The massive opioid drug settlements are finally trickling down to Main Street U.S.A., resulting in a welcome uptick in both sobriety and economic activity. Some of the worst-hit counties on the opioid overdose death map are the new boomtowns in addiction treatment and addiction recovery.

In June, we wrote about how Harlan County, Kentucky, one of the worst-hit towns for opioid use disorder, had become a leading provider of employment and research in addiction recovery. A first-person account of the transformation in Harlan, Kentucky, reported that:

Now, the faded buildings lining Harlan’s downtown are filled with posters for recovery groups, prevention events and nightly AA meetings in an alleyway beside the local bank.

That assessment applies equally well to Dickenson County, Virginia, a rugged Appalachian town of about 14,000 people on the border with Kentucky. One of the few cities in Dickenson County is Clinchco, named after the Clinchfield Coal Corporation, where the population has been in decline since 1960.

Dickenson County has been “ravaged by substance abuse and overdose deaths,” according to a recent article by Susan Cameron, reporter for Cardinal News. Dickenson experienced 53 overdose deaths between 2018 and 2024, doubling the per capita average for Virginia. Cameron reports on a plan tested in nearby Pikeville, Kentucky, and now being implemented in Dickenson County:

[T]he county’s plan [is] to use substance abuse treatment coupled with job training as an intentional economic development strategy that they hope will put people back into the workforce and result in much-needed economic growth.

As we have articulated before here at AddictionNews, when addiction treatment is accompanied by temporary housing, followed by job training and a transition to low-income housing and employment, it can be a boon for both the economy and the lives and families disrupted by substance use disorders.

When Dickenson County first looked at the cost of building residential housing for addiction treatment, the estimated $125,000 per unit was prohibitive. However, like other cities, they discovered they could put together parks of prebuilt micro units close to medical facilities for half that cost.

The county built 112 residential units for a total cost of $7.7 million, or less than $70,000 per unit. Funding was secured in the following ways:

• $4 million loan from the Virginia Coalfield Economic Development Authority
• $2 million loan from the Virginia Small Business Financing Authority
• The Gene and Anne Worrell Foundation
• The Rapha Foundation
• Dickenson County Public Service Authority
• Town of Clintwood, Virginia

It turns out that the long view of addiction recovery generates economic benefits all along the way — as long as there is continuity from emergency room to residential treatment, to housing and job placement. Each step generates economic benefits and reduces shared costs for emergency rooms, police, attorneys, courts, jails, and the many other costs that sadly result from untreated addiction.

The saved lives yield a steady supply of reliable workers for the industries where they acquire job training and where they apprentice during recovery. Instead of a cycle of addiction, places such as Harlan County, Kentucky; Dickenson County, Virginia; and even Juneau, Alaska; are taking a comprehensive approach toward addiction recovery that is yielding significant benefits for families and for communities where they are located.

Written by Steve O’Keefe. First published August 18, 2025.

Sources:

“Addiction treatment as an economic development strategy?” Cardinal News, August 11, 2025.

“A Kentucky county’s recovery from opioid crisis could be a model for Tennessee,” The Tennessean, May 26, 2025.

“Interactive Drug Overdose Map,” All Opiates Detox, retrieved May 28, 2025.

Aerial image of the Wildwood Recovery Center courtesy of the Dickenson County blog, used under Fair Use: Commentary.