The Intergenerational Transmission of Trauma: Coal Colonization and Opioid Addiction

That's West Virginia native Wayne Coombs writing in "Analysis: the Pharmaceutical Colinization of Appalachia, was published by Daily Yonder on 2/7/18 and forwarded by Roy Silver, professor of sociology on the Cumberland campus of Southeast Kentucky Community and Technical College since 1989.

Coombs, a counseling professor at Marshall University from 1991 to 2015 and director of research and development at its West Virginia Prevention Resource Center, chartered in 1998, currently lives in Johnson City, Tennessee, where he still serves as a consultant to the Center.  In 2003, Purdue Pharma gave the Center a $125,000 grant to fight opioid abuse. Wonder how that worked out?

In his article, Coombs, references a story he heard years ago, that had great resonance for his work in treating addicts:
One afternoon, a group of townspeople sees a baby in the river. One person dives in and rescues the infant. But as he climbs ashore, one of the other townspeople spots another baby in the river in need of help. Then another. And another. Overwhelmed by the sheer number of babies, the townspeople grab any passer-by they can to help them.
Before long, the river is filled with desperate babies, and more and more rescuers are required to assist the towns people. Unfortunately, not all the babies can be saved. And, tragically, some of the brave rescuers occasionally drown. But they manage to mold themselves into an efficient life-saving organization and, over time, an entire infrastructure develops to support their efforts: hospitals, schools, foster care, social services, trauma and victim support services, lifesaving trainers, swimming schools, etc.
At this point one of the town citizens starts walking upstream.
“Where are you going?” the others ask, disconcerted, “We need you here! Look how busy we are trying to save these babies!”The citizen replies: “You carry on here. I’m going upstream to find the bugger who keeps chucking all these babies in the river.”

When seeking an answer for why communities in Central Appalachia are so vulnerable to addiction, he found the conclusions of the ARC report Appalachian Diseases of Dispair by Michael Meit, Megan Heffernan, Erin Tanenbaum, and Topher Hoffmann of the The Walsh Center for Rural Health Analysis at the University of Chicago "upside down."
Are they saying that poverty causes this vulnerability? It seems much more likely that these problems, just like the diseases of despair, are symptoms and outcomes rather than its causes. What is it that creates this vulnerability? Obviously, something deeper is happening here.
 Coombs notes that that higher rate of death doesn't correlate with economic conditions and links to another article in Daily Yonder that in turn cites "Mortality and morbidity in the 21st century (2017),” in which Princeton Professors Anne Case and Angus Deaton rebut the prevailing argument that economic decline causes opioid crisis. (This follows up on their 2015 study, "Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century.")

In looking at maps of West Virginia, Coombs realized that the  counties with the greatest substance abuse problems also had coal mining.  He couldn't buy that the solution was to blame the victim. 

I was aware that folks who were struggling with addictions most often came from families and communities who were also struggling with addictions, but this was usually accounted for through family dynamics. In other words, dysfunctional families begat dysfunctional kids who became dysfunctional adults who begat more dysfunction. However, the explanation did not really explain anything other than it was a problem of the people themselves and that is usually where the explanation ended. There was nothing about how the dysfunction got there in the first place or what kept it going. The only thing this explanation was good for was more subtly and “scientifically” blaming the people for their problems. But that explanation is bogus. What was happening here was different.
Then he came across the Holocaust research of Rachel Lev Wiesel, "Intergenerational Transmission of Trauma across Three Generations (2007)."

Unfortunately, Coombs's conclusion offers no solution, only a question:
How can Appalachian communities – and others affected by historic trauma – heal from these wounds and go about the business of creating the kind of communities they really want? Answer this question, and we will go a long way toward solving the problem of addiction.
Beth Macy has a new book coming out in August, Dopesick: Dealers, Doctors, and the Drug Company that Addicted America. According to her recent talk at the Radford library, she looks at not only those addicted to opioids, but at those currently trying to help them heal.  I'm wondering if any of these healers are addressing the larger issue of historic trauma and overall community change.  Beth certainly knows the history of trauma, as revealed in her review of Ramp Hollow, but it won't be simple, as she wrote:

Four years ago, I spent a few days reporting from the poorest county in West Virginia, one of the poorest states in the nation. The mayor of War (pop. 800, give or take) had been killed by an in-law’s brother in a drug-fueled rage months before. At the time, the mayor had been working in earnest to clean the town’s water, improve access to drug treatment and attract new industry, but as one unemployed young woman told me: “Not enough people here can pass a drug test.”