Recovery-to-Work Resources

Substance use recovery requires collaborative action to help individuals become stable contributors to the workforce. See below reports and other resources for supporting your Recovery-to-Work Ecosystem.

Tools and Guides

Overdose Mapping Tool

This tool offers users a nice, dynamic, interactive map of overdoses in the Appalachian region. Various race, education, and socioeconomic variables can be layered over overdose data. Tooltips provide a county by county exploration of the data.

The map can be printed but the data cannot be freely downloaded. Data is drawn from federal, publicly available sources, so it is possible for an individual to source it on their own.

Curated Library about Opioid Use for Decision-Makers (CLOUD)

CLOUD is a newly launched, searchable library of curated, evidence-based resources on opioids and the opioid crisis. The goal is to provide everyone working on this important issue with a centralized source to find actionable, evidence-based resources. CLOUD engages in a thorough inclusion review process to ensure the highest quality of materials are selected for the site. The library is a dynamic project, regularly adding resources to ensure users have the latest information available, and we invite material submissions through the call for submissions page.

Rural Resource Guide

October 11, 2018

ONDCP has identified 26 overarching categories to organize this resource guide and help users identify potential sources of assistance for issues they find most challenging. This list is not exhaustive: many of the programs and resources listed in these pages cover a much broader range of potential uses.

The tool covers: American Indian/Alaska Native; Community; Economic Development; Education; Elderly People; Employment; Government; Health/Wellness; Healthcare Systems; Housing; Infrastructure; Justice; Mental Health; Opioids; Overdose Prevention; Parenting/Family; Prevention; Recovery; Rural/Frontier; Social Services; Substance Use Disorder; Transportation; Treatment; Violence, Trauma, and Abuse; Youth.

Each section provides a list of funding, aid and information resources broken out by opportunity area. A good starting point for people trying to identify federal funding opportunities.

Rural Community Action Guide

February 6, 2020

The Rural Community Action Guide is a compilation of qualitative data collected from numerous community organizations, and data arranged by category. The guide aims to educate the public by providing an overview of the key challenges rural communities face when addressing the consequences of prescription opioid misuse and the use of illicit substances. It also showcases localized efforts implemented to help mitigate the impact of substance use disorder.

The guide addresses the stigma surrounding addiction, how to effectively use and interpret data, the impacts of addiction on rural communities, and best practices for treatment, prevention, and recovery. The report focuses on the involvement of faith communities and housing as crucial elements of recovery and stresses the need for centralizing the recovery ecosystem around the experiences of those engaging with it.

ARC Addressing Appalachia’s Substance Abuse Crisis

This is an information landing page hosted by ARC that features a collection of tools and resources the ARC has published to address the SUDs crisis in the region. Most (if not all) of these resources are detailed elsewhere in this document, but the page serves as a useful primer on the issue. Would be a good starting resource to share to raise awareness of the problem.

Tools to Help Employers Navigate the Opioid Crisis

The TN Chamber has produced a toolkit to support employers in the state. They also hosted a series of breakfast discussions in early 2020.

Ohio Opioid Toolkit

With the help and expertise of a member company, Working Partners, and financial support from member company, Anthem, Ohio developed the Opioid Toolkit containing several resources free of charge to any company that is doing business in Ohio.

This 5-module course (13-16 min. per module) gives an overview of the legal and operational issues an employer must consider in dealing with an employee’s use of opioids and other substances. The modules include best practices around how, when and why to drug test; how to handle a situation if the employee confesses or is discovered to be using harmful substances; and much more. Although each module contains valuable information, it is not necessary that they be watched in order or in their entirety. Additional informational resources are available as well.

Strategies for Helping Individuals Impacted by Opioid Use Disorder: A Toolkit for Ohio’s Public Workforce System

The Toolkit includes resources and materials to help Local Workforce Boards get started, including:
• a basic understanding of the causes and symptoms of opioid use disorder;
• a listing of local organizations to partner with and an overview of the services they provide;
• tips for creating more in-depth case management services for individuals in recovery;
• methods for tracking the progress of individuals as they secure and maintain employment;
• tools for developing recovery-friendly workplaces;
• training information and guides to build staff skills;
• new policies to consider adopting to better serve individuals with substance use disorder; and
• key action steps and example documents to kick-off local activities.

Workforce Central Podcast

On this podcast, Ron Painter, National Association of Workforce Board’s (NAWB) President/CEO, interviews public and private sector leaders in workforce development, education, business and economic development on key workforce issues and investment strategies to help America compete globally.

Guidance to States: Recommendations for Developing Family Drug Court Guidelines

2013 (revised 2015)

Family drug courts (FDCs) offer an important and effective way to address substance use disorders and parenting within the child welfare and court systems. In existence since 1994, with more than 300 programs in operation today, FDCs grew out of the adult criminal drug court movement that began in Miami in 1989. In the mid-1990s, the adult criminal drug court model was described by the National Association of Drug Court Professionals (NADCP) in Defining Drug Courts: The Ten Key Components, which offered a framework to develop and refine adult drug courts.

Several States have developed FDC standards by which they monitor local jurisdictions and that provide direction on specific needs and issues related to child welfare such as child development, trauma experiences and child safety concerns, however most States have not. This poses challenges as States and individual FDCs seek guidance in planning, implementing, and monitoring their programs and in turn makes program evaluation and quality assurance more difficult. There have been considerable efforts to identify the characteristics of FDCs in the past decade that incorporate practice changes to address the needs of children and their families. Building on those efforts, this document has been developed to provide assistance to the field in further defining FDCs’ best and promising practices so that States can issue their own guidelines for FDCs or enact standards by which FDCs are held accountable.

This report provides information on best practices and collaborative principles to develop and sustain Family Drug Courts. The Guidelines will assist policy makers and practitioners to enhance and expand these programs across the country.

This is the culmination of a 2-year project of Children and Family Futures. Initial conceptualization and significant contribution was provided by a devoted workgroup of experts from the fields of substance abuse, child welfare and courts.

5-Point Strategy To Combat the Opioid Crisis

In 2017, HHS launched a comprehensive 5-Point Strategy to empower local communities on the frontlines. The opioid epidemic is one of the Department’s top priorities; through the 5-Point Strategy and HHS’s Agency Priority Goal of Reducing Opioid Morbidity and Mortality, the Department continues to focus on most effective efforts for addressing opioid use disorder.

Addiction Group Resources

Here you’ll find most frequently asked questions and find valuable resources for people suffering from substance use disorders (SUDs) from Addiction Group. Addiction Group is an informational web guide that was founded in 2019. Their website was created to help those struggling with alcohol use disorders (AUD), substance use disorders (SUD), and/or co-occurring mental health disorders find treatment for their addiction. Addiction Group is owned and funded by Treatment Pathway LLC, an informational marketing company that specializes in producing authoritative medical content based on addiction literature, accredited scientific journals, and current research in the field.

Personal Finance & Reentry Resources for Formerly Incarcerated People

This guide aims to connect individuals and families to support services, providing sound financial advice to help give the formerly incarcerated community a chance to turn to a new chapter in their lives.

Grants, Programs, and Initiatives

Various HHS Grants

Ending homelessness requires housing combined with the types of services supported by HHS programs. The delivery of treatment and services to persons experiencing homelessness are included in the activities of the Department, both in five programs specifically targeted to homeless individuals and in fourteen non-targeted or mainstream, service delivery programs.

Targeted homeless assistance programs are specifically designed for individuals or families who are experiencing homelessness.

Supportive Services: Non-targeted or Mainstream programs are designed to serve those who meet a set of eligibility criteria, which is often established by individual states, but are generally for use in serving low-income populations. Very often, persons experiencing homelessness may be eligible for services funded through these programs.

FY 2020 Comprehensive Opioid, Stimulant, and Substance Abuse Site-based Program (COSSAP)

Solicitation Status: Open

Fiscal Year: 2020

Closing Date:  May 21, 2020

Solicitation Type: Competitive

The Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) was developed as part of the Comprehensive Addiction and Recovery Act (CARA) legislation. COSSAP’s purpose is to provide financial and technical assistance to states, units of local government, and Indian tribal governments to develop, implement, or expand comprehensive efforts to identify, respond to, treat, and support those impacted by illicit opioids, stimulants, and other drugs of abuse.

COSSAP aims to reduce the impact of these substances on individuals and communities, including a reduction in the number of overdose fatalities, as well as mitigate the impacts on crime victims by supporting comprehensive, collaborative initiatives.

Developing a Workplace Supported Recovery Program: A Strategy for Assisting Workers and Employers With the Nation’s Opioid and Substance Use Disorder Epidemics: Request for Information

Current status: Request for information. The document is open for comments until April 27, 2020.

The National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC), announces an opportunity to provide input on a NIOSH plan to develop resources and conduct research on the topic of Workplace Supported Recovery. Workplace Supported Recovery programs (WSRPs) assist workers and employers facing the nation’s crisis related to the misuse of opioids and other drugs, and related substance use disorders.

You may submit written comments, identified by docket numbers CDC-2020-0001 and NIOSH-333, by either of the following two methods:

  • Mail: National Institute for Occupational Safety and Health, NIOSH Docket Office, 1090 Tusculum Avenue, MS C-34, Cincinnati, Ohio 45226-1998.

Instructions: All information received in response to this notice must include the agency name and docket number [CDC-2020-0001; NIOSH-333]. All relevant comments received will be posted without change to, including any personal information provided.

Continuum of Care (CoC) Program

The Continuum of Care (CoC) Program is designed to promote communitywide commitment to the goal of ending homelessness; provide funding for efforts by nonprofit providers, and State and local governments to quickly rehouse homeless individuals and families while minimizing the trauma and dislocation caused to homeless individuals, families, and communities by homelessness; promote access to and effect utilization of mainstream programs by homeless individuals and families; and optimize self-sufficiency among individuals and families experiencing homelessness.

This link contains support and background materials for the CoC program, including a program toolkit. This toolkit provides user guides, tools, webinars, and other resources on the following topics: Introduction to the CoC Program, CoC Responsibilities and Duties, Determining and Documenting Homelessness, CoC Program Components and Eligible Costs, and Grant Administration (Includes Recordkeeping and Financial).

Federal Bonding Program

The U.S. Department of Labor established The Federal Bonding Program in 1966 to provide Fidelity Bonds for “at-risk,” hard-to-place job seekers. The bonds cover the first six months of employment at no cost to the job applicant or the employer.

This page contains resources for the program as well as information about how to apply and who is served by the program.

Statewide Peer Networks for Recovery and Resiliency

April 20, 2016

This was a SAMSA funding opportunity that closed June 21, 2016. From the description of the grant:

“The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) and Center for Mental Health Services (CMHS) are accepting applications for fiscal year (FY) 2016 Statewide Peer Networks for Recovery and Resiliency (Short Title: Statewide Peer Networks for R&R) grants. The purpose of this jointly-funded grant program (CSAT and CMHS) is to provide a one-year developmental period to promote cross-system collaboration, expand the peer workforce, build infrastructure, and enhance capacity among currently funded SAMHSA Recovery Community Services Program – Statewide Networks (RCSP-SNs), currently or formerly funded Statewide Consumer Networks (SCNs), and currently or formerly funded Statewide Family Networks (SFNs). These networks will work together to enhance and promote cross-service systems, expand the peer workforce, and develop infrastructure that is recovery and resiliency-oriented, as well as focused on implementation, planning, and sustainability.

This program builds on the FY 2015 program for RCSP-SNs, SFNs, and SCNs to develop intentional, collaborative efforts via Memoranda of Agreement (MOA) and sharing of fiscal resources. The intent of this program is for RCSP-SN, SFN, and SCN grantees within a state to form a collaboration that will develop and/or implement a strategic plan, share resources, engage in cross-training, increase capacity to affect behavioral health systems change at the state and local levels, and improve behavioral health outcomes for people in recovery from substance use disorders (SUDs), children and youth with serious emotional disturbances (SED) and their families, and adult consumers with serious mental illness (SMI).”

Rural Response Initiative

Overview of Funding Opportunity

The Rural Responses Initiative is designed to reduce the morbidity and mortality associated with opioid overdoses among individuals who come in contact with law enforcement or are involved in the criminal justice system in high-risk rural communities and regions.

This initiative, co-funded by the Bureau of Justice Assistance, the Centers for Disease Control and Prevention, and the State Justice Institute, supports a six-month planning phase for 21 sites to identify current gaps in prevention, treatment, and/or recovery services for individuals who encounter the criminal justice system within the target rural service area.

During the 18-month implementation phase, the sites will initiate new activities or augment existing efforts to strengthen epidemiologic surveillance and public health data infrastructure, implement effective community-level opioid overdose prevention activities, and establish or enhance public safety, public health, and behavioral health collaborations. Sites may also elect to leverage funding to expand peer recovery and recovery support services that help people start and stay in recovery.

Several sites in Appalachia have been chosen.

Regional Partnership Grants to Increase the Well-Being of, and to Improve the Permanency Outcomes for, Children and Families Affected by Opioids and Other Substance Abuse

Applications for this grant were due 7/31/2019

The purpose of this FOA is to establish, by cooperative agreement, Regional Partnership Grants (RPG) projects designed to increase well-being, improve permanency, and enhance the safety of children who are in, or at risk of, an out-of-home placement as a result of a parent’s or caregiver’s opioid or other substance abuse. These RPG projects will provide activities and services through interagency collaboration and integration of programs. Successful applicants will have a collaborative infrastructure in place that is capable of building the region’s capacity to meet a broad range of needs for families involved with child welfare systems, substance use disorder treatment, courts, and other related service organizations.

2019 Grant award recipients:

  • Acenda, Inc., NJ
  • Colorado Judicial Department, CO
  • Georgia State University, University Foundation, Inc., GA
  • Mary Hitchcock Memorial Hospital/Dartmouth-Hitchcock Medical Center, NH
  • Oklahoma Department of Mental Health and Substance Abuse Services, OK
  • Preferred Family Healthcare, Inc., MO
  • Prestera Center for Mental Health Services, Inc., WV
  • Youth Network Council, IL

April 9, 2019 – Rural Health and Safety Education Competitive Grants Program (RHSE)

Applications for this program closed April 9, 2019.

NIFA requests applications for the Rural Health and Safety Education (RHSE) Competitive Grant Program for fiscal year (FY) 2019 to address the needs of rural Americans by providing individual and family health education programs. The amount anticipated to be available for support of this program in FY 2019 is approximately $2.9 million. This notice identifies the objectives for RHSE projects, deadline dates, funding information, eligibility criteria for projects and applicants, and application forms and associated instructions needed to apply for a RHSE grant. Proposals will be accepted which focus on the prevention and/or reduction of opioid misuse and abuse.

Rural Opioid Technical Assistance Grants

Applications for this program closed June 7, 2019.

The Substance Abuse and Mental Health Services Administration (SAMHSA), is accepting applications for fiscal year (FY) 2019 Rural Opioid Technical Assistance Grants (Short Title: ROTA). The purpose of this program is to develop and disseminate training and technical assistance for rural communities on addressing opioid issues affecting these communities. It is expected that grantees will facilitate the identification of model programs, develop and update materials related to the prevention, treatment and recovery activities for opioid use disorder (OUD), and ensure that high-quality training is provided.

Through this program, SAMHSA will build upon a collaboration with the United States Department of Agriculture (USDA). The USDA provides Cooperative Extension Services programs to improve the quality of people’s lives by providing research-based knowledge to strengthen the social, economic and environmental well-being of families, communities and agriculture enterprises. Extension experts focus on issues which affect rural communities. The USDA has recently identified opioid misuse in rural America to be one of the areas of focus of these programs. SAMHSA’s ROTA grants will build upon these Cooperative Extensions through expanding their reach.

Overdose Data to Action Grant

February 1, 2019

The complex and changing nature of the opioid overdose epidemic highlights the need for an interdisciplinary, comprehensive, and cohesive public health approach. States, territories, and local partners need access to complete and timely data on prescribing, and on nonfatal and fatal drug overdoses to understand the scope, direction, and contours of the epidemic. They also need the tools and resources to then use data to inform and target their prevention and response efforts. This NOFO integrates work funded through three previous CDC funding opportunities: Prescription Drug Overdose Prevention for States (CDC-RFA-CE15-1501), Data Driven Prevention Initiative (CDC-RFA-CE16-1606) and Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality (CDC-RFA-CE16-1608). This three year funding opportunity will continue work focused on: increasing comprehensiveness and timeliness of surveillance data; building state and local capacity for public health programs determined to be promising based on research evidence; making Prescription Drug Monitoring Programs (PDMPs) easier to use and access; and working with health systems, insurers, and communities to improve opioid prescribing. It adds new work focused on linkages to care and other areas of innovation supported by evidence-based practice.

Bureau of Justice Assistance’s Comprehensive Opioid Abuse Program Rural Responses to the Opioid Epidemic

Applications due: July 26, 2019, at 5:00 p.m., ET

The Rural Responses to the Opioid Epidemic solicitation is designed to leverage the combined resources and expertise of the U.S. Department of Justice, Bureau of Justice Assistance (BJA), the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, and the State Justice Institute (SJI), along with other federal partners, to reduce the morbidity and mortality associated with opioid overdoses among individuals who come in contact with law enforcement or are involved in the criminal justice system in high-risk rural communities and regions.

Index of available information on rural programs to address opioid crisis

This guide will help you learn about activities underway to address the opioid crisis in rural communities at the national, state, and local levels across the country. It identifies: Initiatives and funding opportunities, Rural program examples, and Tools and resources focused on prevention, harm reduction, and treatment.

U.S. Department of Labor, Women’s Bureau

September 30, 2019

In September 2019, the U.S. Department of Labor announced the awards of nearly $2.5million in grant funding to organizations in five states to help women affected by the opioid crisis to re-enter the workforce. The 2019 Re-Employment, Support, and Training for the Opioid Related Epidemic (RESTORE) grants are intended to foster cooperative relationships among a wide range of entities, including workforce intermediaries, public health and substance abuse treatment professionals, and other human services and support services providers to offer skills development and employment services to benefit women workers.


    • Urban Workforce Advantage (UWA) – Northern New Jersey
    • The Research Foundation for SUNY – University at Buffalo – New York State
    • Total Action Against Poverty – Roanoke Valley, Virginia
    • Helen Ross McNabb Center – East Tennessee
    • Public Health Management Corp. – Philadelphia, Pennsylvania

Reports, Presentations, and Other Literature

DDAA Recovery-to-Work Cohort Learning Academy Reports

Through the Recovery-to-Work Cohort Learning Academy, DDAA has refined the concept of a “recovery-to-work ecosystem” by assisting four regions in ecosystem development. The lessons from the Learning Academy are now found in “Addressing Appalachia’s Substance Use Disorder Crisis Through Recovery-to-Work”, which introduces the “Recovery-to-Work Ecosystem Framework”: a series of goals, challenges, solutions, and action items that regions can undertake to support recovery-to-work ecosystems. This Framework provides a “menu” of possible activities that a region might prioritize in building their ecosystem. It includes examples of different activities from several regions, lessons from the process, and deep dives into issues including housing and transportation.

The Cohort Learning Academy process itself provided a glimpse into the on-the-ground process of building a recovery-to-work ecosystem, resulting in two supplemental reports. The “Recovery-to-Work Cohort Learning Academy Final Report” discusses the Learning Academy process including how the Learning Academy was developed and descriptions of the activities and facilitation provided during the Learning Academy. “The Four Regions of Cohort I” looks at each regions history with substance use disorder, the composition of their team, their action planning processes, and how they worked to implement the plans developed during the Learning Academy

The Relationship Between Addiction and Job Problems

February 19, 2020

Each year, drug and alcohol addiction costs American businesses and organizations about $81 billion in lost profits. While some may picture an addict as someone who has no home, job, or friends, that is simply not the case for most addicts. In fact, over 70% of people with a substance abuse disorder are employed. However, maintaining employment does not mean addicts are high performers at work: 42% of people with an addiction who have a job report a decrease in productivity due to their addiction. This lost productivity costs employers an estimated $25.5 billion each year. Lost revenue is not the only issue because of an addicted workforce. The list of job problems caused by addiction is long and have a negative impact on everyone involved.

Report of Recommendations: ARC’s Substance Abuse Advisory Council

July 15, 2019

This report includes 14 recommendations developed by ARC’s Substance Abuse Advisory Council to support a robust recovery ecosystem in Appalachia. Additionally, the report lays out the ARC’s definition of a Recovery to Work Ecosystem.

This is a good grounding resource for new entrants to the project and should likely be front and center in any deliverables submitted to ARC.

Opioids in Appalachia: the role of counties in reversing a regional epidemic

May 2019

PDF Version

This report from the National Association of Counties (NACo) details a list of recommendations for local action that counties in the region may undertake to address the SUDs crisis.


      • Exercise strategic local leadership
      • Create and strengthen preventive and educational initiatives
      • Expand access to addiction treatments
      • Implement a criminal justice response to illegal opioid sales and provide treatment and services to justice-involved individuals with opioid use disorders
      • Mitigate local economic impacts and consider new economic development 

Health Research and Development to Stem the Opioid Crisis: A National Roadmap

October 2019

This Opioid FTAC Roadmap identifies R&D critical to addressing key gaps in knowledge and tools, and opportunities to improve coordination of Federal R&D essential to combating the opioid crisis. It builds on the recommendations in the report from the President’s Commission on Combating Drug Addiction and The Opioid Crisis, as well as recommendations from multiple other sources, including the National Academies report on Pain Management and the Opioid Epidemic, the Interagency Pain Research Coordinating Committee’s Federal Pain Research Strategy, the National Governors Association report on Governors’ Recommendations for Federal Action to End the Nation’s Opioid Crisis, and the Surgeon General’s report Facing Addiction in America. The draft version of this Opioid FTAC Roadmap was released for public comment in November 2018 and open for public comment for approximately one month. In that time, OSTP received an overwhelming response from the public, including highly detailed perspectives, comments, and recommendations from: individuals, including patients, family members and friends; healthcare providers, including physicians, emergency medical personnel, nurses, psychologists, and other clinicians and caregivers; state and local agencies, including public health departments; private companies and industry associations; non-profit and charitable organizations; public policy institutes; and numerous medical and academic societies and professional organizations —all of which were read and thoroughly considered during a lengthy revision process leading to the final version of this report.

Reclassifying drug felonies would open career pathways – Retroactivity would maximize reach

January 15, 2020

This white paper argues that Ohio should pass SB 3, taking steps to reclassify low level drug offenses from felonies to misdemeanors, providing treatment for Ohioans who would otherwise face time in prison. SB 3 would reduce the number of people charged with felonies. For those affected, it would also remove 268 legal barriers to employment.

Restrictions known as collateral sanctions limit employment opportunities for Ohioans with convictions, even years after they’ve been released. Because many of those restrictions are triggered by felonies—but not misdemeanors—SB 3 would eliminate many barriers to employment for reclassified Ohioans. A separate bill, House Bill 263, takes direct aim at those rules.

This is an important aspect of SB 3’s reclassification because getting and keeping a stable job is a vital component of recovery. High unemployment rates among formerly incarcerated people hurt not only those aspiring workers but their families and communities as well. For businesses, overlooking these workers is a wasted asset.

This type of law has been shown to have a positive impact in other states.

How Data Can Help in the Fight Against the Opioid Epidemic in the United States

November 18, 2019

Data can be an invaluable tool in the fight against the opioid epidemic. This report examines four key areas where data has the greatest potential to help: ensuring health care providers properly prescribe opioids; identifying risk factors for prescription opioid abuse; scrutinizing the prescription opioid supply chain; and improving intervention effectiveness. Fortunately, government agencies, public health officials, and other stakeholders have made headway in using data in all four areas. However, significant obstacles remain, and many opportunities are still out of reach.

The scope of this paper is limited to opportunities to better leverage data to help address problems primarily related to the abuse of prescription opioids, rather than the abuse of illicitly manufactured opioids such as heroin and fentanyl. While these issues may overlap, such as when a person develops an opioid use disorder from prescribed opioids and then seeks heroin when they are unable to obtain more from their doctor, the opportunities to address the abuse of prescription opioids are more clear-cut.

 Emerging Trends in the Evolving Opioid Overdose Epidemic

April 9, 2019

This short document explores some of the recent historical trends in the overdose epidemic. Notably, in the past five years, overdoses due to heroine and prescribed opioids have equalized and leveled off, while overdoses due to other synthetic opioids such as fentanyl have skyrocketed. Poly drug overdoses, meaning fentanyl mixed with another drug such as meth or heroine, appear to be a large contributing factor to this rising statistic.

Rural Communities in Crisis: Strategies to Address the Opioid Crisis

April 2016

The growth in opioid use and the related health care and social problems call for a comprehensive community-based public health approach (Office of the President 2011; Kolodny, et al. 2015; Crawford 2014). This policy paper outlines strategies to help curb the current opioid crisis in rural America.

Communicating about Opioids in Appalachia: challenges, opportunities, and best practices

Key findings:

Community members were asked to describe factors that were improving the opioid crisis or presented opportunities for supporting prevention, treatment, and recovery efforts in their communities. Participants in every focus group mentioned their local anti-drug coalition or community-based organization as vital forces in bringing partners and community members together, leading substance-abuse prevention programs and awareness campaigns (e.g., “simulated workplace,” random drug screening, peer-to-peer clubs, prescription drug take-back programs), and assisting in finding treatment for those facing addiction. Several mentioned the significant role religion, pastors, and churches are playing in addressing the opioid crisis. Faith-based organizations are reaching out to individuals in need of treatment, partnering with programs like Celebrate Recovery, supporting children and families impacted by addiction (e.g., providing mentorship, meals), and challenging community apathy and stigma (e.g., “Our churches are everything; in our community. They’re saying ‘we know this is here. We are not going to turn our backs. We are going to face this together’”). Community members in recovery frequently mentioned drug courts as providing access to treatment and giving those struggling with addiction a necessary chance to turn their lives around. Though subject matter experts were not specifically asked about protective factors during their interview, the majority represented prevention, treatment, and recovery organizations that were implementing successful programs. The following tables summarize the interventions discussed.

Opioid Use Disorder: Challenges and Opportunities in Rural Communities

February 2019

This fact sheet describes some of the challenges rural communities face in providing access to evidence-based treatment and strategies used by federal and state agencies to enhance treatment capacity, including how one rural community responded to the opioid epidemic by addressing the specific needs of its residents. The policies and programs described are not an exhaustive list but are intended to be illustrative.

Careers of Substance

This website provides a list of resources to support the work by the substance use and addictions workforce with those affected by opioid use.

Employment in Recovery: Job Resources for Recovering Addicts in Sober Living

August 16, 2018

After transitioning into sober living, many individuals focus their time on finding employment. This is often because they have either left their job to enroll in rehab or lost their job prior to enrolling. Becoming self-sufficient in recovery is a great goal to have. Establishing financial independence and standing on your own is a beautiful thing, and it’s a common goal for people in recovery. After beginning a sober living program, many individuals run into problems finding employment for various reasons.

This page works through some of the common problems people experience when seeking employment during recovery and provides resources for employment help for recovering addicts. Additionally, the site features a selection of good jobs for recovering addicts: a substance abuse counselor or therapist, an addiction treatment admissions specialist or support person, a detox nurse or medical support person, and a sober coach or recovery specialist.

Treatment Communities of America: Workforce Development

TCA believes the substance abuse treatment community would benefit from an array of incentive programs to recruit and retain counselors and other staff trained specifically in alcohol and drug abuse.  These programs include: Career ladders for advancement within the field, Loan repayments, Scholarships and other collaborative efforts with the education community, Public service announcements and utilization of other marketing tools, Mentoring programs, Training of other caregivers specifically in evidence-based substance abuse treatment, and Apprenticeship programs.

TCA recommends the inclusion of specific substance abuse counselor training funds within HHS that are responsive to the needs of the substance abuse community. Secure funding and leadership for career development activities for substance abuse workforce shortages. Inclusion of specific substance abuse counselor training funds within HHS that are responsive to the needs of the substance abuse community. Secure funding and leadership for career development activities for substance abuse workforce shortages. Assessment of present opportunities within federal agencies and State grant programs to dedicate specific federal funds for loan guarantees and other programs. Development of demonstration projects within the Department of Labor and/or the Veterans Administration to develop training institutes and career ladder opportunities for veterans and service corps members to become qualified addiction counselors and other innovative demonstrations to stimulate and sustain pipeline career development opportunities for new youth populations to be recruited and trained as counselors. Introduction of legislation specifically addressing the substance abuse treatment workforce issue including a grant program to state governments and the territories to develop and implement specific remedies.

Housing as treatment

May 1, 2019

Stable housing plays a vital role in recovery from SUDs. An inability to pay rent and the threat of losing housing can lead to stress that triggers substance misuse and relapse. People experiencing homelessness who also have SUDs typically find it difficult to address their substance use without a safe place to live.

The findings of these studies are clear, housing plays a central role in the ability for individuals to access and complete treatment and is a crucial element to ensure that an individual can access stable employment and reenter the workforce. A recovery to work ecosystem will likely face long-term issues if it lacks a permanent supportive housing and/or rapid rehousing component.

Choice Matters: Housing Models That May Promote Recovery for Individuals and Families Facing Opioid Use Disorder

June 24, 2019

A study conducted for HUD found that people without stable housing are less able to engage in medication-assisted treatment (MAT). Further, although MAT has been well documented as an evidence-based practice (EBP) to treat opioid use disorder (OUD), individuals without housing who are receiving MAT still experience barriers to supportive housing because of misconceptions about medications used for MAT.

Despite the strong relationship between OUD and housing instability, the researchers found few programs that specifically targeted individuals with OUD who also had housing instability. The most relevant models they identified include: the Housing First Model, other permanent supportive housing that follow housing first approaches, and recovery housing

Rural Homelessness and Poverty in Appalachia


Homelessness is all too often a result of long term or chronic poverty, or the result of poverty combined with the unexpected. Poverty hits the hardest in rural areas where options for coping are limited and helping hands are fewer and farther in between. Appalachia consistently ranks higher than the national average in poverty related statistics. While almost every in-depth study of Appalachia at least touches on poverty and/or its related issues, not very many have made poverty a primary focus, and almost none have focused on homelessness in Appalachia. This brief summary will help those focusing on rural poverty and homelessness, especially in Appalachia, get the most out of their research time.

Conceptualizing homelessness in rural Appalachia: Understanding contextual factors relevant to community mental health practice

Considering the complex mental health needs of many homeless individuals and the unique features of rural Appalachia, community mental health practitioners who work in the region need to be equipped with an understanding of the issues related to housing insecurity. To assist, researchers propose a model that demonstrates the interplay of various regional, cultural, and individual factors as they relate to housing insecurity. They arrive at this model through an exploration of the following questions: (1) How is homelessness experienced in rural Appalachia in comparison to urban areas? (2) How do regional economic and resource deficits impact Appalachians who are homeless? (3) What role does culture play in the lives of individuals who are homeless in rural Appalachia? (4) What individual factors increase the risk of homelessness for Appalachian individuals and families? (5) How does the interplay between environmental, cultural, and individual factors impact housing security?

Big Cities Health Coalition

The Big Cities Health Coalition (BCHC) is a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the 62 million people they serve. Together, these public health officials directly affect the health and well-being of nearly one in five Americans.

This brochure offers a brief overview of the coalition and its impacts and actions.

Final Report Appalachian Regional Commission Recovery-to-Work Listening Sessions

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. 

The Impact of Naloxone Access Laws on Opioid Overdose Deaths in the U.S. – Southern Regional Science Association

April 22, 2019

Opioid overdoses are the leading cause of unintentional death in the U.S. This research investigates the effects of state-level Naloxone access laws on opioid overdose death rates. Spatial difference-in-differences models reveal that no matter how the access law is measured (either as a binary variable, number of days after the law, or differentiated between access law provisions), the only consistent result is positive indirect effects on overdose death rates. These results indicate that Naloxone access provisions have regional impacts via spillover effects in neighboring states. Looking across multiple provisions, our findings show that, except for third party authorization, there are significant positive effects on overdose death rates. When access laws are evaluated in isolation of any other state level policy response to opioids, increasing access to Naloxone does not reduce overdose death rates, but leads to an overall increase. Thus, the moral hazard problem stemming from this public health policy may be an accurate assessment of the outcome.

A New Approach – Family Treatment Courts as Part of a Continuum of Care

May 31, 2018

This presentation discusses the opportunities and challenges of building a continuum of care that is responsive to families’ needs and provides proven practices to all families involved with child welfare affected by substance use disorders. The presentation explores approaches in Jefferson County (CO) and Wapello County (IA) as that integrate family treatment courts into a continuum of care.

The FIT court in Jefferson County (CO) is one of our case study profiles.

December 13, 2019 – The Department of Justice announced (in this press release) awards of more than $333 million to help communities affected by the opioid crisis. The funds support families, children and crime victims dealing with the impact of substance abuse, along with first responders whose actions can often mean the difference between life and death for those who have overdosed. The following programs were awarded funding:

      • The Comprehensive Opioid Abuse Programs ($163 million) will help jurisdictions plan and implement programs aimed at reducing opioid abuse and mitigating its impact on crime victims and will provide training and technical assistance.
      • The Justice and Mental Health Collaboration Program ($23.8 million) will address the treatment needs of people using opioids.
      • The Enhancing Community Responses to the Opioid Crisis: Serving Our Youngest Crime Victims ($15.8 million) program will help service providers ensure children and youth are supported as they heal from the impact of crime and substance abuse.
      • The Opioid Affected Youth Initiative ($7.9 million) will develop effective programs for children, youth and their families who have been affected by the opioid crisis and drug addiction.
      • The Drug Courts Program ($83.5 million) will provide financial and technical assistance to states and federally recognized tribes to develop and implement drug courts to help adults, youth and veterans suffering from substance abuse issues.
      • The Child Abuse Training for Judicial Personnel program ($1 million) will provide specialized training for juvenile and family court judges on serving families affected by opioids.
      • The Mentoring Opportunities for Youth Initiative ($15 million) will support mentoring programs that address the issues experienced by youth affected by opioids.
      • The Research and Evaluation on Drugs and Crime Program ($6 million) will support research on criminal investigation, prosecution, drug intelligence and community surveillance to reduce violent and other crimes related to fentanyl and its analogues.
      • The Paul Coverdell Forensic Science Improvement Grant Program ($17 million) is being made available to address the impact of the opioid crisis on forensic laboratory operations.

Tracking Federal Funding to Combat the Opioid Crisis – Bipartisan Policy Center (BPC)

March 2019

Over a six-month period, BPC conducted a detailed analysis of federal appropriations and identified 57 federal programs that, either entirely or significantly, fund efforts to curb the epidemic. In total, the federal government included nearly $11 billion for these programs in its FY2017 and FY2018 discretionary appropriations bills. This includes a 124 percent increase between FY2017 ($3.3 billion) and FY2018 ($7.4 billion). These programs span the continuum of care, including prevention, treatment, and recovery. In addition, funds are directed to research, criminal justice, public health surveillance, and supply reduction efforts. Between FY2017 and FY2018, funding specifically targeted to opioid use disorder treatment and recovery increased by $1.5 billion (from $599 million to $2.12 billion). Over three quarters (77 percent) of the appropriations to opioid programs are administered by the Department of Health and Human Services (HHS).

The report also examines how federal opioid investments are spent across five geographically diverse states: Arizona, Louisiana, New Hampshire, Ohio, and Tennessee. The average drug overdose death rate in the five case study states was nearly one and half times (144 percent) higher than the national average in 2017. Each state case study takes an in-depth look at how these states are allocating the two largest federal opioid grants, the State Targeted Response and State Opioid Response grants. BPC’s analysis also incorporates county-level maps of federal funding and drug overdose deaths from 2015 to 2017 for each of the selected states.


DEA to improve patient access to substance use disorder treatment

March 1, 2020

The DEA has announced a proposed rule that will ensure healthcare providers can use telehealth to diagnose and treat patients suffering from substance use disorders.

U.S. Sen. Mark Warner, D-Va., has been out front on the issue, helping draft and pass the Senate’s comprehensive substance abuse treatment bill, which included a provision directing the Department of Justice, in consultation with the Department of Health and Human Services, to create a process for exempting certain health care providers for the purpose of providing telehealth services for substance use disorder.

Bryan Helps Job-seekers Break Down Barriers

March 3, 2020

A story about Christy Ryan, a western Pennsylvania native, and her journey through recovery.

“Bryan suffered damage to her spinal cord and a cervical fracture. Her recovery was long and painful. Her doctor prescribed the painkiller OxyContin – 280 30mg pills every month. Within five years, she was taking 20 pills a day.”

Letter: Reduce stigma, increase treatment and recovery

March 3, 2020

A letter to the editor no reducing stigma associated with substance use, from Mike Boyer, Education and Advocacy Coordinator, The RASE Project.

The RASE Project is a 501 (c) 3, non-profit, charitable organization. RASE is a Recovery Community Organization, which means that it is comprised entirely of staff and volunteers from the Recovery Community and it exists to serve the Recovery Community. Recovery Community is defined as: any person in, or seeking recovery, their families, close friends and other loved ones.

The RASE Project was designed to provide a voice and body for the anonymous recovering population. For decades there has been a strong advocacy movement for persons struggling with mental health issues; the RASE Project did the same for persons in recovery from the disease of addiction. RASE provided advocacy for persons being discriminated against due to the disease of addiction. The RASE Project began its services by providing grassroots organizing and built a strong regional body of dedicated advocates committed to speaking out for the rights of the Recovery Community.

Ride-to-recovery pilot in Huntington, West Virginia

August 1, 2019

This is a press release about how ARC support will be used in Huntington, WV to provide ridesharing to address transportation gaps for those in recovery. The article also features a small story on an ARC ATP summer fellow from 2019.

Appalachia creating hope at third annual Substance Use Disorder Education event

Mar 02, 2020

PIKEVILLE, Ky. (WYMT) – Shaping Our Appalachian Region (SOAR), Operation UNITE and the University of Pikeville hosted the third annual Health Provider Substance Use Disorder Education event Monday, inviting health professionals and medical students together to hear from people who are working in the community to battle the opioid epidemic.

With discussions from researchers, healthcare workers, and state leaders, as well as educational resources and NARCAN training, the event served as a way to show the options and obstacles present across the region when dealing with addiction recovery.

The Opioid Epidemic Might Be Much Worse Than We Thought

February 27, 2020

This article discusses a report by Elaine Hill and Andrew Boslett, economists at the University of Rochester, which stemmed from their study on how deaths from overdoses of opioids, such as heroin or OxyContin, were influenced by the decline of coal mining and the rise of shale gas fracking. The researchers noticed that in a significant amount (about 20%) of drug overdose deaths, the type of drug was not specified. So, they set out to try to determine the real causes behind those unspecified drug overdoses.

Core Team Call Recordings