MARION, N.C. -- Rural North Carolina is battling two health epidemics - substance abuse and COVID-19 - as treatment centers navigate shutdowns and internet-access challenges to address addiction and mental-health issues.

In McDowell County, Jacqueline Fox heads McDowell Impact, a peer-support specialist network. Her organization is working to place specialists with key agencies that work with people battling addiction and related challenges such as family separation, finding housing and infectious disease. She said building a strong network of resources and educating people is critical to reducing the long-term societal effects of COVID-19.

"In McDowell, we're kind of resource poor," she said. "We have one mental-health provider. And when you're working with people who struggle with substance misuse, you have a small timeframe when they're ready and seeking help. Transportation is always an issue. Medication was always an issue, the cost."

A new report from the North Carolina Division of Public Health found that emergency-room visits related to drug overdose have jumped by 22% compared with last year. The highest rates of overdose occurred in rural counties among the hardest-hit by COVID-19.

Fox added that prolonged social isolation and economic hardship will affect families differently, so treatment centers and social-service agencies will have to work to meet individual needs.

"When you isolate folks and you take away their connection to community, to churches, that's just going to have far-reaching effects," she said. "It's going to have a ripple effect on their life. Maybe they're not able to afford meds, or they are having to seek out those services for food, they become food insecure. So, I don't think there's really one thing that we can pinpoint to focus more on."

Anthony Tyre, a behavioral health counselor and founder of the Eastern Community Care Foundation, said the stigma surrounding mental health and substance use, combined with fear of COVID-19, deters people from seeking help. Also, many rural residents lack reliable home internet and can't have online appointments. So his organization checks on clients at home, in what he called COVID-safe "front-yard visits."

"We're kind of seeing a lot of the kids going through major depression," he said. "A lot of the folks who are living with substance-use disorder and trying to battle that, they're struggling because they're having difficulties getting in to their appointments."

This summer, the Centers for Disease Control and Prevention reported more Americans are experiencing worsening mental health linked to the pandemic, especially among younger adults, people of color, essential workers and unpaid family caregivers.


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One popular New Year's resolution is to quit alcohol consumption.

Although easier said than done, one recovery center said there are modifications to try if previous attempts are not working. A good start is taking a hard look at what has worked and what has not.

Marissa Sauer, a licensed clinical addiction counselor at Avenues Recovery, a Fort Wayne recovery center, pointed out if there was a simple answer, everybody would use it. She added other influences are linked to alcohol and substance abuse.

"There's genetics. Were my parents and my grandparents struggling with substances? Does someone have maybe adverse childhood experiences that have led to substances being a coping mechanism of some kind?" Sauer explained. "Maybe there are these mental health diagnoses."

Sauer mentioned people, places, or things which could inhibit or enable someone to abuse drugs or alcohol, making it complicated to simply walk away. Medication, therapy or conversations with people who have beaten their addictions are all effective measures for recovery.

The US Surgeon General's 2025 Advisory Report indicates alcohol consumption is the third leading preventable cause of cancer after tobacco and obesity and the public is taking notice.

There is a growing momentum of the "sober curious" movement, avoiding happy hours at bars, ordering a low or no-alcohol drinks known as mocktails, or completely abstaining from alcohol for 30 days for "dry January." Sauer said longtime substance abusers fear change and she wants them to know there is hope.

"Whether you're 21 or whether you're 51, that ability to heal is there," Sauer emphasized. "The best gift that you could give yourself for a healthy 2025 is to give your loved ones the absolute best version of yourself."

An Indiana State Epidemiological report from 2021-2022 revealed almost 24% of residents aged 12 and older have participated in binge drinking, with the highest rate among young adults aged 18 to 25.


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A statewide program in Kentucky aims to provide credentialing and pathways to a career in social work for people in substance use disorder recovery. Advocates say the Career Ladders in Mental and Behavioral Health or CLIMB-Health program is vital for the state to boost the mental health and social services workforce.

Carl Wilson, senior fellow for healthcare development and initiatives with the Kentucky Council on Secondary Education, said it also provides opportunities for those in recovery to make a living and expand their career horizons.

"You can gain both occupation credentials and or employment all the way up through a professional level within this program. So the program offers individuals with lived experience a tailored pathway," he said.

Community colleges across the state serving more than 100,000 residents are now working with people who have been state-certified peer support specialists, to transfer their training toward Bachelor of Social Work degrees. The CLIMB-Health program began on Kentucky Community & Technical College System campuses in counties with the highest overdose deaths.

Wilson said residents in drug court programs in all 120 counties face barriers to employment.

"When they get to that employer interview, and that employer runs that background, and they see the addiction issue, they see in most cases, the justice involvement, they're locked out of opportunities," he added.

The goal is to fill urgent gaps in the state's healthcare system and boost long-term economic stability for people living in recovery.

"We have approximately 50,000 to 0,000 untapped workers for our workforce in Kentucky that have not been given that opportunity to have a specialized program which addresses them," Wilson continued.

While overdose rates in other states are declining Kentucky ranks among the top ten states in the nation for drug overdose deaths, according to the CDC.

While overdose deaths in the Commonwealth have declined, deaths among Black Kentuckians have increased by 5%, according to data from the latest Kentucky Overdose Fatality Report.

Organizations across the state are working to stem overdose deaths among residents of color. In Bowling Green, the nonprofit HOTEL INC. is focused on harm reduction.

Rebecca Troxell, HOTEL INC. lead navigator, explains the group's street teams go into homeless encampments and provide Narcan, fentanyl strips, hygiene packets and medical care.

"We have volunteer doctors, EMTs and nurses who go out with us, so we're able to provide medical care on site. We're able to provide educational components with that, as well, helping people understand what harm reduction really is," she said.

She added a recent SHIFT grant from the Foundation for a Healthy Kentucky will allow the street teams to reach more people. The program, which awards funding up to $50,000, aims to reduce disparities and other inequities worsened by the drug crisis.

In Lexington, the nonprofit agricultural organization Black Soil KY is adding Narcan boxes and educational materials to its farmers markets. They are also working to improve access to fresh food among Kentuckians in recovery.

Ashley Smith, co-founder and CEO of Black Soil, said farmers will also receive harm-reduction training: "We know having that unbarriered access to local goods, like seasonal produce, local meat within your recovery housing, just really provides an advantage for the overall outcome."

Kayla Migneron, director of the Louisville-based maternal health program Granny's Birth Initiative, said the SHIFT grant funding will help expand stigma-reduction training for doulas.

"Our main goal is that any person would be comfortable coming to get assistance from us, whether it's accessing resources using our stuff, even just asking for connections to other programming," explained Migneron.

Nationwide, overdose deaths among mostly younger Black women nearly tripled between 2015 and 2021.