Great Health Divide | EKY addiction recovery ecosystem is strong, but gaps, high demand remain

Successful pre-pandemic efforts provide a blueprint as advocates try to address COVID-era overdose increases.
Successful pre-pandemic efforts provide a blueprint as advocates try to address COVID-era overdose increases.
Updated: Jan. 5, 2023 at 4:00 PM EST
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CORBIN, Ky. (WKYT) - Before he led Addiction Recovery Care, Tim Robinson was in need of addiction recovery care.

“I almost drank myself to death,” Robinson told WKYT’s Garrett Wymer on a recent winter day inside Corbin City Hall. “I was a prosecutor, but I was also a raging alcoholic.”

Back then, he saw, it was a lot harder to find help - one reason he founded a residential recovery center and eventually ARC, which now operates a network of more than 30 addiction treatment facilities across the state.

“There was not a lot of resources in Kentucky, and not a lot of resources in eastern Kentucky,” said Robinson, ARC’s CEO, having recently celebrated 16 years of sobriety. “We went from really a treatment desert in 2008, and because of efforts like ours, Recovery Kentucky, and other organizations - the Healing Place in Louisville, VOA in Louisville, Manchester - a lot of organizations - we’ve really increased access to treatment, leading the way in terms of having resources for our neighbors.”

It has been two decades since one newspaper declared eastern Kentucky the painkiller capital of the world. In that time, the commonwealth has seen drugs devastate lives and decimate communities.

But there is hope.

WKYT recently reported how early overdose numbers for 2022 show a promising dip as advocates try to get back on track with pre-pandemic declines. And research shows that strong “recovery ecosystems” around the region are helping to bridge the great health divide over what has become a devastating and decimating public health crisis.

The Recovery Ecosystem Index is a county-level tool, developed by NORC at the University of Chicago, East Tennessee State University, and the Fletcher Group, that measures the factors in a community that support people in recovery.

[Check out the Recovery Ecosystem Index Map here.]

“I think there’s a lot of room for other areas to learn from eastern Kentucky,” said Megan Heffernan, a public health research scientist with NORC at the University of Chicago, “and to see sort of how they were able to make progress and the things that now in this post-COVID world as we’re trying to sort of regain the ground that we lost during COVID, what are some of those successful things that happened in eastern Kentucky?”

A team of researchers, including Heffernan, found in a pre-pandemic study that overdose mortality was steeply declining in eastern Kentucky as strong recovery ecosystems were fostered around the region. Now 32 of 54 Appalachian Kentucky counties have the two strongest recovery ecosystem index scores.

Several factors helped explain those declines, Heffernan said, including:

  • Medicaid expansion
  • the idea of a “recovery ecosystem,” including a focus on recovery housing
  • having strong champions for recovery in the region
  • an evolving approach of the criminal justice system
  • the growth of needle exchanges and other harm reduction services
  • the area’s longstanding commitment to addressing the problem

“As drug overdoses and issues around substance use and opioid use disorder continue to be such a critical issue across the country,” Heffernan said, “this is really the step that we need to do as people are coming out of treatment and coming into recovery, and building those supports for them.”

Heffernan said they hope the tool will help start discussions at the local level about what communities should have in place to improve outcomes for people battling addiction.

But gaps remain.

REI scores consist of three sub-scores that look at different components of a recovery ecosystem:

  • substance use disorder treatment
  • continuum of substance use disorder support
  • infrastructure and social factors

While SUD treatment scores are strong in eastern Kentucky, scores for infrastructure and social factors remain distressingly weak. And spikes of overdoses during the pandemic show that the need for more services is still great.

University of the Cumberlands hopes it can meet some of that need.

“This is our way of saying we can help with that,” said Dr. Matthew Lyons, dean of the University of the Cumberlands School of Social and Behavioral Sciences.

Cumberlands is now offering a new online degree program for a Master of Science in Addiction Studies. The goal is to create more addictions counselors, especially for Kentucky and our Appalachian neighbors.

[See more of WKYT’s award-winning Bridging the Great Health Divide coverage here.]

“We all know the stories of ways that addiction impacts lives and families and communities,” Dr. Lyons said, “and we’re really proud to be able to put people out into the communities to provide answers to some of those needs.”

A Kentucky state law passed in 2021 made changes to allow for credentialing of licensed alcohol and drug counselors with a 30 credit hour master’s program.

Experts expect the need to be long-term.

The Bureau of Labor Statistics projects a 22% growth in similar counseling jobs over the next decade, much faster than the 5% occupational average.

“I wish there wasn’t a demand for addiction treatment,” Robinson said. “It’s hard to get excited that you’ve grown, because that means that people are suffering.”

ARC is now hiring, looking for dozens of counselors, peer support specialists, medical staff and other workers as the company’s footprint expands across the commonwealth.

“The folks in addiction, they’re our spouses, our parents, our siblings, our neighbors, the folks we grew up with,” Robinson said. “And they deserve an opportunity to get better. Because they can.”

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