By Katie Pratt

Like an unexpected natural disaster that strikes in the night, substance use has carved a path of destruction across hills and valleys of the commonwealth, destroying lives and tearing apart families.  

Illustration of a personsitting in a chair, head in hands

To say Kentucky has been rocked by the opioid epidemic is an understatement. According to 2018 data from the Kentucky Injury Prevention and Research Center, the state has one of the highest overdose mortality rates per capita in the nation. Kentucky leads the nation in the number of Hepatitis C cases. It also has some of the highest drug-related illnesses, including babies born drug-dependent and adults infected from IV drug use.

As the state looks for ways individuals and families can recover from the effects of opioids, more and more Kentuckians are turning to the University of Kentucky Cooperative Extension Service for help.

Extension is well-positioned to assist people looking for ways to sustain recovery, as many of its programming efforts in financial stability, healthy relationships, and nutrition are educational messages people in recovery need. In January, 2019 UK Family and Consumer Sciences Extension hired Alex Elswick as the nation’s first extension specialist dedicated to substance use prevention and recovery. His task is to find ways that extension can leverage and tailor its educational resources better to help Kentuckians recovering from addiction.

“This position is unique to Kentucky Cooperative Extension and is considered to be a model by other land-grant universities,” said Jennifer Hunter, assistant director of Family and Consumer Sciences Extension. “Although this initiative is relatively new, its impact is going to be substantial.”

In long-term recovery himself, Elswick understands the hardships and barriers those in recovery face in achieving and maintaining their sobriety.

“People accumulate a lot of problems in addiction,” he said. “Financial issues are a big barrier to recovery. They have to rebuild relationships with those they have wronged. Many are unemployed with no degree and no marketable skills. They lack stable housing and reliable transportation. Some have a criminal record. They also have a lot of physical and mental health-related issues.”

Elswick, who received his master’s degree in family sciences from UK and is working toward his doctoral degree in the same discipline, has studied barriers young adults face when recovering from substance-use disorder and ways to aide in their recovery. He found that the age range from 18 to 25, also known as emerging adults, faces challenges when transitioning from childhood to adulthood.

“Emerging adults struggle to find residential and financial stability, and they struggle with who they are as a person,” he said. “The role of their family members and mentors who can serve as role models and advisors may be critically important to providing these adults with the support and guidance they need.”

Elswick’s research found that losing family relationships or ultimatums from family members often prompt an emerging adult to initially seek treatment. Once the person is in recovery, renewed family support plays an important part in their continued recovery success.

His research found young adults look to their peers in treatment for support and guidance. This spurred another area for study. Elswick is now analyzing how this age group responds to a peer-led telephone service, in which people in recovery call each other to make sure they continue down the right track after they leave a treatment facility. He is also studying using peer mentors with pregnant women and mothers.

Reaching Those in Need
In addition to his research, Elswick is working with his FCS colleagues, to tailor extension’s life skills educational program to meet the needs of those in recovery. He recently worked with Kelly May, senior extension associate for family finance and resource management, to develop a curriculum about financial issues those in recovery face. It is being piloted in Mercer County this fall and will roll out in Boyd, Bourbon, Knox, and Leslie counties through a grant from the U.S. Department of Agriculture’s Rural Community Development Initiative.

Planting Seeds for Healthier Lives
Extension personnel are meeting clients wherever they are on their road to recovery. Through Cooperative Extension partnerships with local recovery centers, gardens have sprouted across the state, providing those in recovery with calmness, solace, and healthy living skills, as they work through their personal storms. Extension installed its first garden at The Healing Place, a women’s treatment facility in Louisville in 2017. Since then, and with additional funding from the Supplemental Nutrition Assistance Program-Education, there are now gardens at addiction treatment facilities in 11 counties.

“It’s something different to do in a place like this,” said Christopher Browning, a client at The Healing Place’s male treatment facility in Campbellsville. “It makes us not so sheltered in. We get to get out and do some things that we might enjoy doing on the outside.”

While residents at the facilities learn gardening skills, extension agents and SNAP-Ed program assistants teach them about healthy eating, meal planning, budgeting, and even feeding young children.

“Our eight-week class is geared toward trying to have a healthy family and a healthy lifestyle on an economical level,” said Angie Freeman, a SNAP-Ed program assistant in Taylor County.
Freeman has offered classes at the treatment facility for a number of years. She has had great success.

“We had so much great feedback from our participants, and Angie agreed to keep doing the program, so we made it a life skills requirement for people once they enter a certain phase,” said Matthew Wise, site coordinator for The Healing Place. “Some people have never even cooked for themselves before, and skills like that are vital for their success in after-care.”

Freeman holds a small graduation ceremony for those who complete her class, which is a well-anticipated event by many residents. On the day we interviewed him, Browning received his certificate.

“It’s nice to actually complete something,” he said. “I have not done so well with that the last few years of my life, but I have actually had the patience and the time to do something productive.”

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Life Skills Please
It was the need for life skills education that connected Jereme Rose with Kelly Mackey, Calloway County family and consumer sciences extension agent. Rose is the executive director of Neartown, which runs a treatment facility and two sober living centers in Murray.

“Our clients need to learn about employment skills, like how to fill out an online application, how to develop a resume, how to dress and conduct themselves during an interview, and then about budgeting and how to handle money once their paychecks starting coming in,” Rose said. “We had been teaching life skills programs ourselves but were really wanting a partner who we could trust to do a good job teaching it.”

Mackey is working with Elswick and Rose to develop programs that she can teach at all three of Neartown’s facilities in the very near future.

Elswick has also worked with family and consumer sciences extension agents in Scott, Woodford, and Bourbon counties, as they partnered with their local drug courts for the Beyond program. During the program’s biweekly meetings, agents educate participants about finances, parenting, cooking and nutrition, health and wellness, and addiction education.

“Participants come to Beyond in the latter phases of the drug court program, a time when life skills are particularly important,” Elswick said.

This fall, Elswick, Hunter, and Alison Davis, director of the Community and Economic Development Initiative of Kentucky, received more than $1 million from the Substance Abuse and Mental Health Services Administration to provide a new substance use prevention program in southcentral and western Kentucky.

The grant gives UK personnel the opportunity to provide more outreach efforts including an opioid addiction education program geared toward workers in health care, extension agents, and community leaders. Other areas the grant will cover include a substance use prevention program geared toward middle school students and arts as a healthy, creative outlet to deal with the anger and sadness caused by substance use addiction. It will also expand the Recovering Your Finances curriculum to additional counties.

"Kentuckians said substance use, and its related effects, was the most significant issue facing the commonwealth today in extension's recent community assessment survey. This grant will help us aggressively address this issue and help set communities on the path to recovery," Davis said.

Hope for the Future and Their Caregivers
Addiction not only affects those in recovery but their families. Because of the power that substances have over their lives, many people dealing with addiction lose custody of their children to a relative. Roughly, 1 in 10 Kentucky children are in kinship care. While not all are placed in kinship care due to an addicted parent, many are.

“Many grandparents that attend our county Grandparents As Parents support groups express how alone and isolated they felt, until they came to the group,” said David Weisenhorn, senior extension specialist for parent and child adolescence education. “I want them to know they are not alone.”

During his presentations, Weisenhorn discusses possible developmental and cognitive delays common to children born with Neonatal Abstinence Syndrome, the effects of neglect, child developmental stages, behavioral issues, and disciplining children of all ages. His goal is to explain normal child development and ways Neonatal Abstinence Syndrome and emotional issues can impact a child’s development. Caregivers then know when they may need to seek additional help or when they shouldn’t worry so much about a particular behavior or development stage.

“Many caregivers come to these meetings to discuss a child’s behavior problems. I offer hope through scientific evidence that shows most of the behavioral problems dissipate with a loving environment and proper nurturing,” Weisenhorn said. “I discuss secure attachment and how many of the children are lacking in that area, but those bonds can still be formed through much work.”

UK extension’s efforts have not gone unnoticed. Elswick is routinely asked to share about his position and UK’s ongoing efforts with other institutions, including Penn State University, Virginia Tech, and Iowa State University, so that they too can shine a light on a problem that is affecting individuals and families across the United States. ◆