By Liora Engel-Smith

Targeting some of the epicenters of the national opioid epidemic, the Appalachian Regional Commission announced a plan to revitalize the workforce in communities ravaged by addiction.

The agency, whose mandate is to promote economic prosperity in 420 counties in 13 states, including North Carolina, outlined a plan to bolster and link programs that support people struggling with substance use disorders to recovery and career-readiness skills. The federal-state partnership has also made it a priority to support initiatives that document and duplicate successful efforts across communities. The exact sum of money the agency will dedicate to these efforts in fiscal year 2020 isn’t yet finalized, pending congressional budget approval, an agency spokeswoman said this week.

The announcement comes on the heels of increased federal funding to combat the opioid crisis. Last month, the U.S. Department of Health and Human Services announced it was investing nearly $400 million in expanding and integrating opioid treatment in community health centers, which care for patients in rural or underserved areas, including the mountain region.

The Appalachian Regional Commission covers 29 counties in North Carolina 

Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Cherokee, Clay, Davie, Forsyth, Graham, Haywood, Henderson, Jackson, McDowell, Macon, Madison, Mitchell, Polk, Rutherford, Stokes, Surry, Swain, Transylvania, Watauga, Wilkes, Yadkin, and Yancey

shows all Appalachian counties, with counties marked in red to show distressed. Most at-risk countis are clustered in Kentucky and West Virginia with a number of distressed and at risk in North Carolina
A map of economic conditions in Appalachia. All 420 counties depicted in the map could benefit from the Appalachian Regional Commission’s recovery ecosystem initiative. Map credit: Appalachian Regional Commission

Source: ARC 

Like other parts of Appalachia, opioid addiction disproportionately affects the mostly rural western North Carolina region. In 2017, more than 500 people fatally overdosed there, according to data from the N.C. Department of Health and Human Services. These deaths account for roughly a fifth of all fatal overdoses in the state that year.

“It’s not hard to travel to western North Carolina and meet someone who is an employee or a business owner who says, ‘it’s really hard for me to keep employees because of this epidemic’ … or ‘if I do drug testing on the job and I find out someone has an addiction, I don’t know what to do with that information,’” said Kody Kinsley, deputy secretary for Behavioral Health and Intellectual and Developmental Disabilities at the state health department.

A man in a gray suit and red tie stands at a podium with two microphones in front of him.
Kody Kinsley, N.C. Department Health and Human Services deputy secretary, speaks at the opening of the renovated Broughton Hospital in Morganton last month. Photo credit: Liora Engel-Smith

Kinsley, who was part of the group that created the recovery ecosystem recommendations, said helping people with substance use disorders recover and return to the workforce has the potential to revitalize Appalachia by re-integrating people into their communities. Getting hired can also help people with substance use disorder, many of whom are uninsured, gain access to health insurance through their employers. And it  can open up more avenues for support and treatment, he added.

“We’re taking the next leap forward, which is recognizing that you can’t have a thriving economy unless you have healthy workers to participate in that economy,” he said. “Health is so core to everything and this really takes an organization whose mandate is really centered on economic development, it’s them putting their hand up and saying ‘You know what? We need to engage in this because unless we have a healthy workforce, we can’t succeed.’”

‘Not just a job coach’

Across the region, those who help people in recovery with job-readiness skills applauded the emphasis on workforce development, saying that recovery has unique challenges that can make finding and retaining a job difficult.

In the early stages of recovery, balancing work demands with commitment to treatment can be difficult, said Philip Cooper, Up Skill Western North Carolina coordinator at A-B Tech Community College in Asheville. Outpatient drug treatment programs, he said, are a time commitment, sometimes requiring several hours-long meetings per week in addition to time dedicated to support groups. Finding a job that is flexible enough to allow clients to make the meetings can be challenging, he said. And many of the jobs that offer such flexibility don’t pay a living wage.

two African American men look at the camera. The man on the right has a t shirt on reading: "Holy with a touch of the Hood"
Philip Cooper (right) with Lionel Hightower. Cooper writes of Hightower: “He returned home in 2016. He has retained jobs, been a present father, and more importantly stayed engaged with his support system. He now works as a Tech at a local crisis center, where he is a role model for those in crisis.” Photo courtesy: Up Skill WNC Buncombe Facebook page

And if the client has a criminal record, he added, these challenges may be even greater because of stigma. Not every employer is willing to take a chance on people who have a record, particularly if the charges involve some form of violence.

But Cooper, who has helped roughly 100 participants since 2017, said that with the right support people can overcome these barriers. His job, he said, is to help clients with everything from obtaining a Social Security card — a necessity for the hiring process — to helping them navigate the stresses of working while also staying sober.

“I’m not just a job coach. I’m more like a recovery resource,” he said.

Cooper also works with employers, vouching for participants and advocating for them in the job-seeking process as needed. But, he said, while Buncombe County has considerable recovery resources, the region needs more coaches who can help clients in recovery navigate the job market. The commission’s recovery ecosystem initiative, he said, is a step in the right direction because it reminds people that finding a job can be a part of wellness.

“[Addiction is] a health care problem, it’s a workforce problem, it’s an education problem, it’s a criminal justice problem,” he said. “So with them leading with that approach of bringing people together, this ecosystem, they’re saying ‘we’re gonna bring all the stakeholders to the table.’”

No Wrong Door

But more than 80 miles southwest of Asheville in Macon County, that table, and the number of stakeholders around it, is far smaller. And it isn’t because people don’t care, said Sheila Jenkins, executive director of the Franklin-based No Wrong Door to Support and Recovery. The peer support organization, which began operating last March, has been grappling with a general lack of resources for people seeking recovery.

Recovery Resources

In honor of recovery month, Google has created a dedicated recovery resources search page, complete with a searchable map for meetings, recovery centers and other supports. The website also has a drug disposal sites map and Naloxone locator.

The system in the county, she said, isn’t set up to help people succeed, piling barrier upon barrier on people with limited resources. Transportation options are limited, she said. Many clients either cannot afford a car or don’t have a license. Though the county has an informal shelter, it lacks transitional housing options such as sober or halfway houses, she added.

These and other gaps make it difficult for Appalachian people to stabilize their lives enough to even seek work, she said. And those who are ready to find a job may be rejected from positions because of their criminal record.

“We really struggle, and they struggle,” she said. “We have seen [participants] come back into the home they left and then relapse.”

But, she added, No Wrong Door has made some strides in supporting people seeking recovery at the jail and in forming some relationships with local employers to change the stigma of a criminal record. Down the road, Jenkins said, she hopes to encourage more local employers to follow suit. People in recovery need jobs, she said.

“You have to have employment in order to succeed because most of the time you have probation fines you have to pay and you just have to live.”

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Liora Engel-Smith joined NC Health News in July 2019 and covers policies, programs and issues that affect rural areas. She has previously worked for the The Keene Sentinel in New Hampshire and the Muscatine...