder at Brookside Farm is a six-month residential addiction recovery program started almost three years ago in response to the growing health crisis facing our nation and in particular my home, West Virginia.
The decision to include daily farming and gardening activities within a recovery program was made in hopes of changing the activity of the brain of those suffering from addiction—to “re-wire” the neural connections, hopefully leading to increased “future thinking.”
It is working.
These men are successfully working on the farm with counselors, peers and community members to change their lives permanently. The connection of human beings with animals and the earth is a unique catalyst for compassionate change and is an amazing thing to witness. Seeing the broken, suffering individual become a healthy, hopeful person in recovery, armed with tools to continue their journey has been the most rewarding experience of my life.
Kevin Blankenship, MD Founder and Medical Director Jacob’s Ladder at Brookside Farm
Kevin Blankenship is a lifelong resident of West Virginia and earned degrees in pharmacy and medicine, specializing in emergency medicine in the state. In 2014, an immediate family crisis with addiction brought Kevin face-to-face with the significant issue of this growing epidemic and the lack of recovery options throughout our country, inspiring his professional dedication to being part of the solution through directly serving the recovery industry and indirectly combating the stigma surrounding this issue in today’s society.
Rebecca Kiger is a documentary and portrait photographer living in West Virginia. Her work has been published on the Lens blog, TIME magazine, Vox, Everyday Rural America and Looking at Appalachia. In 2018, she received the Edward R. Murrow Award for Excellence in Video. Rebecca has been selected to be a ‘Teaching Artist’ through the Rural Arts Collaborative (RAC) for the next academic year at Bellaire High School, Ohio, where she will work with students on a year-long photography project. She is currently photographing stories about foster care and adoption.
Explore Kiger’s photos of Jacob’s Ladder at Brookside Farm below.