McDowell County--in the southern coalfields of West Virginia--is the second-most at-risk in the nation for an HIV outbreak related to drug injection. Neighboring Wyoming and Mercer Counties follow close behind. All three have some of the highest rates of acute hepatitis B and hepatitis C in the United States.
Dr. Gordon Smith, epidemiologist in the West Virginia University School of Public Health, and his colleagues have received $1.35 million three-year grant from the Appalachian Regional Commission to reduce the impact of substance abuse in these three counties. This POWER (Partnerships for Opportunity and Workforce and Economic Revitalization) Initiative grant aims to help employ people who formerly injected drugs and are from areas savaged by job losses. It's hopeful this model can then serve as a guide to be replicated across Appalachia.
"Given the very high proportion of adults in our counties with substance use disorder, it is essential to develop a robust recovery ecosystem by aiding and sustaining both recovery and physical health, as well as providing enhanced longitudinal support," said Smith, the Stuart M. and Joyce N. Robbins Distinguished Professor in Epidemiology.
"Before job training and education can be successfully pursued and sustained, the first crucial step is to support those in recovery by providing more than just medication for opioid use disorder."
The project is a collaboration with the Southern Highlands Community Mental Health Center in Princeton which serves the three counties and provides comprehensive treatment for substance use disorder.
State-certified peer navigator/recovery coaches will be central to the project. "(They) are individuals with the lived experience of substance use disorder, who are in long-term recovery and able to connect with clients in a non-judgmental, non-stigmatizing, empathetic manner that creates trust," said Lisa Jones, CEO of SHCMHC.
SHCMHC will employ peer navigator/recovery coaches to provide sustained outreach and linkage to integrated care for substance use disorders, mental health and drug use-associated chronic infections. They will reach persons who inject drugs through existing programs and self-referrals, and will provide "the crucial, trusted link between people with substance use disorders and needed services to address addiction and associated chronic viral infections as they make their way into recovery," Jones said.
A key requirement for the project is that it be both comprehensive and sustainable.
"Because substance use disorder is a chronic, relapsing brain disease, relapse--especially under stress--is a reality and a constant threat to hard-won sobriety," said Dr. Judith Feinberg, a professor in the departments of Behavioral Medicine and Psychiatry and Medicine/Infectious Diseases, and the E.B. Flink Vice Chair of Research in the Department of Medicine. "In fact, relapse is so common it is to be expected, and our program will manage this proactively and help keep people in the recovery ecosystem instead of relapsing and dropping out."
As part of the project's proactive approach, SHCMHC will provide warm handoffs to community job training and vocational education partners while peer navigator/recovery coaches provide continued simultaneous support to participants to prevent and mitigate relapse.
"The bond between client and peer navigator/recovery coach enables them to develop a trusting relationship that facilitates the acceptance of guidance and support throughout the client's journey through the continuum of care," Smith said. "Through this ongoing support, our program will be the 'glue' that links needed substance use disorder and health services into and through the period of job training, successful employment and re-entry into the community."
"I congratulate West Virginia University for their POWER award, and commend them on the leadership they have shown in their community," said ARC Federal Co-Chairman Tim Thomas. "POWER grants are playing a critical role in supporting coal-impacted communities in the Appalachian Region as they recover from COVID-19 by building and expanding critical infrastructure and creating new economic opportunities through innovative and transformative approaches. Projects like this are getting Appalachia back to work."