With Higher Risks Of Relapse During COVID-19, Appalachians Are Finding New Ways To Support Recovery

Apr 16, 2020

At 8:15 every weekday morning, the Clarksburg Mission’s staff circles up their chairs to share gratitude. It’s generally thankfulness for something that happened within the past 24 hours, big or small– help from dorm residents in moving furniture, a kind word from a colleague, a new day.

Desi Underwood, who serves as the mission’s ministry coordinator, said that in the past four weeks, as the cloud of COVID-19 has drawn nearer to her Appalachian community, spirits remain high; appreciation, deep. She said that throughout the mission, those with the resources to do so are pulling together impressively.

Desi Underwood is the ministry coordinator at the Clarksburg Mission, located in Clarksburg, West Virginia, where she’s continuing to provide programming for the 50 people who are now on lockdown in the emergency shelter to avoid the spread of COVID-19. Photo:
Credit Jesse Wright / 100 Days in Appalachia

But not everyone within the walls of the Clarksburg, West Virginia, facility has the resources. The mission offers emergency shelter to up to 50 people a night in its Welcome Room. It has a dorm for men and another for women and children, each of which can house about 20. A large majority of those for whom the mission is a temporary or midterm home have experienced addiction; many also grapple with mental health issues.

COVID-19 is a formidable challenge to those across the spectrum of addiction– those in recovery and those still actively using– and to those who provide them with care.

Melissa Carter has traversed that spectrum. Her Martinsburg, West Virginia, youth was nightmarish. She suffered sexual and emotional abuse; repeated rejection and displacement. She’s been jailed and imprisoned multiple times, rehabbed and relapsed many more.

She eventually made her way to the Clarksburg Mission’s sober-living housing, some 300 miles west of her hometown. It was there that, at 38, she was thrown her first birthday party. Carter has been drug-free for two years. She’s now serving multiple roles at the mission, including as a recovery coach.

“Stress is a big trigger,” Carter said of those in recovery. Today, stress abounds.

As of Tuesday, no one at the mission had tested positive for COVID-19. But everyone there is bracing for the near inevitable.

They began preparing four weeks ago with hand-washing and social-distancing instructions.

“And then it just got more and more intense,” said Lou Ortenzio, the mission’s executive director, “and we realized we should probably lock down as a facility.”

Lou Ortenzio’s name is known in many circles in the tight knit community of Clarksburg, West Virginia. Shown here in 2019, Ortenzio was once a prominent doctor in the area and struggled with substance abuse issues of his own, but now serves as the executive director of the Mission where he leads programs and support systems for others in recovery.
Credit Jesse Wright / 100 Days in Appalachia

Many residents, Ortenzio said, “have come through, found amazing strength, have stepped up and are volunteering and cooperating in new ways,” cooking, cleaning, comforting.

But it’s a fragile equilibrium. Like caregivers and advocates everywhere, the Clarksburg Mission team fears what the COVID-19 crisis will mean for those along the edge of addiction.

Sharing Vital Information

Measures are being taken across the country to help people in recovery get the care they require.

On March 16, the federal Substance Abuse and Mental Health Administration relaxed its restrictions on the number of doses of methadone clinics can dispense to patients. Methadone is used in medication-assisted treatment for opioid addiction.

In the past, most people enrolled in an opioid-treatment program would have to visit a clinic daily to receive their dose. After proving stable, they might be allowed to take a few home with them. Now, a person considered stable can take 28 doses home; those not yet deemed fully stable but a good risk can be given 14 doses.

The Centers for Medicare & Medicaid loosened restrictions on services its beneficiaries can receive through telehealth, using computers or smartphones. Health care providers now are able to offer more addiction-treatment services via telehealth. And providers can now initiate medication-assisted treatment, or MAT, via telehealth.

Cabin Creek Health Systems, based in Dawes, West Virginia, 20 miles south of Charleston, serves more than 100 people in its MAT program. Cabin Creek is now using telehealth to reach those patients.

“We tend to have strong relationships with the patients in that program,” said Executive Director Craig Robinson. “They know and trust us, and that carries over into being willing to try the new technologies.”

Narcotics Anonymous chapters throughout Appalachia are convening meetings on Zoom, and Narcotics Anonymous World Services has a webpage with listings for virtual meetings all over the world.

“It’s been really cool to see the recovery communities come together so strongly,” said Dan McCawley, a peer-recovery coach with West Virginia Peers in Morgantown who is himself in long-term recovery. “I’m going to more meetings now than I did before because it only takes me 30 seconds to join in. I’ve been to meetings in Ireland, California, New York, North Carolina, Virginia. It’s cool to feel a sense of unity worldwide, that the recovery community is still there for one another. ”

Telehealth is not, however, always a viable option.

Hillary Brown is director of the Steady Collective, which offers harm-reduction services, referrals to care and education for those using drugs and in recovery in Asheville, North Carolina. The Steady Collective serves a great many people who are homeless, and, Brown said, “virtual isn’t accessible for our folks. Most of our folks don’t have phones or any access to internet.”

The Steady Collective is now providing its syringe-exchange services from a mobile unit. But Brown is plenty concerned about the other essential services her clients are losing access to: food, housing, public restrooms and medical care. (The North Carolina Harm Reduction Coalition has petitioned municipalities to reopen public restrooms and deploy portable latrines and to refrain from clearing encampments.)

Brown and her colleagues are distributing masks made by a local kid (“Great fabric. They’ve been a big hit.”) and hand sanitizer provided by the state. They have an herbalist riding along with them a couple of times a week talking with people about how to manage withdrawal symptoms using herbal formulas.

A lot of the folks the Steady Collective is serving are not getting much information around COVID-19, Brown said. “They don’t have access to televisions or to social media, and so they’re not getting a lot of updates about this. So we’ve had to do a lot of education, giving folks materials and saying, like, ‘You know, this is a serious thing.’”

“But how many protections can you really give yourself when your only option for staying inside is an apartment where 10 people are staying,” Brown asked, “or an abandoned house or camp where a lot of people are sleeping?”

Stephanie Almeada is battling a lack of access to information in her rural Western North Carolina community, where she is providing emergency tents, food and medical supplies to people who are homeless, some of whom are also in recovery.
Credit Taylor Sisk / 100 Days in Appalachia

“I have really deep concerns that because we’re working with so many folks who were already immune compromised, that we’re going to lose a lot of people,” she said. “And that’s really heartbreaking.”

Seventy miles to the southwest of Asheville in Franklin, North Carolina – a town of 3,800 in a mountainous, predominantly rural region – Stephanie Almeida provides care to those across the spectrum of addiction. She runs Full Circle Recovery Center and is the executive director of Smoky Mountain Harm Reduction.

Almeida is distributing food, medical supplies and tents for clients who are homeless. But like Brown, she recognizes the urgency of providing information. In these mountains, bandwidth is coveted; cell phone service is spotty.

“Most of the people that I talk to have no idea at all about what’s happening or ways to prevent the spread of infection,” Almeida said. “They’re cut off completely, really, from the information that’s life saving.”

What they do learn is often of little use: “They’re told, ‘If you get sick, just stay at home and call your doctor.’ Well, my folks don’t have a doctor. Cut them off from every access to life and then tell them to call your doctor? They don’t have medical insurance. They don’t have $5 to get to [the convenience store] to get gas.”

Almeida is witnessing her neighbors cycling through the stages of grief. Many are still at denial.

“‘No, this isn’t gonna bother me; I’m healthy.’ And I’m like, ‘Okay; let me show you this little infographic of how your “I’m healthy” has just exposed 100 people.’”

“Those that do get it,” she said, “are, like, ‘Holy shit.’”

“I think we know what’s coming,” Almeida said. “We can’t handle that here.”

‘Forcing People to Be Still’

Though the Clarksburg Mission isn’t taking in any new residents, it’s not turning anyone out– not unless it’s necessary for the well-being of the others. Some have chosen to leave, unable to handle the pressure of being cooped up. Some have returned to drugs. As of last week, Melissa Carter said, nine people had relapsed in the previous couple of weeks.

Melissa Carter has found a sense of home and community at the Clarksburg Mission. A former resident of its sober-living home, she now works for the facility in a number of ways, including as a recovery coach
Credit Jesse Wright / 100 Days in Appalachia

Carter is especially concerned about those newly in recovery, a particularly fragile time. She shares the story of a guy with whom she’s been working very closely:

“He hasn’t really had too many people show him that they really care whether he’s clean or not. So I’m trying to take the time to not only help him figure out a way to get clean but to show him that he matters.” He continues to struggle.

“I’m taking the people that just relapsed and the people that are in recovery, and we’re starting back at the beginning,” Carter said, “the relapse warning signs, writing about it. We’re just going to meet each day and talk, talk about our struggles, talk about where we are and try to work the problems out.”

The Mission folks, residents and staff alike, are doing the best they can, given the dimensions, to be mindful of social distances. Chairs are set apart in the now-otherwise-empty dining hall for small recovery meetings. Daily devotions are held in the dorms.

Desi Underwood emceed a spelling bee in the Welcome Room one afternoon, with prizes for the winners. On a recent Friday night, the mission staff threw an ice cream sundae party to show their appreciation for the cooperative spirit that’s prevailed.

“We’re trying to get by as best we can,” Ortenzio, the director, said.

“I think it’s giving everyone an opportunity, almost forcing people, to be still,” Underwood said. “I think people are becoming more insightful and more aware of their struggles, and ways to deal with their struggles, and they have more opportunity to come alongside one another– to be kind and see kindness in each other.”

This story was co-published by 100 Days in AppalachiaMicrosoft News and Spotlight for Poverty and Opportunity, a nonprofit, nonpartisan site featuring commentaries and original journalism about poverty and mobility. MSN News and Spotlight partnered on a package of stories and long-form videos, Poverty Next Door, late last year. Follow Spotlight on Twitter @povertynews and 100 Days at @Appalachia100

Correction 04/16/20 10 a.m.: A previous version of this story included an image that misidentified Melissa Carter. It has been replaced. We regret the error.