With Eyes to See Addiction, Appalachian Churches Respond to the Opioids Crisis

It was the prayer requests that caught the new minister’s attention. Not long after Lisa Bryant arrived at the Madam Russell United Methodist Church, a historic congregation named for one of the original pioneers in Saltville, Virginia, she began to notice the repetition. The same underlying problem kept rearing up in the needs she heard.

“I got phone calls from some members: ‘Please pray for my grandson, he’s on drugs again,’” she said. “Or someone’s niece would get arrested again.”

Drugs—methamphetamines, oxycontin, heroin, fentanyl—were hiding everywhere in the prayers of the people.

The town of just 2,000 people in southwestern Virginia had almost nothing to help those struggling with addiction. The nearest recovery group was an hour’s drive away. Residential rehab facilities were even farther—out of reach of anyone without a decent income and reliable transportation, which is a lot of people in that part of the country. So Bryant believed that the church, in the Wesleyan spirit of doing all the good you can for all the people you can, could start a recovery group.

It shouldn’t be too hard, she thought. Churches have been hosting 12-step meetings across the country for decades.

She brought the idea to the church council: They should launch a program to help people in Saltville deal with the opioids crisis ravaging the region.

“Everybody was quiet,” Bryant told CT, recalling the moment from five years ago. “Then one guy spoke up and said, ‘We don’t really have that problem here. That doesn’t pertain to us.’”

“Really?” she asked, stunned to tears. “It’s all around us. You have to see it.”

By the numbers, the crisis should be impossible to miss. A record number of people died of drug overdoses in the US in 2021 and again in 2022. Almost 110,000 people, twice—the vast majority connected to opioids. The Centers for Disease Control and Prevention expects to see that many deaths again in 2023. That’s like losing the entire population of South Bend, Indiana, or Sugar Land, Texas, three years in a row.

And the problem has grown rapidly. Seven years ago, the overdose toll was less than half of what it is today. Twenty years ago, it was less than a third of that size. But the numbers have soared with increased availability of fentanyl, which is highly addictive in even small quantities and is frequently and fatally mixed into other drugs.

Appalachia, the mountain region that stretches from Mississippi up to New York State, has been especially hard-hit. Some of the highest per capita death tolls are in Eastern Tennessee, Kentucky, West Virginia, and Ohio. Researchers connect this to the economics of the region, especially the decline of the coal industry, which contributed to widespread poverty and depression. Many of the jobs that do exist entail risks of physical injury, which increases the likelihood of prescribed pain relievers, which in turn increases the likelihood of addiction, plus a ready quantity of leftover pills that can be sold for extra cash. In the 2010s, opioid prescription rates were 40 to 50 percent higher in Appalachia than anywhere else in America.

Yet the drug abuse can still be hard to see. A lot of congregations, like the Methodists in Saltville, have had trouble recognizing the problem, even as the destruction wrought by opioids filled their prayer lists. It seemed like something that happened to other people. And it was covered up by deep shame.

This has started to change, though. A growing network of churches—evangelical and mainline alike—have started acknowledging the drug problems in their communities and responding like they think Jesus would: with an outstretched hand.

Once people see the need, they go do it,” said Andrea Clements, a psychology professor at East Tennessee State University in Johnson City, Tennessee. “It’s just getting the fire lit.”

Clements, who earned her doctorate at the University of Alabama, researches the connections between religion, health, and responses to trauma, with a particular focus on addiction. Her work has led her to believe that faith communities have a critical role to play in dealing with the substance abuse crisis at the grassroots level.

Addiction goes back to trauma, according to Clements, and the impact trauma has on neurological systems. When people are loved and cared for, their bodies produce a healthy amount of hormones, including natural opioids such as endorphin, the “feel-good” hormone. When they’re not cared for or otherwise experience severe stress, the hormone receptors are not replenished. Chemical substances including alcohol, heroin, and fentanyl can meet that same physical need, though, and the external drugs are so powerful that the body will stop producing its own hormones.

“It shuts down the natural production,” Clements explained. “And when it’s gone, it’s awful. The feeling is often something below sadness.”

The process fuels addiction, which is both a strong physical craving and a deep emotional need.

“There are biological reasons for what’s going on, a reason for why it happens,” Clements said. “That’s not an excuse, but it is a call for compassion.”

Because addiction isn’t only a medical issue, though, Clements and others are skeptical it can be addressed in a strictly biological way. Medication-assisted treatment, such as methadone, can certainly help people cope with cravings and be functional. But is there a way to address the underlying trauma?

The question, according to Clements, is whether the natural system can be restarted with enough love, care, and human connection. That’s where the local church could step in.

“The church needs to walk with people,” she said. “The gospel is what we offer differently from everyone else.”

That part isn’t theoretical for Clements. She and her husband, Dale, and their son, Tanner, joined with others to plant a nondenominational church in Johnson City in 2012 with the goal of helping people dealing with substance abuse, including users and their families.

One of their primary forms of ministry became transportation. The church connected people who could provide rides with people who needed to get to jobs, medical appointments, court hearings, recovery meetings, and church events. As the practical need was filled, relationships formed and people became a community. Together, they believed it was possible to not only stave off the wreckage of addiction but also address deeper human needs and begin to flourish.

In 2019, the Clementses also helped start Uplift Appalachia, an organization that equips faith communities to respond to the substance abuse crisis in their areas. Uplift is an “ecumenical but evangelical” group, which views faith in Jesus as central but is willing to work with groups that start from a different place. It serves as a hub for a growing network of congregations.

Image: Illustration by Vartika Sharma

“We want to help churches to be equipped,” Clements said. “We help churches develop plans that are appropriate to their circumstances and can act as a liaison between the faith, science, and medical communities.”

Uplift has connections with more than 80 congregations, including Baptist, Methodist, Episcopal, Presbyterian, Stone-Campbell, Pentecostal, and nondenominational churches. The group also works with researchers at East Tennessee State University; the University of Virginia, in Charlottesville; Duke Divinity School; the Duke University Medical Center; the Wolfson Research Institute for Health and Wellbeing at Durham University, in the United Kingdom; the Center for Integrative Addiction Research at the University of Vienna, Austria; and other institutions.

When Appalachian congregations contact Uplift, once they’ve seen the problem in their own community, touching their churches, they are asking
a fairly basic question: What can they do? Is there any way to help?

“We can sit with them while they survive—walking along, having someone who answers the phone,” Clements said. “It might start with: Can you give someone a ride?”

David Ball, pastor of The Anchor Church in Tupelo, Mississippi, said it started pretty simply for his church. He planted Anchor at the southern end of Appalachia in 2011, as the opioids problem was dramatically expanding in Mississippi. It began with 80 people reading the Book of Acts and talking about the New Testament model for bringing “health and hope and healing to hurting people.”

As they kept meeting, praying, reading the Bible, and discussing what it meant to be “a church for today’s world,” they started to see that a lot of people in northeastern Mississippi were hurting in a very specific way.

“We wanted to be the hands and feet of Jesus, and we kept discovering needs,” Ball said. “Our mindset needed to shift to find the biggest need in the community and start meeting it.”

Through its Grace and Mercy Ministries, the church launched twin residential programs for people struggling with substance abuse: the Transformation Ranch for men in 2014 and, a year later, Transformation Home for women. The women’s program is housed upstairs at the church building in the Tupelo suburb of Verona. The men’s “ranch” is on church property outside of town.

Not everyone at Anchor loved this idea. Ball said the decision to help people with addictions led to an exodus of members the first year. Others came, however, and today about 500 attend the church’s two Sunday services. Around 100—70 men, 30 women—come from the Transformation ministries.

The 10-month program does not provide medical care. If people need a doctor, they are sent to a licensed facility. But Ball is skeptical of medication-assisted treatment. He doesn’t like how it gives people different drugs, and it concerns him that medical treatments don’t address the problem of living life. It’s the daily struggle of being alive—getting up, going to work, paying bills, feeding a family—where people face the temptation of returning to opioids, he said.

“We have to teach people how to cope and deal with life,” Ball said. “We do that through a relationship with Christ.”

Transformation Ranch and Transformation Home walk with people through four stages of intensive discipleship. When they first arrive, it’s like “Jesus boot camp,” according to Ball. Residents attend worship services, 12-step meetings, discipleship classes, and Bible studies. They are given chores and prayer partners and are cut off from contact with the outside world—at least until counselors can identify the people in their lives who are most likely to disrupt their attempt at sobriety.

In the next two phases, residents meet with peer counselors to “start figuring out their identity in Christ,” Ball said. They take more classes and receive job training, money management lessons, and instruction in other life skills. They are integrated more into the life of the church. They also join a work program Anchor organized through local businesses to start earning and saving money. Typically, a resident graduates with $6,000–$8,000 in the bank.

After about nine months, residents enter the fourth and final phase when they move into their own housing, paid for with their savings, and check in with their mentors once a week. The goal is to get reestablished as thriving, independent adults who are also part of this church community.

Ball reports that the program is successful for about a quarter of the men and one-third of the women. The program has a slightly higher relapse rate than the overall rate for recovery programs tracked by the Department of Health and Human Services. But Anchor’s standards are also higher, only counting people who never return to addiction, no matter how long they’re out of the program.

Brett McCarty, a theological ethicist at Duke Divinity School and associate director of the Theology, Medicine, and Culture Initiative, has observed a divide in the way Christians think about addiction. More conservative Christians tend to favor abstinence, making sobriety a first priority. This is usually structured around 12-step programs. More progressive Christians typically support harm-reduction efforts, like methadone treatment, needle exchanges, and fentanyl testing kits. These deprioritize staying clean, but still reduce overdoses.

Such polarization frustrates McCarty. There are strengths and weaknesses in both approaches. There’s a lot of data that supports the effectiveness of harm-reduction efforts, but researchers can also see the impact of community involvement.

“The opposite of addiction is connection,” McCarty said.

Aaron Hymes, a licensed professional counselor and board-approved clinical supervisor who oversees the addiction counseling program at Milligan University in East Tennessee, suggests an “every door approach.” Bring people in the door—any door.

“You go with what works,” he said. “Medical assistance helps to minimize urges and cravings, to let a person work on other skills.” At the same time, “If all you do is hand out meds, nothing’s going to happen. They need to be engaged with a community, such as a church” to change their lives.

Hymes studied peer counseling for his doctoral dissertation and found that it had real value. But he also encourages congregations that offer peer counseling to look into training and professional supervision.

“Recovery happens in community,” he said. “But it’s not the same as clinical therapy. … Without training and supervision, someone can actually do harm.”

Before any of that can happen, though, churches have to see the need. They have to identify the problem as their problem and see themselves as the hands and feet to meet the need.

Back in Saltville, the youth group led the way. The teens of the church befriended a high school junior they knew from school and welcomed him into their community. As the boy started to share more about his life with the church, Lisa Bryant, the pastor, learned that all the adults in his family—both parents, a grandparent, and an uncle—were addicted to drugs. The boy wasn’t a user, but he was struggling to keep his head above water while he helped his family function and finished high school.

Sometimes his home was not a safe place to sleep. On those nights, he would sneak through an unlocked door at the town’s public library, where he found refuge in a crawlspace.

Bryant shared some of the details of his situation with a Bible study made up mostly of retired teachers and asked them to pray. She couldn’t help but notice the repeated need—drugs again.

This time, however, her church felt like it pertained to them. It wasn’t abstract anymore, a problem “out there” that they knew through statistics. This was a person in front of them with a need. They began collecting money, clothes, and food, and committed to support the boy until he finished high school. He graduated a year later and enlisted in the Army.

Now, the church is reconsidering starting a recovery group and thinking of other ways to address the opioids problem as well. The congregation is working with other Methodist churches in the district and a regional government agency to secure some short-term housing. They hope to set up an addiction counseling center.

“You do what you can,” Bryant said. “In 10 years, I’d love to see less drug use, but more realistic is that when we see somebody struggling with addiction, we see the image of God in them. What can we do to bring out that image?”

S. J. Dahlman is a professor of communications and journalism at Milligan University and the author of A Familiar Wilderness: Searching for Home on Daniel Boone’s Road.

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