FINAL REPORT

APPALACHIAN REGIONAL COMMISSION 

RECOVERY-TO-WORK

LISTENING SESSIONS

December 2018–April 2019

Bruce Behringer

Prepared for the Appalachian Regional Commission

July 2019

This report summarizes the outcomes of six Recovery-to-Work Listening Sessions 

hosted by the Appalachian Regional Commission December 2018–April 2019. In each 

of the six sessions—held in Big Stone Gap, VA; Wilkesboro, NC; Muscle Shoals, AL; 

Pineville, KY; Portsmouth, OH; and Beckley, WV—ARC leadership discussed 

substance abuse related workforce issues with representatives from local and state 

government, treatment and recovery service providers, workforce development entities, 

employers, law enforcement, and individuals currently in recovery. 
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The Appalachian Regional Commission (ARC) was established by Congress in 1965 to build 

community capacity and strengthen economic growth in the 13 states that make up the 

Appalachian Region. The Region has made considerable progress toward these goals, however, 

recently, feedback from the Region indicates that the prevalence of substance abuse is negatively 

impacting the Region’s economic potential, specifically posing challenges to workforce

availability in the Region. 

In a study commissioned in 2016 by ARC, the Walsh Center for Rural Health Analysis at NORC 

at the University of Chicago found Appalachian Region opioid-related overdose mortality rates 49 

percent higher than in the non-Appalachian parts of the country (24.6 deaths per 100,000 

population ages 15-64 in Appalachia, compared to 16.5 per 100,000 in the non-Appalachian U.S.). 

Among Appalachians ages 25-44, the overdose mortality rate—which includes overdose deaths 

due to both opioid and non-opioid substances—is more than 70 percent higher than for those living 

outside the region. Typically, this group includes those in their prime working years, which creates 

a significant challenge to economic development in rural communities.

To better understand this challenge, ARC participated in listening sessions, focused on describing 

the workforce impacts of the substance abuse crisis on regional economic development. Held from 

December, 2018 through April, 2019, the sessions sought to define challenges and elements 

needed to develop an effective “Recovery Ecosystem” to mitigate the pervasive nature of this crisis 

in both lives lost and economic potential.

ARC participated in six meetings to gather recommendations for effective goals, strategies, and 

programs to address substance abuse issues in an economic development context. The sessions

captured insights and generated ideas about how communities could strengthen the recovery 

ecosystem to create pathways that help individuals achieve long-term recovery while getting the 

training and skills they need to integrate into the workforce and ultimately gain meaningful 

employment. Participants included treatment and recovery service providers, workforce 

development entities, employers, law enforcement, and the recovery community, as well as 

representatives of local and state governments, among others.

The ARC alternate representing each state where a session was held worked with the Commission

to organize their respective session, and identify and recruit participants and speakers. Sessions 

were held in the following states:

• Virginia – Big Stone Gap, December 14, 2018

• North Carolina – Wilkesboro, January 15, 2019

• Alabama – Muscle Shoals, March 20, 2019

• Kentucky – Pineville, March 28, 2019

• Ohio – Portsmouth, April 5, 2019

• West Virginia – Beckley, April 18, 2019
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Each meeting followed a set agenda. 

An introduction and background were

given by the ARC Federal Co-Chair. 

Additional welcomes and comments 

were provided by a state official. A

local individual in recovery then shared

their story about the journey from 

treatment to recovery, and securing

employment. Invited participants to the 

morning listening session then rotated 

to flip-chart sessions in small groups,

providing insights on the three key 

elements in the ARC Recovery 

Ecosystem Model; recovery services, 

workforce training, and employment. 

The afternoon public meeting included a panel of speakers from the area who provided comments 

about local, regional, and state issues for each of the three model elements. To capture additional 

perspectives, the audience then participated in a facilitated public discussion about the issues. An 

average of 75 individuals participated in each of the six public meetings.

A wealth of ideas was generated by participants through flip chart exercises, comment cards, and 

discussions. Similarities were found in input from across the six states. From this input, a number 

of key themes emerged.

Recovery Ecosystem – The recovery ecosystem in Appalachia is complex, spanning multiple 

sectors, to include; health, mental health, social work, criminal justice, housing, income support, 

transportation, education, and employment services. The availability of services to support the 

recovery ecosystem varies in each community, determined by a number of factors such as existing 

recovery infrastructure, prevalence of stigma, resources and funding, employment opportunities, 

and the length of time and experience communities have in working to address the crisis.

Recovery Needs – Among the recovery needs most frequently discussed were: sober housing; 

child care and elder care; transportation; on-going attendance with support groups; and assistance 

with medical, mental health, and dental care. Additionally, lack of adequate clothing and poor 

hygiene can serve as significant barriers to obtaining a job. 

Building a recovery community providing support to address the many medical, behavioral, legal, 

and employment challenges faced by people in recovery, was emphasized. Peer support by those 

who have achieved successful, long-term recovery was seen as essential to promote recovery, 

identify and manage patients’ needs, and encourage progress toward employment. Participants 

called for programs throughout the region to focus on use of peer support as helpers to link needs 

with resources. As such, there is a growing need for a certified peer recovery support workforce 

to support these efforts.
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Coordination of Services – Rural communities in Appalachia often lack the resources to identify

gaps in services, and to provide those services to individuals in recovery in a sustainable way. For 

individuals who have completed treatment, navigating these various services on their own can be 

discouraging, often leading to relapse. Further complicating an individual’s journey to recovery 

are existing organizational and legal mandates, absence of or backlogs in services, and the 

unstructured nature of relationships among service organizations. For instance, criminal justice 

involved individuals may experience difficulty finding employment as a result of their 

involvement with the justice system, or finding sustainable employment to address court-ordered 

costs and basic needs such as food and shelter.

Throughout the Region, there exists a general lack of coordination among the various components 

of a recovery ecosystem, to include communities with robust infrastructure. For example, in many 

of the sessions, participants discussed how this was the first time they had interacted with other

stakeholders invited to the session to discuss this issue. As such, more must be done to reduce 

siloing of services and encourage greater collaboration among the various stakeholders in a 

geographic region that make up the recovery ecosystem.

To address these challenges, participants recommended the need for community-based 

assessments and planning to better organize local and regional efforts that promote linkages among 

recovery services, workforce development, and employers. Such linkages could be built and 

maintained by new and existing intervention programs that employ individuals, often recovery 

peers, responsible for helping people in recovery succeed, along with workforce training, 

education, and employment connections they need to secure employment. Individuals in need of 

these services could be referred to the needed services by “navigators” or services can be colocated within an existing program.

Employment – Individuals in recovery were identified as a potential untapped resource for 

regional workforces. As regional employers continue to worry about unfilled job openings, there 

is increasing recognition of the need to reengage a significant number of persons in recovery into 

the workforce. Most importantly, 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.

Employment was identified as a long-term goal of the recovery ecosystem, however, participants 

described multiple barriers to employment for those in recovery, to include education and skills 

training; child care and elder care; transportation; court-ordered appointments; lack of jobs paying 

living wages and with potential for advancement; and stigma against hiring persons in recovery 

among employers and generally in communities. Some common challenges for economic growth 

can include recruiting drug-free workers; higher rates of worker turn-over; and companies and 

industries reluctant to do business, or expand current operations, in the region due to workforce 

availability. 

More attention is needed to focus on client-centered linkages between willing employers, 

workforce training, and recovery services organizations. As stated earlier, one idea for linking 

these various components can include colocation of multiple services at single sites to improve 

communication and shared goal-setting with clients, and reduce transportation issues (identified 
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as a key shortfall). Participants unanimously indicated that GED obtainment, improving soft skills, 

and boosting self-confidence of those in recovery should be included in all workforce training and 

education curriculum.

Helping employers with incentives to reduce financial risk as well as assistance with human 

resources issues, employee assistance policies, and recovery friendly workplace culture were

identified as areas that need to be strengthened. While employers identified many hiring issues, 

they also confirmed that those in recovery in general were productive and loyal employees.

Effective Practices – Appalachia communities need more information in the way of effective 

practices and programs to help them assess, plan, and develop local and regional efforts that 

promote the recovery ecosystem. Specific to employers, participants encouraged development of 

toolkits for human resources departments and employee assistance program managers to explain 

recovery and effective methods in hiring and retaining individuals struggling with substance abuse. 

ARC’S SUBSTANCE ABUSE ADVISORY COUNCIL

In May 2019, ARC established the Substance Abuse Advisory Council (SAAC), a 

24-member volunteer advisory group of leaders from law enforcement, recovery 

services, health, economic development, private industry, education, state 

government and other sectors representing each of the Region’s 13 states. The 

Council’s goal is to draw on the themes identified from the Listening Sessions to 

develop recommendations to anchor ARC’s strategy to help address the workforce 

impacts of Appalachia’s substance abuse epidemic. The Council’s final 

recommendations will be formally presented to the Commission in early 

September.