Appalachian Regional Commission, working on substance abuse and the workforce issues, calls for 'recovery ecosystem'

The Appalachian Regional Commission held six listening
sessions about substance abuse and workforce issues,
including one in March in Pineville, Ky. (Photo from ARC)

The Appalachian Regional Commission hosted six listening sessions this year to better understand the challenges around substance abuse and how it relates to the Appalachian workforce, and came up with themes to work toward building a "recovery ecosystem."

ARC's mission is economic development, but its leaders say the region's drug problem is an obstacle to those efforts. People in the region, especially those of working age, have been hard hit by the opioid epidemic.

 An ARC-commissioned study in 2016 found that opioid-related death rates were 49 percent higher in the ARC region, compared to the rest of the country: 24.6 deaths per 100,000 people between the ages of 15 and 64 in Appalachia, compared to 16.5 per 100,000 in the non-Appalachian U.S. Among Appalachians between the ages 25 and 44, the study found the overdose death rate was more than 70% higher, compared to those living outside the region.

The sessions focused on "gathering effective goals, strategies and programs to address substance abuse issues in an economic development context," says the commission's report on the "Recovery-to-Work" sessions, from which five themes emerged:

First, participants stated the importance of establishing a "recovery ecosystem" that involves multiple sectors and services to support people who suffer from addiction. This would include health, mental health, social work, criminal justice, housing, transportation, education and employment services.

The report recognized that the availability of services to support such an ecosystem varies in each community.

Graphic from ARC "Recovery-to-Work" sessions report

The sessions also identified the need to have "recovery communities" to help with the recovery needs of this population.The report said the most frequently discussed needs were: sober housing; child and elder care; transportation; ongoing attendance with support groups; and assistance with medical, mental health and dental care. It added that the lack of adequate clothing and poor hygiene can also serve as barriers to getting a job.

A peer-support model was suggested as an essential way to link those with substance-use disorders to resources, adding that there is a growing need for more certified peer-recovery support persons to support such efforts.

The listening groups also called for better coordination of services for people with substance use disorders, noting that the current lack of coordination often leads to relapse. Further, they recommended community based assessments and planning to better organize local and regional efforts toward this end.

Employment was emphasized as a long-term goal of the recovery ecosystem.

"For people in recovery, securing work is considered a contributing factor to successful recovery outcomes as employment provides motivation and a sense of hope in addition to providing for the physical needs of individuals and their families," the ARC report says.

The listening groups identified many barriers to employment for people who have substance-use disorders, including education, skill training child and elder care, transportation, court-ordered appointments, lack of jobs that pay living wages and have potential for advancement, and the stigma that exist around hiring a person in recovery among employers and generally in communities.

The report also noted that employers struggle with recruiting drug-free workers, high rates of employee turnover, and a reluctance to build or expand businesses due to workforce availability.

The groups also stressed that Appalachian communities need more information about effective practices and programs to help them assess, plan and develop local and regional efforts that promote a recovery ecosystem.

For example, they suggested toolkits should be made available to human-resources departments and employee assistance program managers to explain recovery and effective methods of hiring and retaining individuals with substance use disorders.

ARC Federal Co-Chair Tim Thomas said in the news release, "Solutions to the substance abuse crisis in our region and our country as a whole are not going to come from Washington, D.C., but from the collective wisdom of those fighting this epidemic on the ground, from local policymakers and treatment providers, to employers and those in recovery."

Not mentioned in the report, but noted as a workforce-related problem at the Portsmouth, Ohio, listening meeting is that Medicaid will stop paying for medication-assisted treatment in the midst of treatment if the recipient begins to make too much money to no longer qualify for coverage, Tayler Sisk reported in May for West Virginia Public Radio.

Besides Portsmouth, the listening sessions were held in Big Stone Gap, Va.; Wilkesboro, N.C.; Muscle Shoals, Ala.; Pineville, Ky; and Beckley, W.Va., from December 2018 to April 2019. They included representatives from local and state governments, treatment and recovery service providers, workforce development groups, employers, law enforcement and people in recovery.

The sessions focused on "gathering effective goals, strategies and programs to address substance abuse issues in an economic development context," says the commission's report.