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An uphill battle: Appalachian communities ravaged by addiction



Between the Eastern Kentucky hills and the two cities of Morehead and Olive Hill lies a small, close-knit community called Soldier. 


Although not easily found on a map, Soldier is the heart of several multi-generational families living within the Appalachian mountains. Children can be found here playing outside, riding dirt bikes and four-wheelers as their laughter echoes through the air.


But like many other small communities in the United States, Soldier is one of the worst areas affected by the ongoing drug epidemic. National statistics show that one in six adults and adolescents had a substance use disorder in 2022. This crisis is disproportionately worse in Appalachia, where overdose-related mortality rates were reported to be 72% higher than the rest of the country in 2021. 


Alicia Manier, a Soldier resident for nearly 40 years, has seen how drugs have affected her community. Manier currently lives with her mother, niece and great-uncle in her childhood home. 


“Over the past 20 years, everything has changed. It was great growing up as a kid and living here, and now people you’ve known your whole life you don’t even recognize because the drugs have ravaged this place,” Manier said. 

Jillian Jones (left), Alicia Manier (bottom), Kathy Smedley (middle) and Katrina Smedley (right) at Jones home during Christmas in Morehead, Ky. Photo provided.

In her family of five, Manier’s father suffered from alcoholism while her mother never touched alcohol or drugs. Out of three sisters, all of them at one point in their lives were addicts and struggled with substance abuse. 


“At least two, if not three people out of five are addicts around here. Most of the time it’s three and four,” Manier said. 


For over half of her life, Manier has struggled with substance misuse. She first began misusing marijuana and alcohol at 14 years old. When she met her ex-husband at 19 years old, she started misusing hard substance drugs.


“Granted I smoked pot and I drank beer, but as far as drugs, I had never done drugs until then,” Manier said. “I went straight from drinking a beer and smoking a joint to cocaine, pain pills, heroin, crack and methadone.”


Manier’s two younger sisters, Jillian and Katie also struggled with substance misuse. The middle sibling, Jill, was able to overcome her addiction, but Manier and her family lost her baby sister Katie due to a drug overdose in August 2022. 


Katie Smedley was only 32 years old when she died. Although she did not use such heavy drugs as her sisters, she was killed by a fentanyl overdose from marijuana she got from a friend.


Manier said her sister's sudden and unexpected death has been difficult for her family to overcome.


“I didn’t know how to function I guess. You know there were three of us [sisters] and now there’s two,” Manier said. 


An old photo of Katrina Smedley taken by a family members several years ago in Olive Hill, Ky. Photo provided.

After the death of her sister, Manier’s drug use continued to worsen for the first six to seven months. She rapidly lost weight and dropped down to only 80 pounds when she regularly weighs over 160 pounds. 


After deciding to make some life changes, she was able to get into a rehab clinic in January 2023. From then she was able to start processing her emotions while nurturing her body back into good health. Manier was prescribed suboxone to help combat her addiction to prescription pain pills, a treatment that’s shown improvement. 


It wasn’t long, though, before Manier experienced loss once again. She lost the love of her life, her boyfriend Dennis Watson, on September 18, 2023.


Watson also struggled with substance misuse for several years and it was a bond that he was able to share with Manier through their recovery. He was finally on the mend when he became poisoned by a metal rod that was placed in his femur following a wreck.


The poison affected his bloodstream and led to the failure of his kidneys, already weakened from addiction, requiring dialysis several times a week. 


Watson died at Manier’s childhood home. Just like her sister’s death, Watson’s death left the family in shambles. 


“He was the person that I had spent my life looking for. But, because of addiction, I lost Dennis last September,” Manier said. “We were just laughing about toast he burnt in the kitchen two days before he died. It just seems unreal.”


Before Watson’s death, they were helping raise Manier’s two nieces. She is helping raise her baby sister’s daughter and her great-uncle’s daughter as well. This has been an important aspect of her life as the young girls have both been affected by family members’ substance use. 


Alicia Manier and Dennis Watson enjoying lunch at Tyler’s Pizza in Olive Hill, Ky. Photo provided.

“In the long run if she doesn’t have that stability that she needs as a kid, it’s going to affect her and her drug addiction,” Manier said. “It’s mean and it’s harsh but it’s the reality.” 


Through the challenges and losses she has experienced within the last two years, Manier can now finally say she is sober. With the help of her family, friends and the responsibility of helping raise two children, she can now provide the stability that she never had growing up. 


“There were more bad days than good and now there’s more good days than bad, so I’m doing okay,” Manier said. 


Countless families across Appalachia face the same hardships as Manier’s. Studies conclude this is due to many factors, including low education levels, high rates of unemployment and high rates of job-related injuries perpetuating risks for substance misuse. With so many physical laborers in one concentrated area, painkillers are overprescribed often leading to addiction. 


A lack of affordable, quality healthcare and legal efforts to curb substance sales and use extrapolates the issue in Appalachia. Initiatives such as the Appalachian Substance Abuse Coalition are working to address the crisis, but this is not the only example of health disparities in poorer regions of the United States, nor does it seem to be going anywhere anytime soon.




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