Combating A Culture of Substance Abuse in Appalachia

Story by Jared Schultz

At the Grandfather Home for Children in Watauga County, N.C., evidence of the devastation that addiction can wreak on families and communities resides in the residents, some as young as infants.

One baby, less than a year old, went through a multi-week detox process when he first arrived—his mother had shared her drugs with him as a way to lull him to sleep. The boy was removed from a home drenched in chemicals used to make meth; exposed to the harsh chemicals, his skin was so sensitive and painful he would not allow anybody to touch him.

Three siblings between the ages of three and six also reside in the center; the Department of Social Services took them into custody when they were found wandering the streets alone at two o’clock in the morning. Their parents were out doing drugs.

“The vast majority of children have come here not because of their particular actions but because of things that have been done to them,” said Jim Swinkola, CEO of the Grandfather Home for Children. “If you’re a kid, it’s unfair that you’re the one who has to go to a new school or a new place to sleep.”

The problem is not unique to the children of the Grandfather Home, or to Watauga County. Family and cultural disintegration due to substance abuse and addiction have been booming in Appalachia over the past ten to fifteen years. The term ‘meth orphan’—now regularly used in stories such as these—has become more and more common.

This image of a region full of families shattered by meth addiction is only enhanced by reports of dramatically increasing numbers of meth lab busts. Maps found on the United States Drug Enforcement Administration website of meth lab incidents show that, in Kentucky alone, the number of lab incidents more than doubled between 2007 and 2009.

Pharmaceutical Abuse

Appalachia’s decade-long increase in substance abuse-related problems can be attributed to one specific development—the advent of opiates.

A study conducted by the National Opinion Research Center on health disparities in Appalachia found painkiller abuse between 2002 and 2005 to be of primary concern, contradicting beliefs about methamphetamine abuse as the biggest problem. Most telling was the finding that painkiller abuse was particularly bad in central Appalachia, where the coal mining regions of eastern Kentucky and southern West Virginia had the highest rates.

“In Appalachia, we have a number of hard labor kinds of jobs that tend to produce injuries or long-term effects for which prescription painkillers are often prescribed,” explained Kris Bowers of the Coalition on Appalachian Substance Abuse and Policy.

In addition to the mining industry, Bowers pointed a finger at jobs such as long distance trucking, as well as at increasing numbers of cancer and arthritic patients.
“Those kinds of things require heavy doses of pain meds which can also be subverted to sell on the street,” Bowers said.

“The problem is the culture of substance use in Appalachia which then turns into substance abuse,” said Bruce Behringer of the Division of Health Sciences at Eastern Tennessee State University. When policies are created to crack down on illegal substances like meth, lab busts go up and when the meth becomes scarce, the drug problem appears to initially go away.

Unfortunately, taking away one drug does not take away the substance abuse culture. People still have easy access to equally addictive and destructive substances like opiates that are legal and advertised.

High rates of painkiller abuse, mental illness and poverty afflicting the same regions in Appalachia suggest that regardless if the abused substance is meth, cocaine or painkillers, the overarching problem is not one of illegal substances or crime, but lack of economic and social opportunities. “We have a lot of people who have painful, debilitating lives filled with sorrow,” said Louise Howell, Executive Director of Kentucky River Community Care (KRCC).

Searching for Solutions

Advocates like Behringer are trying to take a ground-up approach to combating substance abuse in Appalachia by working with communities to identify and improve social and economic problems that could lead to substance abuse.

During a 2006 conference run by Behringer and colleagues, 26 different groups of people from six different states and a variety of professional backgrounds—including doctors and journalists—came together to brainstorm options for dealing with the problem. Following the conference, Behringer and colleagues received approximately $400,000 worth of regional grants to develop 16 different community programs to combat substance abuse.

Initiatives that emerged included project PEP, a program designed to instill community participation and Appalachian pride in the citizens of Lee County, Ky.

Despite this progress in developing community programs, one cultural barrier to a ground-up approach is ingrained in the mountains of Appalachia, according to Behringer; the view that substance abuse is an individual family’s private problem, rather than a community problem. “How are we going to address substance abuse issues if you can’t get people to think beyond the individual impact?” Behringer said.

A political culture that does not look at Appalachia as a region, but instead confines both data collection and actions to individual states, poses yet another barrier to decisive action at the community level.

Each state has different policies and laws for addressing substance abuse, raising the potential for finger-pointing between elected officials over who passed what laws. But substance traffickers and substance abusers do not care about state boundaries, particularly in a region as tightly knit as Appalachia.

The goal, according to Behringer and Bowers, is to draw different professions working together at the community level in order to address the problem of substance abuse, and then to convince lawmakers to work together across state lines.

The key to making all of this work, says Howell, is for professions and states to make the appropriate policy changes, such as integrating psychological health into physical health care, and to shift funding from correctional institutions to prevention and treatment programs.

“There are a lot of policy shifts that are pending and need to take place,” said Howell. “That’s where it’s at.”


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