CHARLESTON, W.Va. — Brain science can help explain why people with serious addictions are so out of control, and why many addicts have trauma in their history.

Jessica Holton is a licensed clinical social worker and addiction specialist teaching in Charleston this week. She said in her practice, almost all of the addicts have trauma in their background, as well as Substance Abuse Disorder. Holton said this is because both addiction and trauma take over the limbic system - the animal part of the brain - bypassing the rational decision-making part.

"We often think that it's a choice, a moral failure. But really the science shows that the survival part of the brain, the limbic system, actually gets hijacked for those who have a true addiction,” Holton said.

Addicts sometimes say it's as if they've lost control of their own hands. Holton describes that as a symptom.

She'll be in Charleston for the Spring Conference of the National Association of Social Workers, West Virginia. That conference starts Wednesday. It's the largest event of its kind in the country. This year's schedule also includes discussions of foster care and social work in schools.

The limbic system controls pleasure and fear, and the out-of-control impulses known as the fight-or-flight response we experience when threatened. Holton said for those experiencing a trauma, or reliving one, the limbic system is pumping out fear messages that can override everything else.

She said drugs - at least at first - make the system put out pleasure messages. That's part of why people with post-traumatic stress disorder are vulnerable to Substance Abuse Disorder.

"Addiction tends to help people numb out and helps them to avoid,” Holton said. “In trauma, that same part of the brain works in overdrive. So it makes sense as to why when the brain is overreacting and over-responding and everything is a threat, substance use and trauma tend to go hand in hand."

Fairly quickly, serious substance abuse can overwork the limbic system's ability to create pleasure, which is why addicts say they no longer enjoy it. They just take substances to avoid withdrawal, a big part of which is the limbic system sending out fear messages.

Holton said the good news is that even if addiction can't be cured, an addict's limbic system can return to a state closer to normal after some months sober.


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A statewide program in Kentucky aims to provide credentialing and pathways to a career in social work for people in substance use disorder recovery. Advocates say the Career Ladders in Mental and Behavioral Health or CLIMB-Health program is vital for the state to boost the mental health and social services workforce.

Carl Wilson, senior fellow for healthcare development and initiatives with the Kentucky Council on Secondary Education, said it also provides opportunities for those in recovery to make a living and expand their career horizons.

"You can gain both occupation credentials and or employment all the way up through a professional level within this program. So the program offers individuals with lived experience a tailored pathway," he said.

Community colleges across the state serving more than 100,000 residents are now working with people who have been state-certified peer support specialists, to transfer their training toward Bachelor of Social Work degrees. The CLIMB-Health program began on Kentucky Community & Technical College System campuses in counties with the highest overdose deaths.

Wilson said residents in drug court programs in all 120 counties face barriers to employment.

"When they get to that employer interview, and that employer runs that background, and they see the addiction issue, they see in most cases, the justice involvement, they're locked out of opportunities," he added.

The goal is to fill urgent gaps in the state's healthcare system and boost long-term economic stability for people living in recovery.

"We have approximately 50,000 to 0,000 untapped workers for our workforce in Kentucky that have not been given that opportunity to have a specialized program which addresses them," Wilson continued.

While overdose rates in other states are declining Kentucky ranks among the top ten states in the nation for drug overdose deaths, according to the CDC.

While overdose deaths in the Commonwealth have declined, deaths among Black Kentuckians have increased by 5%, according to data from the latest Kentucky Overdose Fatality Report.

Organizations across the state are working to stem overdose deaths among residents of color. In Bowling Green, the nonprofit HOTEL INC. is focused on harm reduction.

Rebecca Troxell, HOTEL INC. lead navigator, explains the group's street teams go into homeless encampments and provide Narcan, fentanyl strips, hygiene packets and medical care.

"We have volunteer doctors, EMTs and nurses who go out with us, so we're able to provide medical care on site. We're able to provide educational components with that, as well, helping people understand what harm reduction really is," she said.

She added a recent SHIFT grant from the Foundation for a Healthy Kentucky will allow the street teams to reach more people. The program, which awards funding up to $50,000, aims to reduce disparities and other inequities worsened by the drug crisis.

In Lexington, the nonprofit agricultural organization Black Soil KY is adding Narcan boxes and educational materials to its farmers markets. They are also working to improve access to fresh food among Kentuckians in recovery.

Ashley Smith, co-founder and CEO of Black Soil, said farmers will also receive harm-reduction training: "We know having that unbarriered access to local goods, like seasonal produce, local meat within your recovery housing, just really provides an advantage for the overall outcome."

Kayla Migneron, director of the Louisville-based maternal health program Granny's Birth Initiative, said the SHIFT grant funding will help expand stigma-reduction training for doulas.

"Our main goal is that any person would be comfortable coming to get assistance from us, whether it's accessing resources using our stuff, even just asking for connections to other programming," explained Migneron.

Nationwide, overdose deaths among mostly younger Black women nearly tripled between 2015 and 2021.

In Robeson County, the opioid crisis is exposing the need for increased addiction support. The Southeastern Prevention and Addiction Recovery Resource Center is tackling the issue by bringing together more than 70 organizations into a unified recovery network.

Jackie Davis, SPARC director, says its goal is to streamline services and improve access to comprehensive support.

"Robeson County has a high rate of usage, and so one of the main challenges has been services and then organizations and agencies working in silos," Davis said.

She added that before SPARC, local agencies were isolated in their efforts. Now with funding and support in part from the Kate B. Reynolds Charitable Trusts, she said community-based initiative is fostering cooperation to better serve the people of Robeson County, with plans to secure ongoing funding and improve access to care.

Davis said SPARC provides critical resources such as training, educational support and help securing opioid settlement funds. She said these efforts have improved patient care and developed long-term recovery strategies tailored to the community's needs.

"Health disparities here, we just want to reduce or even eliminate if we can, because we know that there are major differences from rural areas to urban areas or larger cities, and we just want better for our community," she said.

She noted that future goals include addressing transportation barriers to ensure access to services and ensuring sustainability through continued funding and support for member organizations.